End of the line

The AMH test came back at 0.1 which basically tells us that statistically the odds are astronomically against us conceiving a child. While I believe we may be able to get 1-2 eggs from future IVF cycles, they are not likely to attach or result in a pregnancy. Also statistically there is a 1 in 3 chance of downs.


Biological children are not in our future :-(

Best of luck to others facing infertility.

On to the next stage

We gave Clomid for Male Factor the college try, to unpredictable and undependable avail.

The clock is ticking hard (DW 41 in Oct) and we opted for IVF ICSI. Thankfully the tax return was goo this year and so there was at least one good injection (cash).

All was looking as positive as ever for us- 3 follicles growing, 3 eggs retrieved, all blood work in range. Two eggs were put back in for a day 3 transfer. Sadly- no pregnancy.

This was tough for us to digest.

We are currently in no-where-ville. RE prescribed clomid challenge and AMH. Both tests will likely tell us what we already know- DW is only likely to give 2-3 eggs. (Duhhh!) But I'm done arguing. If anything I was interested in whether or not we are gambling with a 33% probability with Downs or not.

The E2 test came back at 76... which is above the 50 where this clinic is willing to accept the Clomid challenge results but below the 80 mark which keeps us in the slightly better than hopeless zone.

We are waiting on the AMH tests. Wife is nervous, but I have a high confidence level they will predicts exactly what we saw in IVF 1 & 2:

Here's why:

If DW's ovaries were completely done- the souped up IVF wouldn't have had any eggs. If she had plenty of eggs, IVF (1&2) would have had plenty of eggs. The AMH will tell us exactly what we know- she's pushing 41 and the window is barely open. I'm done with suspecting the Drs are trying to fleece us. If that were the
case they would have had us march directly into the next IVF cycle with a golden pen and check book, so I will keep my pie hole shut.

I am blessed with a good income and I'm financially bracing for putting retirement on hold for a year while we battle on, but I wonder if we are prepared to go for IVF 3,4,5,6 w/out success?

and they're gone again

Actually it's been nearly a week since I tested.

Motility was looking extremely good going into ovulation week. We hit it 4 times at the front of the window. However, by the time we went in for IUI, there were barely any swimmers... so no IUI.

Talk about a roller coaster of frustration! Of course the next cycle starts any day now (1.5 days late now). Like any couple trying, this is like waiting to see if your lotto ticket is the winner.

I don't have high hopes, however if I kicked out a couple of good shots before the swim team went on strike again, we may have a winner. Arg!!!!!!!

they're back

One of the best samples in over a week.

So after 48 hrs of abs the samples were horrible. The next few were bad and then started ramping again with last night not being horrible (no microscope view this morning) and one of the top 10 views yet tonight.

More misses than hits

It's been totally hit and miss- with more misses than hits.

One clear trend is that abstinence is NOT an effective way for me to get motile samples. I have yet to get a good sample after 48 hrs of abstaining.

No winning swimmers on the last cycle. New cycle started on Sunday.

On the positive side, my microscope camera is working well. I am now capturing a 1-2 minute video of some of the better views for our next round.

I was really hoping the count would remain consistently high to avoid paying for ICSI, but I'm not convinced we can find a good urologist who can address this in the next year.

Not the motility we need

Although I've seen some spikes, the upward trend hasn't continued in motility.

For the past week, there has been only 1 REALLY good sample and I bet that was only 50% motility at best. The rest have been very low, with 50 swimmers per high powered view.

The doctor gave the ok to officially up the Clomid to every 5 days, so we'll see what that does.

What the heck!!!

Friday 2/5 was ovulation day (2 days earlier than expected). After about 2 weeks of upward trending views, the swim team started showing up DOA. Not only that, the salt-peter side effects of the Clomid hit me HARD this weekend. I had a hell of a time getting the job done twice during the window and I had hoped for 4x.

After our Ovulation window closed on Sunday things started going well again- it's almost as though my body did not want this to be the month for us to conceive.

The microscope view on Sunday morning was the worst I've seen since starting. Hopefully this is because all the good swimmers were on their mission already. This got me rather depressed so on Sunday night, I did another round and there was a slide where the views were between 50-100 again.

Random- again

So after a week of totally awesome results, it's back to random.

The last 3 tests have shown at best 25 - mildly motile swimmers per HPV.

Many views with 1-2.

Not what we were looking for heading into ovulation. Hopefully there will be an uptick.

