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Semen analysis

Resolved Question:

my husband semen analysis before 4 months before ( varicocele repair )

merhod of collection : masturbation
Physical examination
Volume : 2.2 ml
Ph : 7.8
Colour : grey - white
Viscosity : normal
Liquefaction : complete within 120 minutes

Microscopy examination :
Spermatogenic cells : 6-8 /HPF
Pus cell : occaional / HPF
Viabillity test : yellow eosin stain
Sperm concentration : 15400000 / ml
Total count / ejaculate : 33880000

Motilty

Linear progressive
high active 20%
Active 5%

Non progressive
Sluggish : 23%

Morphology
Normal : 4%
P in head : 16%
Abn . Head : 51%
Abn. Mid piece : 11%
Mixed abnormality : 17%
Sedimented cellular elemnts
Spermatocytes : +++
Spermatides : +++++


and this is after 4 months of varicocele repair

Sexual abstinence : 3 days
Physical examination
Volume : 2.9 ml
Ph : 8
Colour : grey - white
Viscosity : normal
Liquefaction : complete within 90 minutes ( normal 30 min ) ????

Microscopy examination :
Spermatogenic cells : 0-1 /HPF
Pus cell : 0-1 / HPF
Viabillity test : yellow eosin stain
Sperm concentration : 86500000 / ml

Total count / ejaculate : 250 mil

Motilty :
Linear progressive
high active 0%
Active 40%
non linear 3%

Non progressive
Sluggish : 2%

Morphology

Normal : 23%
P in head : 14%
Abn . Head : 47%
Abn. Mid piece : 15%
Mixed abnormality : 1%
Sedimented cellular elemnts
neutrophilis few
Spermatocytes : +
Spermatides : ++

fsh 7.9 mlU/ml
lh 4.3 mlU/ml
testosterone 17.18 nmol/l
prolactine 8 ng/ml
tsh 1.3 mlU/l



his urine culture shows

sensitivity to augmantin and amoxilline but dr said this is not important ( but i think he should take augmantin for week ?


why is liquification time long ? give us treatment please ?
our dr not help us just say go for ivf

also i want to understand changes in ( spermatogenic cells , spermatocytes , spermatides ) before varicocele repair and after is this good or bad ?
can you advice us whith his condition and treatment


about me
i have endometriosis grade 1-2 which cause tubal adhesion , i did laproscopy and remove endometriosis tisssue by laser , open both tubal ( positive dye test )
i have pcos , did ovarian drilling , after lap i took decapeptyl for 3 months
my weight normal and i am taking metformin ,
i have MTHFR c677t hetrozygout mutation ( dr said i shouldnt have naturally pregnanyt - ivf - as this mutation mean baby will have down syndrome , Is that true ?

i went to another dr , he did lab tests
prolactin 10
tsh 1.3
fsh 1.5
lh 0.1
e2 15
amh 7.5 ( little high ? )
dr told me that ( fsh,lh,e2 ) low due to decapeptyl 11.25 ( i took it 130 days ago ) this dr told me that i can have normal baby naturally and give me for 3 months
clomid 50 twice a day day 3 to 7
estradiol 2 mg twice a day day 8 to 15
duphastone day 16 to 25

he told me that i can start this stimulation even my ( fsh,lh,e2 ) low
i got pregnant once naturally after 11 month of marriage which ended with misscarrige , i am trying now for year to be pregnant but no positive

please tell me about my husband semen analysis and liquification time ? and his urine culture which show sensitivity to antibiotics ?

what about me ? is that truth that if i got pregnant naturally my baby will have down syndrome due to MTHFR c677t hetrozygout mutation ? i am taking folic acid 5 mg + baby aspirin + vit B complex

please inform me


Category: Infertility Specialist

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Category: Infertility Specialist
Dr. Aarti Vazirani is online now

Expert:  Dr. Aarti Vazirani replied 4 Days.

