male factor clomid question - chld/preg ment

[iMama]

xposted -

My DH and I are scheduled for our 1st IVF cycle in November due to male factor infertility. DH is 41 and I'm 30. We were able to conceive a son 4 1/2 yrs ago and I have 2 other kids. All of my hormones levels and tests show I'm still fertile. DH has hormone problems related to type 2 diabetes & uncontrolled high blood sugar. Diabetes can lead to infertility. Also, the prescriptions given to DH for diabetes and blood pressure are known to affect fertility.

For awhile, DH had nothing coming out at all-aspermia. Then, by using sudafed for the last 6 mos or so, he's had some. But the count is only 2 mill motile and with good morph. So, even though we've been timing intercourse for 6 months-about 9 cycles for me, since mine are short, we've never got pregnant. The Dr's at our HMO said they wouldn't prescribe anything for his hormone levels except testosterone, which I wouldnt allow, since it destroys your bodies ability to make sperm.

I asked for clomiphene, since it stimulates FSH and sperm and testosterone - indirectly. I was told "no" by his HMO's endocrinologist.

My RE wouldnt prescribe DH hormone therapy either- I think because the likelyhood they'll work is low. We never did iui's, just started saving for IVF. Studies show that men with low T who take clomid get higher counts, but that the pregnancy rates in these men doesn't increase.

Yesterday, my DH's endocrinologist prescribed clomid to him. Yesterday, we also saved enough money (~$14,500) to pay for our 2 cycle IVF with ICSI.

I feel that clomid will work for him, as long as he can tolerate the side effects-which are less for men than women. He'll have to take it for 100 days before expecting a result, since it takes that long for the body to make sperm. At that point, we'd need to keep trying for about 6 months of times intercourse to make sure we're giving our bodies a chance.

So, should I go through with our plan to do IVF or should I wait 9 months and keep TTC??

Any input would be appreciated.

[IT_Guru]

Wow good question.

Let me give a little about myself and then give my opinion. So My doctor put me on clomid for low testosterone. My count is not that bad but my morph. is off and the hopes are that if we can just up the counts and that there will just be more of the "normal" ones.

Here's my opinion.

I would think you should wait the 6-9 months that it will take for the affects of clomid to take effect. I would also make sure that he is taking some sort of vitamin to "help" with fertility. There are many out there but I would suggest one that is NSF Certified. You should also be on some vitamin with Folic acid, something greater then or equal to 400mcg. At 3 month intervals he should be doing an SA with Kruger/Strict. So that you can chart the progresses. Also make sure that he is having full blood work ups each month to make sure the dosage is correct. I assume that you have already had a full workup but if not do it in this waiting period. I would pick the month that you want to do your IVF and setup the appointments. Last step enjoy the next 9 months together and try not to think about it much.

Just my opinion take it for what it's worth. The only other thing is always get a second opinion.

[iMama]

Thanks for the reply IT-Guru! We decided to go through with our planned IVF cycle. Partially due to the fact that his regular Dr, who prescribed the Clomid, will not be doing workups, labs, semen analysis while administering the clomid. I think he'll do blood work, but that's it.

I actually just emailed my DH your post about starting Clomid, since DH is going to take it, just not for the sole purpose of IF.

I wish you good luck with the clomid, I know from reading threads on here that it can work and does work for many men.

[IT_Guru]

Yes the taking of clomid is not for IF but if you have low testosterone it will help increase the production of it and hopefully increase SA numbers. There are a couple of things that you need to be aware of while on it. While on Clomid has shown to consistently DECREASE pituitary sensitivity to GnRH (more LH was released before treatment). So there might be other drugs to try that don't have this effect. Also you have to watch that estrogen does not raise to high as it will have adverse affects on SA numbers.

It sounds like the Dr. that's treating him is not monitoring him closely enough. I would be in search of another Dr. that will do a little more monitoring.