Even less random sampling

It looks like every new crop of swimmers is getting more and more plentiful.

I've started checking the microscope samples at 40x to see where the major moving fields are; there are tons of fields with hundreds (or close to a thousand) per high power view.

At this point, it is looking very optimistic that IUI is going to be viable, presuming we don't get a winner in this current round.

clomid- blood test 2

I'm 6'0 and 220 lbs.

Before clomid:
Free testosterone: 9 and the range is 5-40.
Total testosterone: 314 and the range is 332-896

30 days of clomid (50 mg every 5-7 days)
Free testosterone: 23.2
Total testosterone: 729

Less random

Shot round 2 tonight for the microscope viewing audience.

1 month, 2 days on Clomid (50 mg, 5-7 days)

• abs: 8 hours
• volume: ~2 tsp
• low motility: 25 per hpf
• high motility > 1000 on multiple views

Similar to what I saw earlier this week, there were multiple fields of view where the entire slide was moving.

Ovulation is about a week away, and while I realize that most couples with completely normal situations have to try multiple cycles to get a win, I am modestly optimistic about our chances this round.

Especially given the fact that we plan on carpet bombing the egg with whatever swimmers are available.

Randomly better samples

Haven't measured in several days, so I wasn't sure what to expect today.

1 month, 2 days on Clomid (50 mg, 5-7 days)
abs: 24 hours
volume: ~2 tsp
low motility: <25 per hpf
high motility > 100 on multiple views

I think today the overall total motility was the highest I've seen yet in a sample. The interesting part was that in most views to date, the total number of swimmers and wigglers observable has normally decreased in the course of an hour. Today the number seemed to increase as the liquefaction took place.

While no view was as good as the miracle view on Wednesday (~1000 in one view), the number of views with 100 or more were extremely plentiful.

I had a blood draw done Friday morning for the free and total testosterone. My fingers are crossed that the result shows I need a stronger hit of Clomid. Why? Because while I'm aware that that it takes 60-70 days to grow a crop of swimmers and that there may be better crops in the making, it would be good if triple the Clomid yielded triple the results.

I'm not sure what impact the psychological effect of the Clomid is with regard to my overall vigor, but I sure don't mind the energy- real or perceived.

Random good samples

On Monday night I did two samples- this was a continuation of the project of moving the swimmers out of the bull pen as fast as possible to see what happens.

Sample 1: Almost none. Very lack luster (quite disappointing).
Sample 2: Over 1000 swimmers per high field view. The entire slide was motile. (volume was low).

WTF?

On the positive side- the fact that the random occurrances are containing larger numbers of motile is good to see. Heading in for a blood test in two days.

Also, neglected wife says put away the microscope for a few days.

Rhyme or reason for the counts

After a stellar count on Wednesday afternoon I waited until Friday evening (54 hours) to view the next round.

Volume - ok.
Count - nada. Maybe 1% of low motile swimmers at max.

This is a major bummer of course, but what I don't get is what is physiologically cause the count to go from substantial to substandard in 2 days. Unless this is just what happens with a low dose of Clomid after only 1 month.

To test this theory further, we were wondering if the numbers game of abstinence and shooting a large volume is actually causing the swimmers to die waiting in the bull pen.

So this weekend is a marathon round of research. Minus a round of sport last night, the goal is to get as many rounds under the microscope as possible. Round 3 was early this morning and the percentage looked similar to week 1 of Clomid. Round 4 was Saturday evening 5:00 PM and some of the views were above 100.

The volume of everything but the first round was between 1 to 1 1/2 teaspoons. Round 1 was about a tablespoon.


Round 1: 54 hours of abs: Nothing 1% max
Round 2: (not viewed): 4 hours of abs
Round 3: 7 hours of abs: ~25 swimmers per high powered view
Round 4: 10 hours of abs: ~100 swimmers per high powered view (max) ~25 on average.
Round 5: 24 hrs of abs: ~100 swimmers per hpv (max) ~25 ave


OK- WHAT THE HECK IS GOING ON BETWEEN ROUND 1 and 4?

Note on round 5 there were lots of views with 100 plus.

things i'm curious about

1. Is this repeatable?
2. What will the WHO tests tell me for the abs sample and the no abs sample? (at a hundred bucks a pop, I'm only curious enough to try one.)

I'll try one at some point, but may try daily views for a few more days before burning time on abs.

