Question: Hi Doctor,

I'm 31 years old male and i'm recently diagnosed with Hashimoto's hypothyroidism. Last time, when I had tested for Vitamin D and TPO, they were 21 IU (30-100) and 218 (<35) respectively. My TSH was 5.37 which after synthroid medicine, it came down to normal level. My T4 and T3 are in normal range. I've taking 1000IU vitamin D3 capsule since 2 months(However, I've not retested its level).
Problem is - We have trying to have a baby since 2 yrs but were not sucessful. My wife's blood tests are all normal. I had went for two semen analysis and both of the times, 0 sperms count was found. My Urologist did tested for FSH, LH, Testesteron, Chromosomes etc..everything came normal except FSH. It was quite high i.e. 8.9 ( 1 to 8). These tests were done in XXXXXXX I'm planning to have retest of FSH. My doctor is saying that since my FSH is quite high, I may be having primary testicular failure. After physical exam of my testis, doctor said it seems to be a bit small. Therefore he suggested to go for testicular bioscopy in which embryologist will extract sperms from my testicular and do an IVF with eggs from my wife..

But I am not sure if this is really required now as i am not good at my hormone levels and have high TPO. I've read over many websites that auto immune disease will result in infertility. I'm also having abdomen bloating, gas since 5 months..thinking i may have celiac disease..not sure where should i go and confirm that i dont have this celiac disease..i know that this will also create infertility issues..

I did nutritional test recently and all my vitamins level came normal. IRON, CALCIUM etc looks good.

I would like you to suggest me whether should I go another test or another doctor to confirm if I have really an infertility isse? Should I have one more round of FSH test?

Your inputs are really appreciated.

Thanks,
XXXX

Hi XXXXXXX -

My Urologist just said that it is quite small than its normal size. Recently, I had Chromosome Karyotype test which says " This analysis shows no evidence of clinically significant numerical or structural chromosome abnormalities. The standard cytogenetic methodology utilized in this analysis does not routinely detect subtle rearrangements or low-level mosoicism and cannot detect microdeletions. Also, it cannot detect molecular cytogenetic abnormalities ( such as microdeletions and microduplications) that may be detectable by microarray analysis.".

KARYOTYPE - 46,XY ( 46, XX, or XY)

MetaPhases counted - 20
Metaphases analyzed-5
Metaphase karyotyped - 3
Number of cultures -2
Banding technique - GTW
Banding resolution - 550

Other tests results as follows -

Cholesterol Total - 173 mg/Dl (125-200)
HDL Cholesterol - 32 mg/DL (> OR = 40)- LOW
TRIGLYCERIDES - 94 mg/DL (<150)
Direct LDL - 125 mg/dL (<130)
Glucose - 82 mg/dL ( 65-99)
Urea Nitrogen(BUN) - 9 mg/dL (7-25)
CREATININE - 0.88 mg/dL (0.60-1.35)
Sodium - 140mmoI/L (135-146)
Potassium - 4.1mmol/L (3.5-5.3)
Chloride - 104 mmoI/L (98-110)
Carbon dioxide - 27 mmol/L (19-30)
Protein, Total - 7.4 g/dL (6.1-8.1)
Albumin - 4.5 g/dL (3.6-5.1)
Globulin - 2.9 g/dL (1.9-3.7)
BILIRIBIN, Total - 0.6 mg/dL (0.2-1.2)
AST - 21 U/L (10-40)
ALT - 17 U/L (9-46)

CBC test reports -
WBC count - 5.1 Thousand/uL (3.8-10.8)
RBC count - 6.53 million/uL (4.20-5.80)
Hemoglobin - 13.2 g/dL (13.2-17.1)
Hematocrit - 41.8% (38.5-50.0)
Platelet Count - 167 Thousand/uL (140-400)

Semen Analysis report -
Macroscopic Examination
Volume - 4.1ml
Color - Pale yellow
Sperm count - 0
motility -0
Progressions - 0
Morphology - 0

Thyroid Test reports -

T4, FREE - 1.3 ng/dL (0.8-1.8)
TSH - 2.66 mIU/L (0.40-4.50)
Vitamin D, 25-OH, TOTAL - 21 ng/mL (30-100)
Testosterone, TOTAL, LC/MS/MS - 494 ng/dL (250-110)
Free Testosterone - 72.6 pg/mL (35.0-155.0)

T4, FREE - 1.1 ng/dL(0.8-1.8)
T3, Total - 87 ng/mL(76-181)

Throglobulin Antibodies - <20
Thyroid Peroxidase Antibodies - 218 (<35) HIGH
IRON TOTAL - 95 mcg/dL (45-170)
FERRITIN - 42 ng/mL (20-345)


FSH - 8.9 mIU/mL (1.6-8.0)
LH - 5.4 (2.0-9.3 mIU/mL)
Prolactin - 7.0 ng/mL (2.0-18.0)
Testosterone. Total, Males - 335 ng/dL (241-827)

These are the tests above that I've done so far.

All the test results looks good except FSH, Vitamin D, TPO. I'm not sure if this is the right time or last chance to go for testicular bioscopy. If there are not sperms extracted during this process, it will be really depressing. I would like to know how would I increase the sperm count or semen quality in case if I go for bioscopy so as to increase the sperms count from my testis.

i've heard about SpermHope product to increase the sperm count. I would like to know your advice on this.

Thanks,
XXXX

Hi - Thanks for the reply.

I already had Y Chromosome Microdel test and below is the result -
No Deletion Detected

Interpretation - This individual is negative for deletions in the AZF regions of the Y chromosome. Therefore, infertility in this individual is not likely to be caused by deletions in the AZF regions of the Y chromosome. This result does not rule out other genetic abnormalitites causing male infertility.

After this seeing this test result ( which was ordered by reproductive fertility doc), Urologist has order Karyotype test. I've no genetic problems as we're a big family and had always been.

Please let me know if any further tests that can be done to prove the infertility. Can high FSH level be lowered?

THanks,
XXXX

Sure, I will follow up with my endo on further required tests. However, I had CT scan of my head last month, everything was good. Thank you. XXXX