Brandon and I are feeling really great about our new fertility plan. See a couple posts down for more details.
We are feeling better about choosing to do IUI rather than IVF. And it all comes from reading a blog from an infertility doctor. He really puts things into perspective and makes us feel like we are really making the right choice. Most of the following comes from his blog. My comments are in bold.
During intercourse, 1% of the sperm make it to the uterus, and another 1% make it to the tube; the place fertilization takes place. So most of the sperm doesn’t make it. Some get stuck, some die, some get lost (we’ve all heard jokes about that). In a fertile couple a small number of sperm in the tube is all that’s needed. By doing insemination (intrauterine insemination that is), we are playing a numbers game. More sperm are getting to the tube, so if one doesn’t do it, maybe the next one will.
This makes a lot of sense for us. Brandon has a great count and motility rates. The shape aren't great but that doesn't mean that they can't penetrate the egg (see below). Our issue (I think) is that the 1% that do make it aren't the greatest quality. But if we increase the number of sperm that actually make it to the uterus our odds of a good quality sperm making it are higher.
If we have a man with good counts, good motility and low morphology, we do not recommend IVF with ICSI. We will treat him as if there is not a problem (because we don’t think there is one) and allow the couple to do insemination. If they do go on to IVF, we do not perform ICSI, and the eggs fertilize just fine. Of course, we would not follow this plan if the counts or motility were very low. And we at times have exceptions. Other clinics do things differently. Sometimes its because other places have found that they need to do ICSI to get good fertilization rates in their patients with low morphology. I can’t speak for the techniques of other offices, but you should know things are done differently in different places. As with all of my entries, don’t change any of your treatment plans without speaking to your doctor first.
The Sperm morphology myth
This week I saw a couple who were told the reason they were not getting pregnant was “bad morphology”. The sperm, they were told, could not penetrate the egg because of the abnormal shape of the sperm. Because of this, they would need to go directly to in vitro fertilization with ICSI. This was in spite of the fact that they were young, had normal hormone levels and open tubes (sound familiar??!).
I’ll tell you what I told them.When we test sperm (the semen analysis) we look at a few different parameters. First is the volume, which should be 2cc or higher (Brandon's is perfect). Second is the count. This is the number of sperm per cc, so it’s technically a measure of the sperm concentration. This should be 20 million per cc or higher. The average is around 35 million (Brandon's was above that). Next is the motility: the percentage of sperm moving. Should be 50%, most normal samples are not much higher (Brandon's was normal) . And then there is the morphology: the percentage of sperm normally shaped. This should be 14% or higher. The average is 2-6%, but why? The original guidelines for sperm parameters, from the WHO, stated normal morphology should be 30%. Then about 20 years ago, Dr. Kruger came out and said we really need to be looking more carefully at sperm shapes. If we are really careful we will see that there are more abnormal sperm than we think, and the cutoff should be 14%. He called his classification "strict criteria". He also said that by being more careful we could better identify the men who are infertile due to badly shaped sperm. This all sounded well so the andrologists (the people who do your sperm test) started looking harder, and harder, and harder. They now deduct for every sperm that does not look perfect. So over the past 20 years, the andrologists have been getting pickier and pickier, and now a man is lucky if his morphology is over 5%, and almost everyone is less than 14%.Obviously this has all gone too far. We are telling almost all men that their sperm is abnormal, and that just can’t be. The fact is we do not know what a normal sperm looks like.
So all in all, IUI is not an unreasonable option for us! Feeling much better about it! 17 days until our appointment with Dr. B. And Brandon goes in on November 1st to do another semen analysis (11:00-reminder to me). So we will know more about what we are dealing with then! :)