On the down side, the wife's cycle started today, so no baby from this past round :-(

clomid side effects

in my last post I mentioned some of the clomid side effects. Here's a quick summary.

• sore back and shoulders
• libido all over place (from erectile dysfunct to wanting to hump 5 x a day)
• not as tired all the time
• generally less depressed (not that I was a wet blanket, but I generally have more vigor now)
• drinking more water
• drinking milk like crazy (wife noticed I polished off nearly 3/4 gallon during dinner)

Upward trend- microscope 1/20

I checked on 1/18 Monday night- volume was signficant, but unfortunately the first bit overshot the container (another Clomid side effect?) and although the volume was good, the sample was lack luster for swimmers (barely any). With minimal refract time I hit another round- and there were some good fields, but not quite like Sunday morning.

Since then there hasn't been more the 12 hours of abstinance (another Clomid side effect?) despite some erectile dysfunk (DEFINATELY a Clomid side effect).

So this afternoon I sent a round to the microscope- and holy tad poles!!!! This is 2x what I saw 3 days ago. This is EXTREMELY positive. I'd estimate that there were easily 100-150 fast swimmers per high powered field. Morphology was extremely good.

At this point I'm not only enthused about the prospect of getting us knocked up, but not having to drop 15k to do it. As we are looking for twins, we may do the IUI with drugs to try and get two eggs.

Both the GP and the OBG had said that it would be a month+ for the Clomid to really take effect (well the GP said that was the case for T shots, he wasn't as familiar with the impact of Clomid).

This leaves me curious about what things will look like a month from now. It also leaves some hope that if we hit it hard during the Ovulation window- we may even see a natural pregnancy this month.

Thinking about a centrifuge

I'm curious about the swim up stream factor I touched in on my last post.

As I see improvement in the raw sample, I'm curious about how many will be lost in the sperm wash. It seems to me that my lame swimmers aren't making it up stream after the 1 hour wash- so that might be something I watch.

The home made centrifuge would be pretty easy- Test tube /pippette is a soda or coffee straw with the end crimped off and an old bathroom fan I kept around from a remodel project. Duct tape ought to keep it in place for the ride. Of course the limits the analysis to Sunday mornings, because there is no way I have this sort of time in the week.

Sunday 1/17 Microscope

12 hours of abstinence
21 days on Clomid
5x50 mg consumed since 12/28 (average 1 every 5 days)

A continuing trend: The number of swimmers per high powered view is between 50-80. The number of wigglers may be higher than that as this number has gone up a lot. It is easily 100 on a good screen. The worst screens were probably down at 20-25. This is continued improvement, but the amount of dead or non moving material still out weighs the wigglers by 100:1.

Also we are still way short (especially in terms of forward progressive movement)of what would work for IUI based on the last attempt. The "wigglers" would not survive the sperm wash, as they wouldn't make the swim up stream after the centrifuge

The physical affects of Clomid seem to be waves of it working like salt peter followed by waves of increased libido mixed in with some teen angst. The wife says not to worry promises to repay my Clomid induced teen angst with lots of hormonal chaos of her own after we conceive.

Interesting: Swimming fields

Microscope time again:

On Monday night I noted there were a couple of fields that looked decent, but the rest looked pathetic.

Today, same thing, but more so. Some fields had as many as 50 progressive swimmers, best yet. However by the end of the hour, I was seeing less then 5 in other fields. I would expect that even if all fields were as good as the best field, this would not be good enough for IUI.

Of note is the Clomid history over the past 10 days. I took 50 mg on days in bold.

Friday sat sun mon tue Wednesday thur fri Saturday sun mon tue, today.

Also of note is that I hydrated like crazy yesterday. I know that hydration is not the issue, but I should note that I normally drink about a pot of coffee a day.

WRT Clomid, I'm switching back to every 6 days, as I want to be closer to the actual recommendation when I go for the next blood test at the end of the month.

Monday night by the amscope

Saturday was ovulation day (and saddly no IUI day) so the pipes were cleaned 3 times playing the fertility lottery. Our goal was to hit it again Sunday morning, but we were exhausted. Go figure.

Tonight's crop (46 hours of abst) didn't blow my metaphorical skirt up. While some views were quite good with easily 25 average to better swimmers and lots of "wigglers," there were vast fields of less than 5-10. Also- a lot of the better swimmers appeared to have poorly formed tails.


Thoughts: This is intriguing in several aspects.