Hello
Thanks for writing to DoctorSpring.com with your health concern,
1. Liquefaction time is increased when semen is hyperviscous. It can be due to infection, or due to deficiency of accessory enzymes made by the prostate.
Yes, he should take a course of antibiotics, that will improve this factor.
2. Spermatids and spermatocytes are immature forms of sperms, the more these are in number, it is worse for conception. After varicocele repair, even this has improved. The number of immature sperm forms has decreased, which is an improvement.
3. You are heterozygous for MHTFR mutation, there is 50 % chance of having a normal baby if your husband is negative for the mutation, only that your chances of having a miscarriage and preterm labour are higher than normal. This can be minimized by taking aspirin and heparin during pregnancy also.
4. There is no association between this mutation and Down's syndrome.
5. IVF seems to be the next step as 3 cycles of Clomid have failed.
6. You can try 3 more cycles of Clomid with IUI in conjunction, before going for IVF.
All the best.
please feel free to discuss further.


Patient replied :

thanks for your reply


1/ what you mean by ( i have 50 % chance of having a normal baby ) do you mean this heterozygous for MHTFR mutation, can lead to abnormal baby ?


2/ my dr oprescribe for me for 3 months
clomid 50 twice a day day 3 to 7
estradiol 2 mg twice a day day 8 to 15
duphastone day 16 to 25
starting this month ,
but i am afraid that my endometriosis come back again very fast ? what do you think ?


3/ is my husband recent semen analysis good or not for naturall pregnant ?


4/ Is prolonged liquification time a problem ?
please can you tell me what medicines he can take ? in my country we can take medicines without prescriptions so please prescribe for him medicines to improve his semen ?


5/ do you think drugs like bisolvon can help with liquification time ?
do you think that urine culture which show senesitivity to ( amoxilline and augmantine ) cause semen problems ?

6/ i tried iui twice , but my dr cancell it before obulation because he said ( i have pcos with small stimulation drugs many follicles growth up ) Is that really problem ?


thanks alot


Expert:  Dr. Aarti Vazirani replied 3 Days.

Thanks for the follow-up.

1. You have a 50 % chance of passing on this mutation to the baby. The baby would be completely normal otherwise, as this mutation causes no serious health effect. By no means is this mutation associated with Downs syndrome
2. Yes, endometriosis can recur very fast, it is better to opt for the next step fast , instead of wasting time.
3. Husband semen analysis is good enough, however if you waste time in trying naturally, endometriosis might recur.
4. Prolonged liquefaction is not a major problem. A course of antibiotics ( augmentin ) should be tried.
5. Yes, they can help, but it is not a major issue, as his count is normal.
6. Yes, PCOS have higher risk of hyperstimulation with injections and drugs, and they often fail to respond to lower dosage. Ask him to try 1 - 2 more cycles of IUI with antagonist protocol also.

Regards


Patient replied :

thank you dr ,
please tell me about my mutation more ,

1/ if i got naturally pregnant and my mutation passes to my baby ? what it will cause for baby ? i am really thinking about it ? i dont understand what do you mean in you snswer , please tell me the truth , i want to be sure that i will have health one , or if not i will not try naturally , since my dr told me that my mutation may lead to down syndrom baby i cant stop thinking

2/ if we go for ICSI do you advice us for Pre implantstion diagnosis due to my mutation ? , it is more expensive for us but if we need it we will do it ,

thank you , i dont have another trusted dr to ask


Expert:  Dr. Aarti Vazirani replied 2 Days.

Thank you for your trust and faith. I am honoured and really happy to be of some help for you.

Now, this is a difference in the gene, that is present in some populations.
It is not even a mutation, but just a difference seen in certain races and populations.
IT causes no serious health effects.
I would not advice you to go for PGD at all.
THere is a 25 % chance that your baby might inherit this mutation, and he / she would be as healthy as you are, and in no way abnormal.

So please do not worry.
To further reassure yourself, please consult a Genetic Counsellor and have complete discussion from the genetic point of view.


Patient replied :

thanks alot , the medicine in my country very bad , as they told me this will lead to down syndrome and they make me crying and hopeless

my last question / how can i know if my endometriosis come back ? should i do laproscopy or tubal dye test ? or what ?


Expert:  Dr. Aarti Vazirani replied 1 Day.

You do not need a repeat laparoscopy just to diagnose that the endometriosis is flaring up again.
You can clinically diagnose it.
Your symptoms would come back - such as painful periods, pain during intercourse, painful bowel movements, irregular menstrual spotting etc.
In fact, why wait for it to come back ?
Pregnancy is the best cure for endometriosis.
Please go for active fertility treatment.
Also, stop worrying about the MHTFR mutation.
Wishing you success in your efforts and good health always.


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
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