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What Does This Semen Analysis Report Indicate?
Question: Hi Doc - we have been trying for last 5 years. I am 38, my wife is 33. All our reports are normal - and having consulted 5 different doctors all of them advise it is unexplained. Couple of IUI cycles failed.
My wifes tubes are clear and she also underwent laproscopy and drilling for PCOD couple of years back. All her blood tests (inc throid, hormone, prolactin) are normal. Ovulation study done multiple times always results in multiple folliclular ovulation.
My semen analysis is as follows - vol 1.8ml, visc normal, liq time 45 mins, ph 8, fructose +ve, total count 60 mil/ml, motility 58%, rapid 30%, medium 20%, slow 8%, static 52%, morphology: normal spermatozoa 14%. Pus cells present, epithelial cells present, rbc absent, bacteria absent
As there is no definite way forward we are being suggested IVF - which I am trying to avoid as it involves injections and may have side effects on my wifes health.
What do you think? Thanks.
My wifes tubes are clear and she also underwent laproscopy and drilling for PCOD couple of years back. All her blood tests (inc throid, hormone, prolactin) are normal. Ovulation study done multiple times always results in multiple folliclular ovulation.
My semen analysis is as follows - vol 1.8ml, visc normal, liq time 45 mins, ph 8, fructose +ve, total count 60 mil/ml, motility 58%, rapid 30%, medium 20%, slow 8%, static 52%, morphology: normal spermatozoa 14%. Pus cells present, epithelial cells present, rbc absent, bacteria absent
As there is no definite way forward we are being suggested IVF - which I am trying to avoid as it involves injections and may have side effects on my wifes health.
What do you think? Thanks.
Brief Answer:
IVF is safe.
Detailed Answer:
Hi, I think IVF is safe. The injections don't have major side effects. Minor side effects like injection site pain can be there. I think in your case, IVF has been suggested due to long duration of infertility. The chance to get pregnant in one cycle of natural trying is 5 to 7 percent. If timed intercourse is done with medicines for ovulation it increases to 7 to 10 percent. The chance to get pregnant in one cycle of IUI, it is 10 to 15 percent. In one cycle of IVF, the chance to get pregnant is 40 to 50 percent. So, you can compare the success rates.I think if you want some time, you can go for 2 to 3 cycles of IUI, because we recommend atleast 3 to 6 cycles of IUI before proceeding to IVF. Discuss with your doctor regarding this. Hope I have answered your question.
Regards
IVF is safe.
Detailed Answer:
Hi, I think IVF is safe. The injections don't have major side effects. Minor side effects like injection site pain can be there. I think in your case, IVF has been suggested due to long duration of infertility. The chance to get pregnant in one cycle of natural trying is 5 to 7 percent. If timed intercourse is done with medicines for ovulation it increases to 7 to 10 percent. The chance to get pregnant in one cycle of IUI, it is 10 to 15 percent. In one cycle of IVF, the chance to get pregnant is 40 to 50 percent. So, you can compare the success rates.I think if you want some time, you can go for 2 to 3 cycles of IUI, because we recommend atleast 3 to 6 cycles of IUI before proceeding to IVF. Discuss with your doctor regarding this. Hope I have answered your question.
Regards
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Thanks Dr XXXXXXX Please also see the attached reports and advise if you see any area that needs to be improved. Currently my doc has put me on Levocarnitine (Carnitor 500) twice daily and LycoRed once at night. My wife is advised Folsafe twice daily. What do you think of these prescriptions - are they inline with the expected result?
Besides the reports attached, my doc has advised further semen reports like: CASA, DFI, HOS and for my wife FSH, LH, Free testesterone, DHEA - What do you think of these prescriptions - are these going to be any useful?
Also, last few ovulation study shows that she always ovulates on 16th day of cycle with 2/3 follicles on each side with endometrium grade between 10 to 11. Is there a way we can still have a possibility on natural pregnancy?
Besides the reports attached, my doc has advised further semen reports like: CASA, DFI, HOS and for my wife FSH, LH, Free testesterone, DHEA - What do you think of these prescriptions - are these going to be any useful?
Also, last few ovulation study shows that she always ovulates on 16th day of cycle with 2/3 follicles on each side with endometrium grade between 10 to 11. Is there a way we can still have a possibility on natural pregnancy?
Brief Answer:
Prescription is fine.
