Male problem...IVF question...please help!

[mb1981]

I am new to this site. I am a 27 years old, normal, fertile woman. My husband is 38. I ovulate every month, have open tubes and a normal uterus. My FSH is also low (6.35). We are having a fairly rare male factor problem (at least I have not seen any postings anywhere about it!) my husband does have normal sperm count and motility- morphology is borderline low- however our problem is with ejaculation. My husband cannot “shoot” semen, which is the first part of the problem. The second problem is only a small amount of semen will “dribble” out on its own when we have sex. In order to get the remaining semen out, he has to exit and then force out the remaining semen (for lack of a better word- jerk it out ) He has been to a urologist and they think that the problem is lack of blood flow from the testicles.

Normal sperm are given a good “head start” from ejaculation (normal ejaculation is 28 mph if you can believe it) so as you can see we are at a severe disadvantage from the get go, combined with the effect of a very small ejaculation inside of me.

We have been trying to conceive naturally despite this problem (and even tried instead cups) however it is not working and the urologist recommended that we make an appointment to try IUI, which would give the sperm a fairer shot.

My question is the following…I do have an appointment with an infertility doctor next week, however I was puzzled to read that (at best) IUI only has a 15% success rate, and that is with injectibles! It seems silly to me to waste monetary and emotional capital trying a procedure with an 85% failure rate when IVF has such a high success rate. Especially since my insurance covers $10k per year of infertility services- I am concerned that after 3-4 cycles of IUI we will not have enough insurance money to pay for IVF. Does anyone have any thoughts on this? Is it common to go straight to IVF if insurance will pay for it? Thanks so much in advance for your feedback. I’m quite anxious right now..

[baylorbear33]

We too had male factor, my DH had undecended testicles as a child and his surgery at the age of 3 left him with only one viable testicle, which causes him to have low count, motility, etc. We did IVF with ICSI as our decision was to not "throw good money after bad".We went straight to IVF because it gave us the best success rate. I would say that if you have insurance that covers up to $10K a year, I would go for the IVF. You might check with the clinics in your area to see if any of them are participating in any IVF studies. If you are able to get into a study it will pay a good portion of your IVF expense so that your $10K will go further. As far as your hubby's diagnoses, the doctor's should be able to go in and extract the sperm from his testicles if necessary in order to get a good sample. This is not something he will most likely look forward to, but could be an option. Best of luck to you!

[mb1981]

baylorbear, thanks for your response. My hubby actually will have a normal sperm count with normal motility if he does "force" out the semen, so i wouldn't think it would be necessary to extract the sperm from the semen. I am hoping that our infertility doctor does not make us try the IUI first, as I will never be able to take off that much time from work to do 3-4 cycles before IVF to do all the monitoring...such a frustrating thing!

Thanks again for your response, I appreciate it!

[babyluv]

DH and I believe that IUIs (for the most part) are such a waste. I have only known one person it has worked for. It's hard to want to go straight to IVF because of the expense, and in your case an IUI might work just fine. BUT, go with your gut. Don't let you RE force you to do an IUI if you don't want to. Remember, you have a lot more power than you think. It took me years to start demanding extra monitoring, etc, but they didn't even bat an eye and said ok to whatever I requested (because everything was within reason).

If you wanted to try one IUI just to see, go for it since it is WAY less invasive and less expensive than IVF. But go with your gut.

Good luck!

[Liam'sMommy]

I think you should give iui a fair chance. In your case, it could very well be all you need. You would not need injectables at your age. Femara plus trigger shot should be all you need. That should make your cycles about $750. If you can milk out enough semen to get a decent post wash count then i would go for it. If your husband is not ejaculating correctly then you will get a much better improvement in odds than 15%. Because as it stands now the odds are almost nil. FYI, i got pregnant on my third IUI at 42 years old but i m/c. I have seen many, many women get a BFP within 3 cycles. Those gals that have husbands with bad sperm are not so lucky. But you have good semen just inability to get it were it needs to be. Just my 2 cents worth.

[Sisi1]

I would definetly recommend going with IVF , after having done 3 IUIs with up to 6 mature follicles and nothing to show for it........

Good luck!

[Liam'sMommy]

But Sisi because of your age your number of abnormal eggs are far greater than hers are. Does that make sense?

[Warren Dew]

My question is the following…I do have an appointment with an infertility doctor next week, however I was puzzled to read that (at best) IUI only has a 15% success rate, and that is with injectibles!

You should keep in mind that most people who try IUI have much more severe fertility problems than you do, and that affects the success rate. For couples that have issues that prevent the embryo from fertilizing, or from getting to the uterus and implanting - as for my wife, who has endometriosis - IUI does not help. Since the insurance companies insist on our trying it anyway, though, we push those success percentages way down.

IUI should work perfectly well if the sperm and woman are healthy, as seems to be your case. It sounds like your only problem is getting the sperm near the egg, and IUI does that perfectly.

You'll also want to figure in the difference in cost. The $10,000 could pay for an IUI for every cycle in the year, and even if your chances were only 15%, they'd add up after a while. On the other hand, a single cycle of IVF will blow the entire $10,000 and then some.

[mb1981]

thanks so much for all your informative responses! i am now leaning towards trying the IUI. I wanted to ask whether you typically have to wait a cycle in between IUIs? Also, I am seeing an RE tomorrow to discuss my options. Do you think they will start me on IUI for the next cycle (I will be 4 days away from my period when I meet tomorrow)

I don't want to waste any more cycles!

[babyluv]

You should be able to do IUIs each month. Generally you would need to wait if you developed cysts, but if not then you would be good to go.

As far as starting right away, you may first need an HSG done to make sure everything is clear. If you've already done it, I don't see why you wouldn't be able to start right away. Good luck!