Semen Analysis Results and several other questions :/


#1

So I have been a longtime lingerer on these forums. My husband and I just went to a Urologist on thursday and we have been referred to a RE in Kansas City, MO. We have been actively trying for 3 years(I am 21 and he is 22). His first semen analysis was in 2010 and it showed Azoospermia. Absolutely nothing but it said his volume was 4.0/ml and the viscosity was 1+? It also showed morphology with a ‘C’ and it states that 10-20 WBC’s seen/hpf. What does this mean??!!:grr:
On his most recent SA it goes as follows:
Liquefication-normal minutes
Semen Volume-5.0ml
sperm motility(progressive) [L] 5%
Sperm count per mL and out to the side it states’see comment million/mL and below that it states:
'Very few sperm seen. 0-2/HPF(WHAT DOES THIS MEAN??:grr: )
Also it states-Normal forms(WHO criteria)-NA % and below that-'normal forms not performed on counts<2million.
White cells-Increased

Can anyone please explain these two to me? I know none of it is good but is the 2nd one any better than the first? The first didnt even show motility. Just 0.0 EVERYWHERE. The Urologist did an exam and felt no varicocele veins and his vas deferens was fine(DH said this physical was painful, is that normal?) We are so new to all of this because we are just now in the position to start figuring out what exactly is going on. Is there any hope of this being a blockage or a hormone problem? Or is IUI a possibility or are we going down the road to IVF?
I have been trying to get as much information as possible just to keep myself from going to a deep dark place which i feel myself slipping into daily. We have never even had a :bfp: . No signs that anything is wrong with me either. My thyroid is enlarged(has been for a long time) i was tested for my thyroid by two doctors who said the labs were normal. And my recent pap smear came back abnormal but i am negative for HPV. My periods are a little abnormal because they range from 30-40 cycle days and they last about 5-7 days. I think that i ovulate because i have done the OPKs and they show LH surges. I tried charting a couple of times but cant make sence of them. Sometimes i think that i did ovulate when i use them and then i look again and think well maybe i didnt? Does anyone elses DH have similar SA reports? Any ideas of what we are getting into? Thanks in advance for anyones advice and :babydust: to all!


#2

:welcome: Kbriner!!

You have several things potentially going on here. Have you seen a Reproductive Endocrinologist (RE)? If not I highly recommend one as other Docs aren’t looking for ideal lab results or lab results that are specific to conception and thus will often go by lab standard values which means that your thyroid could be within the normal range, but still be keeping you from getting pregnant. See a regular Doc and even a regular Endocrinologist is a specialist in what is normal for you when not pregnant or TTC so you really need someone that will look for and treat to ideal levels rather than what is considered clinically" normal.

For example, I have had numerous symptoms of hypothyroidism but my labs have always come back as normal. However when I switched to my RE he said mine was too high for conception because my TSH was a 3.7 and they like to see it under 2.5 and ideally at a 1 for conception. Since going on synthroid and getting my TSH down to a 1 all of my hypothyroid symptoms have disappeared. I also have a strong family history of adrenal disease so…

Upon realizing this I told my little sister who also has similar symptoms and was having trouble conceiving. She had been trying for two years unsuccessfully. She went to her Doc and had her levels tested and they were like mine in the normal range. Her Doc was willing to allow her to try the synthroid and bring her number down to 1 and she conceived the following cycle and is now 15wks or so pregnant.

Okay–so I said all that to say that having an enlarged thyroid is not a good sign and I feel you need someone more specialized who will help you reach ideal levels rather than dismissing your symptoms due to clinically normal lab values.

Also, when you have yout thyroid test done matters as your TSH levels drop during the day so if you have a draw in the afternoon it is actually possible to get misdiagnosed because your levels are highest in the morning so you could have a level that is not normal in the morning and by the afternoon it has dropped within range. This is one of the causes of misdiagnosed hypothyroidism.

Though I am not sure what thyroid disorder you have the fact that it is enlarged says volumes and you need to be properly tested and diagnosed.