• Is the increase in wigglers and flattening of swimmers in some of the fields good?
• Is the decrease in overall swimmers something to be concerned about?
• Do the poorly formed tails on the good swimmers mean anything? Did they get shot out prematurely due to the rigorous pipe cleaning on Saturday?
  

This is not encouraging, but I'll chalk it up to starting from very clean pipes on after Saturday night. Gut check tells me we will be shelling out for ICSI if something doesn't start to shake. Damn it.

On a tactical front today it occurred to me that the low T is something to leverage in the near term: I made some calls to my general practitioner today to see if they could do some referring around with reference to my blood work. Hoping to get my "treatment" onto insurance since this low of T isn't exactly normal or healthy for a late 30's male. At the very least I'd like to get my blood work and next SA paid for. A bit of a gamble since the GP is going to stick me for a 100 bucks to get the referral. It's fucking extortion since the bastards have been worthless thus far in anything on my swim team. Candystripers from the local high school would have been more useful in diagnosing male infertility. The jackass general practictioner should have at least prescribed the blood work when I went there in the first place and told them my motility sucked.

Sorry for the salty sailor talk. I'm a prick when a licensed "professional" gouges a customer.

Good white paper

I haven't yet heard a Dr characterize my condition as hypogonadism as I think technically that is probably far beyond where I am at.

Anyway- here is a brilliant paper on the subject. I came across this as I was hunting for more info on Clomid.

http://www.aace.com/pub/pdf/guidelines/hypogonadism.pdf

Since I'm going through the hormonal changes of a teenager on Clomid, I'll take license to make the snarky remark that there is actually a gonad "Task Force."

BTW- the hormone changes are really trippy. I'm trying to place a healthy amount of skepticism on the potential power of suggestion; that said, this would be one hell of a placebo.

Clomid-- some but not all

We went in for IUI today but cancelled. Although the uptick in the last week is way better than our IVF, the estimated count was not looking good after the sperm wash.

We did have a discussion about the microscope views. I guess they were seeing about 25 swimmers per view, which is consistent with the views I've been seeing. The problem is there should be hundreds.

Frustrating part 1 in today's update is the dr isn't really interested in treating (male) infertility- their biz is taking a bunch of sperm and putting it with an egg.

So the cross roads we are at is whether to drop the $15k now on ICSI or screwing around with Clomid dosages for another 3 months. So I'm not one to piss on the Dr's advice, but I hate jumping to the $15k solution when there is a clear symptom, a clear uptick from a medication.

Frustrating part 2 is, for this obvulation, the few million swimmers I have are now dead in a dixie cup at the OBG's office. We're trying to hit it 2-3 times for the time that's left for this go.

Third hit of Clomid

Day 9 on Clomid. Just before the third 50 mg tablet.

The swim team numbers have continued an upward trend in the past 2 days. At the high end there are easily 20 good swimmers per microscope view (at 800x), though there are of course many views that have less and I'm certain many "layers" I can't see. I can't say this quantitatively, but the numbers appear to have plateaued.

It's hard to assess where the newly produced T is playing its part. Since it takes ~70 days and about 6 days per stage to grow a team, I'm positive the T is benefiting the tail growth stage at the end because I started seeing the big uptick 6 days after the first hit of Clomid. If the numbers continue to grow in the next 3 weeks than it shows that the other stages were also starved for T as well.

I'm still looking for that microscope view that is so full of swimmers, it looks like a bucket of maggots.

Tomorrow 1/6 is my third hit of Clomid (I'm hitting 50 mg every 5 days). We are due for ovulation any day now. It's uncertain if the work schedule will permit IUI this round or not. The birds eye view has me somewhat cocky (no pun intended) that we could get there naturally on this round, but I'd rather eliminate the risk if we can by doing IUI.

Supposedly this ovulation will be good due to the hormones from IVF in Dec still being in play. After years of trying, our expectations are set pretty low for success of any cycle (including those costing us thousands $$$).

Depending on whether we have a swing and a miss this round, I'll be getting an official SA done around the end of the month along with a T test. I really hate the costs of "testing"

History

How we got to today:

1- About 18-24 months of "trying" which built up to 6 months with an ovulation monitor (wife peeing on the stick).

2- Wife getting checked out with a clean bill of health.

3- Me reluctantly going for an sperm analysis (3 months later).

4- Me switching to boxers, taking vitamins and trying for another 6 months.

