What Causes Yellowish And Watery Semen After Taking HCG Injections?

Posted on Mon, 7 Sep 2015

Question: Hello Dr. I have male infertility problem. I have been married for 5 years with no successful partner pregnancy. I have been getting supplements such as: L-carnitine, Vit E, folic acid and zinc for almost 2 years. In January, 2015 I have had left side varicocelectomy and I was on clomid 12.5 mg daily for 5 months. I had progression in concentration; sperm concentration became 17 million/ml (normal ref >15 million/ml) and even the color of seminal fluid became more natural, whiter than before, but progressive motility still low with abnormal viscosity. Then my doctor prescribed me HCG hormonal therapy 1000 IU (1CC) SQ daily/3 days a week for 3 months and advised me to stop taking the Clomid. I stopped taking the supplements and remained only on HCG therapy. My seminal fluid turned yellow, watery just as before the varicocelectomy with yellow-orange chunks/sperms clumping; sometimes I feel a bit pain upon ejaculation because of the chunks that come out. I am getting worse after HCG treatment. The seminal fluid test results were abnormal after HCG. Sperm concentration: 5 million/ml, progressive motility 24% (normal value: >32%, total motility: 60% (normal: >40%) with also abnormal viscosity. For blood work-- total PSA: 0.45 (normal range: <2 ng/ml), total testosterone: 3.58 (normal range: 2.60-7.80 ng/ml), free testosterone: 1.18 (normal range: 0.95-4.30 ng/dl). I am really confused and worried about my case the doctor said the only way to get my wife pregnant is by using IUI technique, but this will not solve the problem. He said your blood work is normal and you have a physical problem. Please I need your help. Thank you

Answered by Dr. Mahesh Koregol (15 minutes later)

Brief Answer:
ICSI is required

Detailed Answer:
Hello,

Thanks for your query.

I have read you query and I understand your concerns.

Following is my reply:

1) Varicocelectomy does not always causes increased sperm counts. Hence it is no guarantee that this surgery would help you.

2) Your sperm count is varying in lower range and you might not be helped even by IUI.

3) I suggest you dont take anymore hCG injections as they are not useful in your case.

4) I suggest go ahead with ICSI ( Intracytoplasmic sperm injection) technuique in a good IVF centre near your town.

I hope I answered you query and addressed your concerns.

Let me know if you wish to ask any further questions. I will be glad to help you.

Regards,
Dr. Mahesh Koregol.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Mahesh Koregol (31 minutes later)

Thank you Dr. Koregol for your reply. Actually, I do not want to go with the easiest way because of two reasons: 1st IVF is very expensive for me now, it costs $15000 to $17000 in the United States. 2nd as long as the seminal fluid getting worse in color and content means that I have a problem either physically or physiologically such as: problems with prostate or urethra. My dr did Digital Rectal Exam and said your prostate is normal, but I would like to have Ultra Sound for pubic area/ or test with scope to check the auxiliary glands. I am afraid of having cancer related case; I have no family history of prostate cancer nor infertility from my father and his father. Only my mother and her mother passed away due to ovarian carcinoma and breast cancer, respectively. What do you suggest doctor before doing the IVF? Note: I have submitted 2 copies of my seminal fluid analysis. Please take a look at them. Thank you

Answered by Dr. Mahesh Koregol (27 minutes later)

Brief Answer:
IUI if not ICSI

Detailed Answer:
Hi,

Seminal fluid colour and consistency does not show the the content, count and motility.

I dont think there could be physical problem considering your age and normal physical examination.

You dont need to worry about cancer as your PSA levels are low.

I have seen seminal fluid analysis attached. The count is in lower range. ICSI would be best option. If not feasible for any reason, IUI is next best bet.

Let me know if you need any more clarification.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Mahesh Koregol (26 minutes later)

Hello Dr. I have a list of questions
1st what is the difference between ICSI and IVF?
2nd do you think IUI is better choice for me according to my test results?
3rd what do you think are major causes for yellow, thick, viscous fluid with chunks (protein aggregation)? UTI? or prostatitis?
4th 6 or 7 years ago my fluid was white, natural and the volume was normal. It was shooting out while now it has no force power. now the fluid only leaks out. do you think I have problems in muscle contraction like I am unable to control the muscles upon ejaculation?
Thank you

Answered by Dr. Mahesh Koregol (21 hours later)

Brief Answer:
ICSI is best option for you

Detailed Answer:
Hi,

I understand your concerns about the fertility.

I am glad to answer your questions:

1) IVF ( In vitro fertilization) is a technique where sperms are left around egg to fertilize by themselves by entering into egg. This method is good if sperm count and motility are normal and sperms are capable enough of entering into egg.

ICSI ( Intracytoplasmic injection) is a process where in sperms are directly injected into egg as sperms may not be able to enter into egg by themselves as in IVF. This method is for couple whose sperm count is low and motility is marginal or low. This is best for any male fertility issues as you are facing.

2) According to spur results , ICSI is best choice looking at your parameters. IUI only if not affordable.

3) Yellow thick viscous fluid needs to be examined as it is difficult to predict the origin. Examination in laboratory is only way out.

4) Muscles of ejaculation are not under your control. Shooting or not shooting of semen is not a measure of fertility. As long as sperm is coming out you are normal and fertile. There is no reason to worry as sperm is coming out. 1ml volume is enough for fertility.

I hope your doubts are cleared.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Mahesh Koregol (9 hours later)

Hello Dr thanks for your reply.

1st..Can you please tell me how could furthur examination be done for the yellow viscous fluid. As I know, hydration has a major effect on the seminal fluid, but it is summer time I cannot drink plenty of fluid. So I already did seminal fluid analysis. Do you think I have to do complex seminal analysis instead of complete?

2nd..Do I need to inform my doctor that I need prostate ultrasound (transrectal ultrasound) to eliminate whether the prostate is the cause or not?

3rd..sometimes I have delay to initiate the urination,sometimes I have urgency to urinate when I want to urinate I have only a little volume to evacuate, and sometimes I have to wake up 2 times during night to urinate. But as long as the DRE was normal so I eliminated prostate enlargement or hypertrophy. According to the urination conditions, I know it is hard to guess, do you think I am suffering from acute or chronic UTI? But I have no fever and my urine sample was normal.
What is the best way to examine if somebody has UTI? What is the best treatment for it and for how long?
Thank you for your efforts

Answered by Dr. Mahesh Koregol (14 hours later)

Brief Answer:
UTI needs to be ruled out

Detailed Answer:
Hi,

1. Hydration has nothing to do with colour of seminal fluid. If you think there is changed colour and clumps, you have to discuss with the XXXXXXX who is testing your semen sample. He can see the clumps and note them in your report scientifically and even the appearance and colour of semen if it is abnormal. They are the best persons to examine and report if they find it abnormal as your report shows no abnormalities you are describing.

2. You can get prostrate ultrasound scan which wont harm you. But these symptoms you have mentioned does not necessarily describe prostatitis.

3. You also seem to have chronic UTI. I suggest you give urine for culture and sensitivity test which will be able to tell about organism responsible for the infection and sensitivity of antibiotics for the same.

Let me know if you need anymore help.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj