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Planning for baby. Semen report was not satisfactory. Taking furtisure. Can opt for IUI after after improvement of sperm quality?

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Infertility Specialist
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We are married for 7.5 years and have no kid. My age is 37 Y 9 M and my wife’s age is 37 Y. We have no past history of abortion or miscarriage.

We are trying for pregnancy (in between 11 to 18th day of a normal 28 day cycle) since last 2.5 yrs under medical guidance.

We both went through few tests and (1 to 5) seems normal except first semen test.
1) Semen Analysis (two times 23.03.12 & 22.01.13)

Primarily my semen report was not satisfactory. (Test done on 23.03.12)

pH 7.7
Total Sperm Concentration 40 millions/ml
Percentage Progressive Motility 38%
Percentage Sluggish Motility 12%
Percentage Normal Morphology 25%
Total Functional Sperm Concentration 5.9 millions/ml
Motile Sperm Concentration is 15.2 millions/ml
Sperm Motility Index 106

After taking furtisure M from 28.03.12 for 3 months my sperm reports (Test done on 22.01.13) came satisfactory

pH 7.7
Total Sperm Concentration 67 millions/ml
Percentage Progressive Motility 47%
Percentage Sluggish Motility 20%
Percentage Normal Morphology 32%
Total Functional Sperm Concentration 16 millions/ml
Motile Sperm Concentration is 31.4 millions/ml
Sperm Motility Index 180


2) Thyroid Profile T3/T4/TSH / Prolactin / Serum Insulation Fasting Test (19.03.2012) – Report OK

3) Blood Glucose Fasting (19.03.2012) - Report OK

4) USG Test of Lower Abdomen (24.03.2012) - Report OK

5) Urine Analysis (19.03.2012) - Report OK

5) Folliculometry (31.07.2013 - Ovulation Normal , D-14, Right Overy)

6) My wife went through HSG test 09.09.2013. It shows that left Fallopian tube is blocked.

Now my queries are as follows

1)     Do you think my sperm reports are satisfactory or more improvement is required?
a.     If yes then should I take Furtisure M (one doctor prescribed 1 yr back) / Q-Gold + Spemen (other doctor prescribed 1 yr back) or any other for 2 more months?
b.     If you think second sperm report is ok and ovulation is normal from right ovary then what may be the reason as we are trying for 30 long months?
2)     Woman ovulation : One month from left one month from right or more from right
3)     IVF treatment is very much expensive here in Kolkata so we are trying for some alternatives. Can we go for IUI after improve quality of sperms with the help of medication?


Thanks and Regards
Husband : XXXXX (Age : 37Y 8M)
Wife : (Age : 36Y 11M)
Posted Wed, 16 Oct 2013 in Infertility Problem
 
 
Answered by Dr. Dattaprasad 42 minutes later
Brief Answer:
Active treatment required.

Detailed Answer:
Hi,
Welcome to XXXXXXX

In your case, semen appears fine. You can continue the medicines prescribed by your doctor.

When everything is normal (semen, ovulation & tubes), the case is labelled as unexplained fertility. In such case cause can be at microscopic level which can't be investigated OR it may be due to reduced fertility (commonly in female with reduced ovarian reserve in advanced age).

In your case major problems are: one blocked tube, wife's age & prolonged duration (30 months) of infertility. After 35 years of age, female fertility starts declining, also with prolonged duration of infertility, prognosis of conception worsens.

You need active treatment in the form of superovulation with IUI. For superovulation, its better to use Inj FSH to improve chance of pregnancy. Though its little costly treatment (costing between Rs 10,000 to 30,000/- depending on the brand of injection used), it will give better chance of pregnancy. IUI alone will not give any benefit.

Before going for further treatment, wife should undergo laparoscopy in a center where expertise for clearing tubal blockage is available. Looking at wife's HSG report, it appears that block can be cleared. Clearing block before IUI will give better chance of pregnancy.

Also don't go on taking ovulation induction tablets (Ovofar) & follicular studies, as its not increasing chance of pregnancy.

If pregnancy is not achieved in 3-4 cycles, you may need IVF.

Let me know if you have other queries.

Regards.


Above answer was peer-reviewed by
 
Follow-up: Planning for baby. Semen report was not satisfactory. Taking furtisure. Can opt for IUI after after improvement of sperm quality? 17 hours later
Thanks for your reply.

We are under medical guidance of following doctors for a given time period

Dr. XXXXXXX Bhowmick (27.08.2010 to 25.03.2012) (Medicine not taken) (Tests are done)

Dr. Debranjan XXXXXXX (28.03.2012 to 24.06.2013) (Medicine taken for given time period)

Dr. XXXXXXX Khetan (02.07.2013 to 10.09.2013) (Medicine taken for given time period)

Dr. XXXXXXX Khetan our last consultant referred us to a infertility clinic for IUI or IVF or ICSI treatment after gone through Folliculometry and HSG.

So presently we are not under any doctor.

As my last semen test done on 22.01.13 after taking Furtisure M for 3 months from 28.03.12

Q1.
Personally I feel that my fluid contains sperms has reduced presently. Should I take Furtisure M(As prescribed by Dr. D XXXXXXX already taken for 3 months) or Q-Gold+Spemen (As Prescribed by R Bhowmick, not taken) one more time for next two months? Has it any adverse effect on my body? Do you feel that I can take those medicine after diagnosis of present sperm condition?

Q2.
Do we have any facility to reopen blocked Fallopian tube through re-canalization or HSG with selective salpingography other than normal laparoscopy in Kolkata or India?

Q3.
Is FSH injection mandatory in IUI treatment?

Q4.
Can you share any good reliable affordable infertility clinic or doctor in Kolkata where mediocre person like us can continue the treatment?
 
 
Answered by Dr. Dattaprasad 4 hours later
Brief Answer:
Repeat semen analysis.

Detailed Answer:
Hi,
Welcome back.
Following are the answers to your queries.
Answer 1: Sperm concentration in semen is not predictable by its thickness/consistency. The medicines prescribed to you are basically nutritional supplements/vitamins/antioxidants. You can do one semen analysis before starting any medicines & if its fine, you may not need medicines.
Answer 2: Such kind of facilities are available all over India, even in small towns. So it should be available in Kolkata. You can consult your local physician for further guidance.
Answer 3: FSH injection will help in multifollicular ovulation & increase chance of pregnancy. If you don't take injections, only single follicle will form & the chance of pregnancy will be same to one without treatment.
Answer 4: Following is a good reliable infertility clinic, but regarding affordability, you have to decide.
Institute of Reproductive Medicine (Dr. Baidyanath Chakraborty)
DD/18/5/1 Sec-1, Saltlake, Calcutta-0000

Hope I have made the point clear.

Let me know if you have other concerns.

Regards.
Above answer was peer-reviewed by
 
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