Only 2 options

[u/Expert_Note4731]

M23 F21 My count is about 400k/ml with 25% motility. Everything so far has checked out so they said the only options are IVF (we have no insurance) or a biopsy of the testicle to try and find “one of 6 things that could be causing it”. I was told I’d be out of work for about a week and it would require about 6-9 months of monitoring with different medications to see if we can fix whatever it is causing it. Has anyone else had this done? I’m not sure what I was expecting but definitely thought there would be other options

[u/DryCaramel6959]

As other poster has said, you should be going to a Dr that will try hormonal treatment to increase numbers.

My husband had numbers around that for 2 years, were based in Europe. Done 2 rounds of ICSI and made only 1 embryo.

Found a Reproductive Urologist in London, Dr Jonathan Ramsay who took detailed bloods, and monitored them, and based on these bloods prescribed hormonal treatment.

Latest semen analysis was 36m, which was the day of my egg collection, where we made 6 embryos.

I would be hesitant to going straight for a procedure. Had we done that, you don't know what happened. But we persevered and met the right Dr who turned things around.

Worth noting, you should have all the bloods done, genetic, hormonal, absolutely everything, before going under the knife

[u/Expert_Note4731 → u/DryCaramel6959]

I had an analysis done 2 months ago with the following results: Volume: 5.2ml Ph: 8.5 Color: gray Motile sperm: 10% Progression: poor Normal sperm: 35 Sperm concentration: <1m/ml (not sure actual count just know it’s less than a million

LH: 3.1 FSH: 5.9 Free test: 10.8 Total test: 407 Inhibin B: 169.6 Y chromosome microdeletion: Negative They checked some other genes that it could be but they all came back negative

We then go to a reproductive center a few days ago for another SA and an ultrasound of testicles, scrotum, and prostate. That all looked good. These were the new SA results

Volume: 5.6ml Viscosity: 1 Liquefaction: Complete Ph: 7.6 Sperm concentration: 430k/ml Total # 2.41 Motile sperm: 25% Progression: 13% Viability: 74% Sperm clumping: none Round cells: 0.48mill/ml

What other hormones should be checked?

[u/DryCaramel6959 → u/Expert_Note4731]

You've covered a lot of ground there, the most promising marker above is the Inhibin B at 169 -the testes is making sperm, it's just not getting out. Another pleasantry is the FSH is well within range. These were just like my husband's. Another one to get is Estrogen. Look up the Testosterone: Estrogen ratio, and see where you sit. Other than that, I'd get them to confirm there's no varicocele (which would have showed up anyway on the US) You profile is just like my husband's previous profile, many professionals called it Cryptozoospermic/Severe Oligo. Clomid absolutely will not work on a profile like this, speaking from experience, he went from 500k sperm to Azoospermic on Clomid, I can't reiterate how bad it is for someone with fragile parameters like this. Is it a TESE or mTESE the Dr has suggested? Also, how many of these procedures do they perform per week/month? (You don't want someone who's inexperienced putting a scarpel to that area)

[u/Expert_Note4731 → u/DryCaramel6959]

They said if we did ivf they wouldn’t have to surgically retrieve the sperm, they said a semen sample would be good enough. I’ll check on the estrogen, and it’s a pretty big center in the US

[u/Fellurian]

You are very young, if you have the chance to try a drug treatment, I'd definitely go for that. I'm not sure why your doctor asked for a biopsy for choosing that, I find it unusual and perhaps there's more to it? Mostly we do ultrasound and blood tests to check what needs to be checked, and go for it.

If you can't do that or don't want to, the IVF route is also a good one for you guys. As I said, you're young and if your wife doesn't have any noticeable issues, you have great chances of success.

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[u/DrBrianSteixner]

Most reproductive urologists would still consider additional hormonal evaluation (estradiol (E2), prolactin, SHBG, thyroid function (TSH/free T4), repeat testosterone morning levels, possibly genetic karyotype testing) and possible medical therapy before rushing immediately into invasive biopsy procedures, because severe semen abnormalities at your age do not automatically mean permanent infertility. Ive seen many men with similar numbers improve over time with hormonal treatment, antioxidants, lifestyle optimization, or eventually achieved pregnancy through IVF/ICSI if needed. One last thing,  your partner’s young age is also a major positive factor for future fertility outcomes.

[u/muller0809]

Mine was the first semen analysis was semen volume 1ml, sperm count 13 million per/ml, motility 17 percent, morphology 3 percent. Semen did not liquified within 30 minutes. Total sperm per ejaculate is 13 million. Went for the second semen analysis. In three weeks. Semen Volume was 0.5ml, sperm count per/ml is 7 million, motility is 28 percent, morphology 3 percent. Liquified in 30 minutes. Blood work was done FSH = 26. LH=9.8. Total Testosterone was normal high. Free testosterone was normal. Doctor said there is nothing he can do in my case. I and my partner is planning on going for ivf. Partner has irregular periods

[u/muller0809 → u/muller0809]

Any one has any idea of what can help