Detailed Answer:
Hi, I think you have been prescribed right medicines. But I think your wife can take metformin and myoinositol also. In pcos patients these have shown some improvements in fertility. Talk to your doctor regarding this. Regarding the tests, CASA is a computer based analysis of semen. DFI and HOS will tell you regarding the quality of semen and also if IVF is needed or ICSI is needed for you. If DFI is high, generally we recommend ICSI. Regarding your wife's test, FSH and LH on day 2 or 3 of cycle is a basic test before IVF. In pcos patients, we do a free testosterone and DHEA to see the level of insulin resistance and the response to the injections can be predicted by these. Now, I have gone through your reports, everything looks fine . Your rapid motility is on a lower side (30%). The cutoff is 32 %. But it is not a major issue because total is 50 percent. In pcod patients, the problem is with ovulation. So, if you want to try naturally, you can plan to do a natural cycle tracking and do repeated ultrasound to see the growth of the follicles starting from day 2 or 3 of periods. If follicle is growing and reaches a size of 17 to 18 mm, you can take injection for rupturing the follicles and be in contact with your wife every 2 to 3 days after her periods stop. Progesterone will be given for next 2 weeks after ovulation. Do a urine pregnancy test at home after that. If follicle grows, you can try naturally. Otherwise, you have to take medicines and can try IUI for few more cycles. Hope I have answered your question.
Regards
Prescription is fine.
Detailed Answer:
Hi, I think you have been prescribed right medicines. But I think your wife can take metformin and myoinositol also. In pcos patients these have shown some improvements in fertility. Talk to your doctor regarding this. Regarding the tests, CASA is a computer based analysis of semen. DFI and HOS will tell you regarding the quality of semen and also if IVF is needed or ICSI is needed for you. If DFI is high, generally we recommend ICSI. Regarding your wife's test, FSH and LH on day 2 or 3 of cycle is a basic test before IVF. In pcos patients, we do a free testosterone and DHEA to see the level of insulin resistance and the response to the injections can be predicted by these. Now, I have gone through your reports, everything looks fine . Your rapid motility is on a lower side (30%). The cutoff is 32 %. But it is not a major issue because total is 50 percent. In pcod patients, the problem is with ovulation. So, if you want to try naturally, you can plan to do a natural cycle tracking and do repeated ultrasound to see the growth of the follicles starting from day 2 or 3 of periods. If follicle is growing and reaches a size of 17 to 18 mm, you can take injection for rupturing the follicles and be in contact with your wife every 2 to 3 days after her periods stop. Progesterone will be given for next 2 weeks after ovulation. Do a urine pregnancy test at home after that. If follicle grows, you can try naturally. Otherwise, you have to take medicines and can try IUI for few more cycles. Hope I have answered your question.
Regards
Above answer was peer-reviewed by :
Dr. Kampana
Thanks again Dr XXXXXXX please see my point wise comments, I invite your comments/advice to below points.
- DFI is available in my city and will get it done. CASA and HOS are not available anywhere in my city (Pune) so not sure
- Metformin and myoinositol = thanks a lot, I will talk to my doctor for these. What dosage do you normally advise for these and any particular day?
- FSH and LH tests are understood thanks. I just found an old (2013) FSH and LH reports which I have attached for your review.
- Insulin resistence - OK, we did insulin resistance report some time back, it is also attached for your review.
- Rapid motility - anyway I can improve on this? I am non smoker/non drinker - any food changes or taking tablet will help for this?
- PCOD/Ovulation - I have attached last few ovulation monitoring reports - every time we had monitored the ovulation had taken place successfully.
- We will again monitor ovulation for few more cycles using sonography. Do LH surge strip help monitor this as well at home?
- Follicle are indeed growing > 18 mm - kindly see the attached last few ovulation monitoring reports. Is rupturing via injections still needed?
- Some of my semen test history is also attached if required.
Again, many thanks. Your advice is very much appreciated.
Do you see the newly attached files in above follow up Q? I had uploaded but somehow dont see it here now.
- DFI is available in my city and will get it done. CASA and HOS are not available anywhere in my city (Pune) so not sure
- Metformin and myoinositol = thanks a lot, I will talk to my doctor for these. What dosage do you normally advise for these and any particular day?
- FSH and LH tests are understood thanks. I just found an old (2013) FSH and LH reports which I have attached for your review.
- Insulin resistence - OK, we did insulin resistance report some time back, it is also attached for your review.
- Rapid motility - anyway I can improve on this? I am non smoker/non drinker - any food changes or taking tablet will help for this?