[COLOR=“Blue”]As far as if you are ovulating: You cannot just go by OPK’s to tell you if you are ovulating or not as they are notoriously unreliable especially for those with underlying conditions such as Pcos and adrenal disease such as thyroid issues. I, for example, got positive OPK’s every month and yet through doing ultrasounds and bloodwork it was determined that I was not ovulating. The reason is because you can have an LH surge where you body is trying to ovulate, but yet not have anything matured to ovulate since your body isn’t maturing follicles as it should. Here again you really need an RE. If your cycles are long that is another sign something is off so having a through workup off your hormones by a Doc that specializes in this is highly recommended.

[COLOR=“Blue”]As far as your husbands SA: It appears he has a high White Blood Cell Count (WBC) which indicates either infection or antisperm antibodies. This would explain why there aren’t many sperm and they are not motile and with white blood cells attached to them they are too heavy to move or potentially dead. A urologist is good for boosting sperm count where boosting it is all that is needed and may be able to get rid of some infection, but if the protective barrier to the sperm has been damaged enough to allow WBC’s in and with the counts you are seeing I am not personally seeing how timed intercourse or IUI’s would be beneficial though I admit I don’t know much about WBC’s. Seems to me you would be wasting your time, money, and emotions to continue with the urologist without taking the numbers to an RE as well for their recommendation as to how to proceed. You may very well need IVF to overcome such as severe male factor. I would read all you can about WBC’s and what causes them and what the treatment is for them. It may be that they can give some antibiotics to clear up the WBC’s and that will raise his count or they may be able to go in surgically and remove a good enough count for the use in an IVF w/ICSI.

This may not be what you want to hear and might be your worst fear since it is the most expensive treatment. I know how you feel as I felt the same way when we found out my DH had 95% of his sperm affected by antisperm antibodies and thus only donor sperm or IVF w/ICSI would work for us. It certainly helps to find out all you can about you and your husband’s issues and what the recommendations/options are for you though because then you can come to terms with what you need to do and move forward and moving forward with a plan is very encouraging and renews your spirit.

Having said that I am not an RE and can only give you my view point based on my limited knowledge of SA’s. Maybe there is something more they can do that I am unaware of. Definitely seek an RE though in conjunction with the urologist and find out where to go from here.

Good luck with everything and please don’t get discouraged. Even if you have to go with IVF I have hope for you and want to encourage you to have hope that you will make your way to that BFP. It is only a matter of the proper treatment in your situation and time. :grouphug:

Sending you lots of :babydust: :babydust: !!


#3

OH!! Thank you so much for posting!! I was really getting discouraged with the lack of information i was finding!! We just went to the Urologist on Thursday and we are in the process of getting reffered to the RE. Hopefully the appointment is soon but as of right now we have only seen a urologist and a gyno. I really do think that something is off with my hormones and thyroid and all of that. I will definately mention the enlarged thyroid to the RE and have them check me out as well as DH!
With my OPKs and charting i have noticed on the charts that i do have an ovulation spike/dip and then i have read that the next three days need to be above a certain temp and mine seems to jump up and then way down about 3-4 days in a row and then level out so maybe ovulation is not happening? I dont know but i am so ready for answers!!
I am so glad you mentioned the WBC because right after i posted this i was looking at information on WBC being in SA and i was hoping i wasnt just seeing things lol! What is a normal range of WBC? I will do further research and see what more i can find and hopefully i will get a call from the RE on monday and know a date! The only thing is that the RE is 3 hours away and my DH is limited on his vacation days so i am hoping(if you know please give input! lol) that they can run some tests on one day and give us results either same day or a couple days later(were wanting to stay for about a week or so depending) and then run through options for treatment that way we dont have to make a trip there just for the tests and then come back for results and then another trip to do the treatments etc! Sorry for the bad grammer i am just rambling :wink: Once again thank you so much for the reply and will probably post more here in a bit!


#4

Well, my understanding is that there should be no WBC’s in the semen (though I think 0-5hpf is okay), but anything over 10hpf I believe is an active infection. Your husband’s analysis in 2010 shows 10-20hpf WBC’s which is high.

Was your husband treated for an infection back in 2010?

Now I guess the SA is showing 0-2hpf for the semen count right? Well hpf means high power field which I believe is how they are looking at it through a microscope or whatever equipment they are viewing it through. So is just a measurement they use for whatever is being looked at. This would indicate exactly what it says which is that there are very few sperm seen. To be more precise I believe it means there were anywhere from zero to 2000 sperm seen. And since he had a good volume of 5.0ml there should have been 20mil pr ml. so he should have a min. of 100mil sperm.

