First of all, if you haven’t read this years nominees for best blog, check them out here and be sure to vote before the end of the month! http://www.resolve.org/vote
Yeah this topic is ugly and embarrassing, but it’s something you gotta know if you’re gonna figure out where your boys stand in the infertility ranking world.
Here’s a simplified version of the techno language so you can at least avoid that deer in the headlight look I had the first time our RE started talking about all this terminology that in a nutshell meant ‘straight to IVF we go.’. Or at least that’s what it should have meant had I been more emotionally equipped to deal with the reality of just how significant my contribution to our infertility was.
I’ve added the translation in italics.
Here goes–special thanks to the Resolve article written by Michael Feinman, MD for the technical language:
- Volume. A typical specimen is 1-4cc. While volume does not play an important role in fertility, a low volume suggests an incomplete collection. In other words you may have missed the cup. This happened to me my first go round, and although subsequent volumes were slightly better, it was my count (explained below) that made medical intervention for baby making a certainty for us.
- Conversely, very large volumes may result in dilution of sperm and may cause considerable leakage after intercourse. Perhaps this explains the many stories I read where women hike their legs up to avoid against leakage immediately after the deed is done. I don’t know of any cases where it produced a final positive result, but it makes logical sense. Bottom line: higher volume doesn’t necessarily help you.
- Count. A normal specimen should contain 20 million sperm/ml, or more. Most low counts go unexplained, but occasionally this can be hormonally related. My first count was about 1 million per ml and subsequent better aimed samples were around 4-5 million. I tried Clomid, Chinese Y-dan, Chinese bitters, relaxation tapes, exercise, went from briefs to boxers and even iced my nether regions before a cycle when the air conditioning went out at my office right before a cycle. My low count was never explained, so my first reaction was self pity and embarrassment. In fact, my first reaction a month after I found out about my count, which has been recounted in prior posts resulted in my first drunken pukefest. I would advise strongly against 14 margarita boat rides in Mexico as a coping mechanism. The hangover was awful, and it didn’t do anything to help my count when we did the next cycle.
- Motility. This is expressed as percent of live sperm. Different labs express this differently, but essentially, about 60% of the sperm should be swimming. Basically you want the bulk of your boys to be Olympic contenders, not lazy sit on the couch waiting for the coach to come in and kick your butt out into the pool guys I apparently had residing within me. I was always surprised given the amount of caffeine I drink on a daily basis that they weren’t hyper spastic but apparently coffee doesn’t have that effect on motility.
- Morphology. This refers to the shapes of the sperm. Over a decade ago, a new “strict” criteria was introduced. The result is that most men have very low numbers. Fourteen percent of “normal formed sperm” is considered normal. In our lab, as with most labs, we almost never see that result. As the number for normal keeps dropping, the usefulness of the test also decreases. This one shocked me. If fourteen percent is normal, then the other 86% is a freak show. And for me it, was. I had pin headed, double and triple headed. Fortunately with techniques like ICSI (where they inject the best looking boys into the egg) they can weed out nasties so you don’t have any Medusa children in your future. The test is widely misunderstood; it is not a test of fertility or a predictor of having a normal baby. Low morphology has only been associated with low fertilization rates in an IVF lab when natural fertilization is allowed to occur. Many labs also report White Blood Cell numbers (WBC). Elevated levels might be associated with infections like prostatitis. However, WBC’s can look like immature spermatids. Immature spermatids occur more frequently in specimens with low counts, so it is important to make sure the lab has stained the cells specifically for WBC’s. Semen cultures can also clarify the situation. After decades of experience with semen analysis, it is clear that the WBC test is not a perfect predictor of fertility. For this reason, it is inappropriate to ask a man to undergo the test before he has tried to father a child. Basically, there is still a lot doctors don’t know about what goes on in the sperm making factories that reside within us. Perhaps that’s because the bulk of the science of infertility focuses on the woman, where the bulk of the baby making equipment resides. Honestly, our contribution to the process is relatively small (both literally and figuratively) and since they only need ONE viable sperm to do an IVF, it’s not the end of the world if you’ve got a low count, low volume, poor morphology, and poor motility all wrapped up in your reproductive biology like I did.
The final point I would make is, you are not defined by a sample. Also, don’t blame yourself for your low count. There is no way to know why so many men are having infertility problems.
Maybe it’s all the environmental toxins.
Or the chemicals in the food we ingest.
Or the fact that we put of child bearing until later in life (yes, guy’s biology does worsen with age).
Whatever it is, just be open minded to your treatment options, and make sure you read up on all the research for what types of infertility treatments are recommended for your particular challenges.
It could make the difference between thousands of dollars and a long path of doing cycles that really have very little chance of working, or going straight to a cycle that has a higher chance of succeeding.