- PCOD/Ovulation - I have attached last few ovulation monitoring reports - every time we had monitored the ovulation had taken place successfully.
- We will again monitor ovulation for few more cycles using sonography. Do LH surge strip help monitor this as well at home?
- Follicle are indeed growing > 18 mm - kindly see the attached last few ovulation monitoring reports. Is rupturing via injections still needed?
- Some of my semen test history is also attached if required.
Again, many thanks. Your advice is very much appreciated.
Do you see the newly attached files in above follow up Q? I had uploaded but somehow dont see it here now.
Brief Answer:
I have seen the reports. These are fine.
Detailed Answer:
Hi,
I think Metformin can be given 500mg twice a day and myoinositol comes in combination with folic acid and other vitamins, as Ovacare myo. It can be taken once daily or twice daily. Two tablets A and B are there to be taken together once or twice.
But do discuss with your doctor regarding this. Insulin report is fine. Regarding your motility, you can take some antioxidants for 3 months. Also, do a semen culture and sensitivity. Sometimes, infection can lead to low motility. You can take Doxycycline 100 mg twice a day empirically for 10 days. But talk to your doctor regarding this before taking it.
Also, you can take sugarcane juice and flaxseed in your diet. Now regarding the ovulation, your wife is ovulating normally. So, injection is not needed. You can monitor ovulation by LH straps also. Be in contact with your wife every 2 to 3 days after her periods stop. It will increase chances of pregnancy. Your previous semen reports are fine.
Hope I have answered your questions.
Regards
I have seen the reports. These are fine.
Detailed Answer:
Hi,
I think Metformin can be given 500mg twice a day and myoinositol comes in combination with folic acid and other vitamins, as Ovacare myo. It can be taken once daily or twice daily. Two tablets A and B are there to be taken together once or twice.
But do discuss with your doctor regarding this. Insulin report is fine. Regarding your motility, you can take some antioxidants for 3 months. Also, do a semen culture and sensitivity. Sometimes, infection can lead to low motility. You can take Doxycycline 100 mg twice a day empirically for 10 days. But talk to your doctor regarding this before taking it.
Also, you can take sugarcane juice and flaxseed in your diet. Now regarding the ovulation, your wife is ovulating normally. So, injection is not needed. You can monitor ovulation by LH straps also. Be in contact with your wife every 2 to 3 days after her periods stop. It will increase chances of pregnancy. Your previous semen reports are fine.
Hope I have answered your questions.
Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Brief Answer:
It is fine.
Detailed Answer:
Hi, I think it is okay to take ovares plus also. It contains coenzyme Q, some vitamins and N acetyl cysteine which is also found to improve the condition in PCO. Metformin is not needed always. Also your wife is ovulating normally, so these medicines will not help much as she is having normal cycles. if she had not been ovulating normally, then metformin and myoinositol would have helped a lot. Hope I have answered your question.
Regards
It is fine.
Detailed Answer:
Hi, I think it is okay to take ovares plus also. It contains coenzyme Q, some vitamins and N acetyl cysteine which is also found to improve the condition in PCO. Metformin is not needed always. Also your wife is ovulating normally, so these medicines will not help much as she is having normal cycles. if she had not been ovulating normally, then metformin and myoinositol would have helped a lot. Hope I have answered your question.
Regards
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thanks for your response. She has now started Ovares Plus. I will do DFI tomorrow, and she will do FSH, LH, Free testesterone, DHEA as advised by my doctor.
I read somewhere that FSH and LH are typically done on Day 3 of the cycle but our doctor has not advise of any such criteria and so it will not be the case when we do her tests tomorrow. Is that OK - or is the criteria important to be followed for accurate results? Thanks.
I read somewhere that FSH and LH are typically done on Day 3 of the cycle but our doctor has not advise of any such criteria and so it will not be the case when we do her tests tomorrow. Is that OK - or is the criteria important to be followed for accurate results? Thanks.
Brief Answer:
FSH and LH should be done on day 2 or 3 of the cycle.
Detailed Answer:
Hi, FSH and LH should be done on day 2 or 3 of the cycle, otherwise reports will not be of significance. Testosterone and DHEA can be done any day. Hope I have answered your question.
FSH and LH should be done on day 2 or 3 of the cycle.
Detailed Answer:
Hi, FSH and LH should be done on day 2 or 3 of the cycle, otherwise reports will not be of significance. Testosterone and DHEA can be done any day. Hope I have answered your question.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
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