Then it goes on to say that the WBC’s are increased, but I guess there is no number given as there were in your 2010 SA?


#5

As far as the 3hr drive: I would just explain your driving situation to the RE. With some of the tests they may be able to order them so that your Gyn or someone else can perform them or you can just go to a local lab if it’s bloodwork. For some of the others you will need to be there to do them, but often you can drive up and do a bunch of tests in one day and then go home and maybe they will work with you on doing a phone appointment where they discuss the results via phone instead so you don’t have to go back down just for results or they may be able to fit in some more tests the same day as you get results to others so that can maximize your time.

It all depends on what your RE does as a workup. Some like to do a clomid challenge test, a pap smear, lots of blood work, an ultrasound, an HSG or SIS or both and then go from there. As far as hubby again lots of bloodwork, and maybe an SA (but you just have one so may not need another–just depends on if your RE wants more testing done of the semen then the urologist did) and maybe some testing to see why your husband is having azoospermia (that is to make sure there is no blockage or abnormalities–though again this may be something that the urologist has already done).

You may be able to knock them all out at once depending on what all the RE wants to do (as some tests cannot be done in the same cycle for the women).

But as I said just let them know your situation and find out how they can work with you.


#6

ahhny-Thank you for the reply! I have tried looking up information about high WBC in semen analysis and there is not much information on it. He was never treated for infection in 2010 which really make me upset! We were never even told anythign about the high WBC :af: . And on this recent one we werent told anything either! He didnt run any further tests…i dont think he even looked at anything other than the extremely low sperm count and physical and just whisked us on our way!! I was also wondering about the verbiage ‘increased WBC’ on the recent one. If this is an infection and its gone untreated for 3 years does this lower the chance that medication will fix it?? If so i will be making a few phone calls tomorrow. I think i will call regardless and question the WBC and just see what they say. I might even question why they didnt do a little more than just a physical and a referral.
As far as the RE goes i hope that they can perform most of this in one week. I know this is personal but did you have to pay everything up front on your first appointment? Or did they bill to insurance? I am hoping to get most of these questions answered by the RE and i suppose i will, i am just impatient i guess :confused:


#7

[QUOTE=kbriner]ahhny-Thank you for the reply! I have tried looking up information about high WBC in semen analysis and there is not much information on it. He was never treated for infection in 2010 which really make me upset! We were never even told anythign about the high WBC :af: . And on this recent one we werent told anything either! He didnt run any further tests…i dont think he even looked at anything other than the extremely low sperm count and physical and just whisked us on our way!! I was also wondering about the verbiage ‘increased WBC’ on the recent one. If this is an infection and its gone untreated for 3 years does this lower the chance that medication will fix it?? If so i will be making a few phone calls tomorrow. I think i will call regardless and question the WBC and just see what they say. I might even question why they didnt do a little more than just a physical and a referral.
As far as the RE goes i hope that they can perform most of this in one week. I know this is personal but did you have to pay everything up front on your first appointment? Or did they bill to insurance? I am hoping to get most of these questions answered by the RE and i suppose i will, i am just impatient i guess :/[/QUOTE]

Yeah that is super frustrating and yes I would think it is possible, depending on what caused the high WBC’s, that it going untreated could cause it to be a bigger problem now than it would have been then. As you have probably seen in researching they can be caused from trauma to the testes as in a testicular surgery or major illnesss, but also due to STD’s so if it was an STD then absolutely not only could that being untreated cause it to be very difficult now to treat, but also that it could cause cancer or other further complications and of course have spread to others as well. Of course one would assume that if it were an STD you would also have some signs of that so it isn’t likely that I wouldn’t think. Tough to say what it is, but whatever it is it is clearly causing azoospermia which isn’t good. Hopefully the RE has more answers for you. Sorry the urologist has left you in the dark and not given any further testing options.

Also, I did not have to pay my RE up front, but I my insurance covered all diagnostics so…however, anything that wasn’t paid for by my insurance was discussed with me by the office and so I was aware when I came in for that particular test that I would be paying for that. The only one we paid for (besides our IVF cycle) was the SA which was like $150. The cost for the cycle was laid out for us long before cycling and we paid for that prior to setting up our baseline so again it was not a surprise and we knew when we set up the appointment what we would be expected to pay.