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Considering IVF?

Posted: Tue Nov 19, 2013 11:03 pm
by Charliedo
New to fertility posting.

I'm 33, my husband (38) and I never used birth control except perhaps the first months. We have now been married 4 years and have been trying especially hard since last year. Monitoring ovulation (clear blue) (. We then tried 4 cycles with Clomid.

Recently my AMH came out low: 0.84
His tests are also not great:

Sperm count: 1million (50 % abnormal, 40% rapid progression, 40% immotile)
TSH: 1.643
LH: 2.45
FSH: 1.06
Prolactin: 14.81

We have done one IUI.

I was reading on other sites that IUI with low sperm counts (especially less than 1 million after wash) don't work. Do you think we should save the time and money and do an IVF directly. Or is there some hope in doing IUI. Is there anything we should be doing to increase DH sperm count?

Given my low AMH i do not want to waste our fertility time.

Hoping to get an answer soon :)

Please please please advise.

Best,

Re: Considering IVF?

Posted: Wed Nov 20, 2013 8:07 am
by Dr. Wisot
Generally IUI is not effective with a low count and if I had a patient with a low AMH I would not be wasting any time.

He could first quickly see a urologist who specializes in fertility to see if there is a fix for his sperm. With a count under 5 million they will probably check his chromosomes and look for a Y-chromosome deletion.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

Re: Considering IVF?

Posted: Wed Nov 20, 2013 12:02 pm
by Charliedo
Dear Dr. Wiscot,

I'm sorry I checked, I've misquoted his sperm count. It was 2 million. What qualifies as a low sperm count?

Best,

Re: Considering IVF?

Posted: Wed Nov 20, 2013 12:08 pm
by Charliedo
Also what does a low AMH of .84 mean for me. :(

Re: Considering IVF?

Posted: Thu Nov 21, 2013 7:59 am
by Dr. Wisot
5 million is the cutoff for doing the genetic tests and for having a decent chance of IUI working.

It means that you may not make a large number of eggs when stimulated for IVF but quality is more important than quantity. You also need to see your FSH and E2 on Day 2 or 3 of your cycle. An FSH of 1.06 is probably not valid especially since there was no E2.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

Re: Considering IVF?

Posted: Thu Nov 21, 2013 1:32 pm
by Charliedo
Thank you Dr. Wisot

I appreciate your very quick and informed responses.I checked back with the nurse and she told us that the sperm count for the IUI was much better at 17 million after wash.

My FSh at day 3 was 5.4, my LH was 2.8
My AMH result doesnt make sense to me. I have been ovulating just fine. We have checked with ultrasound and I also keep track with clear blue ovulation strips. My sonohyst showed a perfectly normal egg maturing and many follicles.

Do you recommend that I run my AMH again?

Thank you and stay blessed.

Re: Considering IVF?

Posted: Thu Nov 21, 2013 8:34 pm
by Dr. Wisot
The after wash specimen is very concentrated but if the unwashed has never been above 5 million that raises genetic concerns.

The FSH needs to be validated by an E2 at the same time. So I would repeat that with an E2. I do not worry too much about the AMH as it reflects quantity more than quality.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

Re: Considering IVF?

Posted: Thu Nov 21, 2013 10:37 pm
by Charliedo
Thanks for your very prompt reply :) I will speak to my RE about this.