Questioning Referral to IVF
Question
Hi– my question relates to sperm motility. My total motile count is 26.5 million (Volume 2.6 mL x Sperm count 34 million per mL x %motility .30). In a second test, unfortunately taken after a night of only two hrs. sleep and high stress, apparently all sperm were dead and this has left my wife and me in a blind panic. Coupled with the doctor’s comments on these two results that I would never father children and that the only answer is IVF in his clinic or adoption, stress levels further escalated. A second opinion would help. I think I am fine, my wife thinks she is fine – we think she has miscarried the last two months, but it is hard to go against opinion of a medical professional. I think the stress of worrying about all of this could have a negative effect on my motility and our objective overall. Can you help?
Answer
Last Updated: December 28, 2014
Comment: If this is indeed what has transpired the physician advising Jason is very much “non-mainstream”.
The lower limit of fertility is thought to be a sperm count of 20 million/cc, and some NFP folks claim successful pregnancies with a count in the sub-10 million range. Motility will vary with the technique of sperm collection since the sperm stop moving when cooled, so I do not know how to assess this particular bit of information. Stress can hurt sperm directly or indirectly by inducing prostatitis (prostatic inflammation) which adds inflammatory cells to the ejaculate and interferes with sperm function.
What would I do in this situation?
First, I would examine Jason’s urine, prostate, and prostate fluid to see if prostatitis is present. If it is I would treat it intensively for six weeks and then repeat the semen analysis using a medical collection condom technique (a special sterile condom containing no chemicals is perforated with a tiny 31 gauge needle so it is still “open to life”; the couple has marital relations with the condom in place; it is removed, sealed with a twist tie, placed in a zip lock plastic envelope, and immediately brought to the lab within 30 minutes, kept at body temperature by placing the envelope in the shirt pocket). If these are not available from your physician, you can obtain them from CANFP. Remember that the highest sperm counts occur after three days of abstinence and no longer than 10-14 days of abstinence.
Second, if the semen analysis shows a count greater than 20 million/cc I would use NFP technique to optimize the timing of intercourse. Should the couple have relations daily at this time? This is a bit problematic with a low count that would be lowered even more by daily ejaculation. Sperm can survive for 1-2 days in the female reproductive tract, so intercourse every other day would seem to be a reasonable compromise. AN NFP teacher would help the couple identify the optimal timing.
Third, I would use the only non-prescription nutrient that has been demonstrated to help both sperm counts and quality (the amino acid, L-carnitine, available as ProXeed at www.proxeed.com). I would also continue to treat the prostatitis, if it was present, until pregnancy occurs.
Dr. Gregory Polito
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