Day 5 Morulas
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ConcernedHusband - March 27

Dear Dr. Smith,

My wife and I have been trying to have a baby for the past 3 years without success. Our case is a unique one or atleast I think so because of our past.

My wife is currently 30 and I am 32. Appoximately, 3 years ago I found that my sex drive had decreased, metabolism slowed down, and conceiving was not as easy as I had previoulsy thought.
Thinking these symptoms may be related to testosterone, my testosterone levels were examined by my GP. My testosterone level was relatively low at 6.2. My GP, recommended Androgel and started using this
twice a day for approx. 9 months. As time went on, it was taking increasingly longer to conceive so my wife and I went to a fertility dr. for infertility, when 2 test were ran - sperm analysis and
Fragmentation, I came back with 2 million count, many abnormal forms and 50% motility, for DNA Fragmentation (SCSA test), I came back with 32% fragmentation.

I went to a Urologist and he immeadietly requested that I stop taking Androgel as this was shutting down my sperm count. After 3 months I revisited the same fertility dr and ran the same tests. My count was now
220 Million per ML (huge jump), motility approx 50%, still with many abnormal forms and the DFI came back at 9% DFI and HDS=7%, the fertility dr was stunned and was hopeful.

We tried 3 rounds of IUI (natural) following without success and just finished our 2nd round of IVF (yesterday). In the first round we used a combination of ICSI and IVF. There were 7 embryos total (6 from left ovary, and 1 from right),
Out of the 7, 2 fertilized abnormally (3 PN), 1 did not fertilize, 2 did not progress past 8 cell, and 2 morula remained (grade 1 and grade 3). The 2 Morulas were transferred but did not make it. My wife and I were devestated.

We just finished another round of IVF. This time the right ovary that was weaker (1 last time), produced 6 eggs in this instance and the other, Left Ovary (previousy worked ok, produced none this time), almost like they were taking turns.
with each cycle. The medication protocol used was different, but not sure if this factored in at all (75 Repronex, 75 Bravelle). Out of the 6 eggs, 2 were not mature, 2 fertilized abnormally, 1 PN (embroyologist felt they may have just
been too mature), and 2 made it to Morula stage (both Grade 1 - good integrity) however progress was slowing down at the time of the day 5 transfer.

We are hoping for a successful outcome and just trying to figure a few things out, hoping you can help shed some light on our situation.

1. I noticed my testosterone level dipped quite a bit at age 25+, I was previously very active (gym daily), but find it more challenging now and have a lower sex drive,
any reason why (low testosterone - symptom) that may be related to fertility, that we may be able to look into?

2. My current semen alalysis, pre-wash: as follows

Abstinance: 3 days

Vol: 1.4 ML
Sperm Count: 133 x 10^6 / ml
Motility: 51%
WBC/ml: 1.4 (though we are able to get [1 ml with antibiotics)
Progression: Sluggish - Erratic
Cellular Debris: Moderate
Aggulination: Moderate
Viscosity: Normal
PH: 8.3
Comments: sperm defects of head (amorphous, pin, loos), mid-piece (bent) and tail (under developed) were observed



Post Wash:

Volume: .5 ml
MOtility final: 99%
Progression: Purposeful / Erratic
Motile 8.52 x 10 ^ 6
Motile sperm 17.04 / ml
Method for pre: Density Gradient
Comments: Clean and Good Sample for insemination

My DFI with 9% was produced Jun 24, 2009.


Do you see any issues from a MF perspective? or do I look fairly normal?


3. My wife is now 30, no health issues, although sister has PCOS, and both parents have diabetes, she has been screened and does not have any of these issues (including Celiac disease - Gluten).
She is 5'3, 150 lbs, not sure if weight could be factoring in to any great exent or not? she is a non-smoker / drinker.

4. If this round of IVF does not work and the growth arrests at morula stage, this would be the second time this has occurred, from other posts, I heard it stated that after 8 cell (day 3) it may be a MF issue, does this correlate
to my scores above

5. Any suggestions of what to do if we go through another cycle of IVF, re: 1 ovary producing eggs one time, and the other producing all the other. Any protocol to get them to turn on at the same time to maximize odds - many eggs?

6. Any tips with helping with get past Morula stage (protocol)?


I know these are many questions, really hoping you can help shed some light on this for us, this has been a long road, any help would be greatly appreciated.


Thank you.

 

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