Question:
My husband and I have been trying to have a baby for 2 years. We became
pregnant in May of 1999 and miscarried in July of 1999 at 8.5 weeks. My
doctor said it was a blighted ovum. We were very upset, this pregnancy
was very much wanted. This doctor seemed unconcerned with my case, so we
changed doctors. We have recently found out that my husbands sperm count
is 18.5 million and sperm motility is 40%. My doctor has suggested that
we try 3 cycles of IUI and then proceed to IVF. We are very excited about
this, but also very frustrated and nervous. Please let us know what your
suggestion would be and if you think we have any chance of a natural
conception. My age is 25 and my husbands is 31. I would also be
interested in knowing our success rate.
Cassie P.
Georgia
Answer
There are many things to consider before intrauterine insemination or IVF.
First off, Lets see if there is really a sperm factor. A single semen
analysis is not enough to determine whether there is a problem. At least
two or three evaluations are necessary to see if the problem is real. So,
can you do something to improve the sperm count and motility?
First step is to review your medical history. If you are taking medications
that may cause a sperm problem, alternatives should be considered. If you are
smoking or taking hot baths...STOP. If there are signs of infection, a course
of antibiotics may help. An examination of the testicles, scrotum and penis
may indicate that a varicocele (www.ivf.com/shaban.html),
a dilation of testicular veins may be present. Small firm testicles may indicate
early signs of testicular failure.
The medication Proxeed (www.proxeed.com)
may help improve sperm quality. This nutritional supplement of L-carnitine and
acetyl l-carnitine appears in early studies to improve motility and count. The
use of Vitamin C and E may also improve sperm function.
If all else fails, you may benefit from ovulation induction and
intrauterine insemination. The abnormalities in the semen analysis are
minimal. And, you and your husband are quite young and have already
conceived without fertility treatment. I would expect good success rates
with either clomiphene and insemination(>35% for three cycles of
treatment). More aggressive ovulation treatment with injectible medications
may yield pregnancy rates as high as 50-60% after three cycles. As such,
consideration of in vitro fertilization should delayed until a more
comprehensive evaluation has been completed and a trial of intrauterine
insemination and aggressive ovulation induction has been unsuccessful.
Dr. Perloe
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