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Semen analysis show count: 49.3 mill/ml. Is this normal?

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Infertility Specialist
Practicing since : 2000
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Hi, I am 34 yrs old (70.5 kg) married for about 6 yrs. My wife miscarried 4 times (around 13-14 weeks). Recently I did my CASA and following is the report. 1. Abstinence: 5 days, Liquefaction: complete, Appearance: Normal, Viscosity: Normal, Agglutinations: Normal, pH: 7.5, volume: 1.5 ml 2. count: 49.3 mill/ml Motility Analysis ============ 1. Progressive: Fast progressive (25.3%), Slow progressive (42.9%), Non-progressive (22.9%), Immotile (8.8%) 2. Curvilinear Velocity (um/s): Total (35.9), Slow (12.4), Medium (27.5), Rapid (47.4) 3. StraightLine Velocity (um/s): Total (31.2), Slow (8.5), Medium (17.5), Rapid (26.8) 4. AveragePath Velocity (um/s): Total (26.8), Slow (10.6), Medium (21.2), Rapid (34.6) 5. Linearity: Total (59.1), Slow (68%), Medium (63.6%), Rapid (56.5%) 6. Straightness: Total (79.1), Slow (80%), Medium (82.5%), Rapid (77.2%) 7. Wobble: Total (74.8), Slow (85%), Medium (77.1%), Rapid (73.1%) 8. Head Displacement (um) - Total (8.6), Medium progr. (1.3), Rapid progr. (2.0) 9. BeatCross Frequency (Hz) - Total (7.6), Medium progr. (6.8), Rapid progr. (8.2) 10. Hyperactive: 1.4 mill/ml Morphology ========= 1. Normal: 23%, Abnormal: 77% 2. Just one defect: head: 31%, midpiece:4%, tail: 0% 3. multi defect: head + midpiece: 22%, head + tail: 0%, midpiece + tail: 7%, head + mid + tail: 13% I am awaiting semen culture report and DNA Fragmentation Report. I also did my routine blood test. I not diabetic and most reports are normal except for low HDL (37 mg/dl), low MCV (78.6 fl), MCH (24.5 pg), MCHC (31.2 g/dl). RBC was reported high at 5.59 M/ul. I want to understand whether there are any problems with above semen analysis and any medication required. I dont smoke, no alcohol in past 4 years, now physically active. -thanks in advance, XXXXX
Posted Fri, 27 Dec 2013 in Infertility Problem
Answered by Dr. Mahesh Koregol 1 hour later
Brief Answer: Normal Semen Detailed Answer: Hi, Thanks for your query. I have read your query & I understand your concerns. Following is my reply: 1) Your semen analysis is normal and nothing to worry about. 2) Please send me details of 4 abortions. How many weeks pregnancy when aborted? Heart beat of baby was confirmed by scan all 4 times? How abprtion performed by D&C or tablets? I dont think abortions have anything to do with your semen. Please type in more about your wife and her investigations. Also let me know if anyone in your or her family had birth defects I hope I answered your query. I will be available for any followup queries you have. Regards, Dr.Mahesh Koregol IVF & Infertility Specialist
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Follow-up: Semen analysis show count: 49.3 mill/ml. Is this normal? 1 hour later
Thanks for the reply. 1st abortion during 19th week. Baby heartbeat was confirmed. Short cervix was the stated reason for miscarriage. She expelled and doctor did give her cytolog (vaginal). 2nd was chemical pregnancy. 6th week her Beta-HCG values was observed to be dropping. To early for fetal heat beat. She was given cytolog (oral only). 3rd was at 9th week where the fetal heart was missing. She was given mizoprostol (vaginal). 4th was at 14th week. NT scan performed at 13 week was normal. But suddenly she got a blood clot and she expelled. She was given cytolog (vaginal). Diagnosis and medication: 1. 4 years ago, she had high TSH and now in control. She was on eltronix-100 for 3+ years. She is on thyronorm-75 now. 2. She has PCOS but her gyne says not a problem. 3. Recently HSG was performed and found normal. 4. Few days back she has been diagnosed for borderline diabetic and she is on glycephage. (BTW, she was on glycephage for PCOS before her recent miscarriage) 5. She is anemic and her HB is around 10. She is on iron supplement and folic acid. I have also attached my DNA fragmentation report. I forgot to mention the following to the semen analysis: a) PUS cells 6-8 hpf b) Epithelial cells 2-3 hpf c) RBC's 2-3 hpf d) semen culture: No pus cells and no organisms observed (Gram Stain). Culture at the end of 48hrs yields no growth (organism isolated) Family history: 1. To the best of my knowledge both the families have history of miscarriage/abortion. But anyone born does not have any birth defects as such. The following are my queries: 1. Normal morphology of 23% is OK? Need any medication to improve? 2. I take milk/soy whey protein (about 30gms) daily. Will that affect fertility? 3. Can DNA fragmentation cause miscarriage? If so please suggest medication/dosage. Please help. -thanks, XXXXX
Answered by Dr. Mahesh Koregol 8 minutes later
Brief Answer: High Fragmentation Detailed Answer: Hi, 1) Normal morphology 23 % is adequate and not a reason to worry as normal level considered are just more than 4%. 2) Please continue taking whey protein. Its good. 3) Your DNA fragmentation is 86.6% which is very high. Literature mentions chances of infertility and abortion with such high fragmentation. 4) I suggest you repeat this DNA fragmentation from a different standard lab as I presume this report could be wrong since your semen parameters are fine. Just repeat it it different good lab. 5) Your wife also needs to undergo hysteroscopy to check if there is anything in uterus obstructing fetal growth. Regards, Dr. Mahesh Koregol
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