5- Us going to the first fertility clinic and getting the hamster test (waste of money).

6- Me going to my GP (2 months later) and getting checked for varicocele.

7- Me going to a radiologist to confirm no varicocele.

8- Me going to a general urologist who said the ultrasound showed no varicocele but suggesting IUI 3 times before paying for IVF.

9- Us deciding to try another fertility clinic and deciding whether to go for IUI or IVF based on 25% motility.

10- The 2nd fertility clinic prescribing a blood test for me- but not telling me that it could point out a condition that could be fixed with a 29 dollar prescription.

11- Us chunking down 7k for IVF (3 years into the process).

12- IVF failed due to only 1 egg (miraculously the egg fertalized even though the swim team was mostly DOA).

13- Me getting the microscope.

14 - Me getting the blood test and confiming it was the testosterone.

15- Clomid prescription - $29.

16- Today----- after two 50mg tablets and 6 days, the swim team is moving like a pile of maggots on crack cocaine (well not quite that much, but it is a big jump).


At the back side of this process, I will write a review of the Doctors involved here. I am ok with the current fertility clinic (who ordered the blood test) and my wife's first OBG. Neither my GP nor urologist blew my up my skirt with their knowledge of fertility / motility issues, but I understand that this to be expected.

The fact that we are nearly 10k into this process before getting blood work done on me is very damning to everyone except my wife--- this includes the Doctor who finally ordered it (why? because he let us chunk down 7k on IVF w/out telling us blood work could point to a 29 dollar solution). It's also egg on my face because I paid the $7k w/out looking into the blood test more than I did- however the first fertility clinic said that it would be 6 to 9 months for ANY hormone treatment to take effect and that rarely solves the issue - so I am doubling down on my anger towards that place.

I am extremely happy that the current doctor did order the test. My complaint was that I've been fleeced for thousands leading up to this step and have had some very bad advice (like the first fertility clinic recommending a bastard baby via sperm donor). I would have been doing hand stands if someone said - hey look, for less than 50 bucks of this pill you can avoid 10k in all of this fertility treatment.

I have some pretty scathing words about the first fertility clinic we went to and for people in the Puget Sound area, I recommend you RUN (don't walk) away from that place.

Vindication- This is your swim team on Clomid

This is a big break through, because it has been a total mystery as to why my swim team has been dead or not kicking on arrival. As noted in previous posts, all my plumbing works, no trauma, no prior steroid use, no mumps, no malnutrition, no diabetes. No good reason.

I'm happy to declare initial findings today that Clomid for male factor infertility (motility) WORKS!!!!!!! Well, not for everyone, but definitely in my case. I say this here because there is a lot of official scribing of not prescribing Clomid because some double blind study failed to show an increase.

Clomid basically raises Testosterone levels, so if your testosterone level is normal or you have plumbing issues, Clomid will probably be of no help to you.

I started on Clomid a week ago after the blood work came back. I did this because my swim team on IVF day was totally dead on arrival. While FSH, LH, TSH, and Prolactin were all w/in range, the free testosterone was at the very low end of acceptable (9 and 5-40 is normal) and the total testosterone was slightly below normal according to this lab (314 and the range is 332-896).

I took my first 50 mg Clomid pill on Monday evening 12/28 and the second on Friday afternoon 1/1. On Friday morning I took another look under scope after 36 hours of abstaining, and there was a small uptick in swimmers, but not as pronounced as today. Today is Sunday morning 1/3 and after only about 10 hours of abstaining (last night was the last full night of our Christmas vacation), I can see more motility in a single field of view under the microscope than in any TOTAL sample thus far.

This was the exponential growth rate in motility we've been looking for.

I've been sleeping in the buff as well, but I'm doubting that as being effective as this jump in motility appears much larger than the few percent we saw on the sample last summer. I'm curious to get lab counts using WHO standards as this jump appears to exponential.

Clomid side effects: I've noticed I've been grumpier than usual and although the main mast still stands at attention, it's not really the "A" game. Starting on Saturday morning I noticed the blood flow affected to the unit. Since even when I'm super tired or stressed out, I've never in my life experienced anything negating my functional performance, it is a safe bet that it is the Clomid. I should note that it's not killing performance, but it sure as hell is negatively impacting it. This is wierd, since the impact is increased T- which ought to be having the opposite effect. Anyway, since we're screwing for babies and not for sport, the numbers in the baby batter are all that matter here.