[anilorak13ska]

...is that possible? I've been reading around about the biopsy step (which was our next step after azoospermia diagnosis, normal hormone levels) and it seems that if sperm are found during a biopsy, the next step is some sort of assisted reproductive technology... is this automatically the case?

I don't want to do sperm donation, nor do I want to do IVF or other "office conception" type situations. I had assumed this after our diagnosis early last year, and we have been actively pursuing adoption for over a year now. However, I wonder if we didn't jump too quickly.

If there is the possibility of conceiving naturally (the old fashioned way!) depending on what the biopsy reveals, then I'd like to return to that. And only bc we have not been terribly successful (yet) on our adoption journey, and I wonder if it's bc the child meant for us is meant to be born to us afterall. I am at peace with adoption, have been since before we even got our diagnosis, but I wonder if we've done everything naturally possible or not.

If anyone has been able to conceive... shall we say, in the comfort and privacy of your own home... after a biopsy and subsequent treatment of some kind, PLEASE chime in and let me know!

I don't want to get my hopes up on yet another route if the end result is necessarily IVF or something similar, as I already know I won't go that route.

Thank you!!!!!
Karolina

[tygerlilly]

I know that it did not work for my husband and I. Now if they find any sperm in his biopsy you will have to have IVF done.

[anilorak13ska]

Maybe I should go back a step and ask a more obvious question - what exactly is involved with IVF and what is it like undergoing the procedure?

What little I know of it doesn't sound at all pleasant for me, the woman, with a low threshold for pain.

Am I right?

(Never mind that our insurance would not cover a dime)

[HopefulinCO]

To answer the first question, I don't think we can ever say never but the chance of conception "naturally" with azoospermia is really pretty low. The fact that they were able to find sperm on biopsy means that there is some being made, so there is a chance of conceiving a biologic child through assisted technologies. And again, it's always fun to try the old-fashioned way! The other question to ask your or DH's doc is how the cancer treatment will affect his fertility. If he has to do chemo, that may also worsen your chances of conception

As for what IVF is like, it's not nearly so bad physically as you might think. I think all the REs are a little different, but I had to have bloodwork and a saline contrast ultrasound (they inject saline into your uterus through a tube they put through your cervix and look at the uterus through the ultrasound) first. Then I started on OCPs and was on them for maybe a month or more (I think this is all on my sig because I can't remember the exact length of time for all these meds). Then I had a baseline ultrasound to be sure I could start my injectible meds. I was on Lupron (an ovulation suppressor) for about 2 weeks, then added the stimulant medications (also injectible). They do periodic ultrasounds and bloodwork (once every day or two) during that phase to see how you're progressing and adjust your medication doses accordingly. When the follicles containing the eggs are getting to around the right size, they'll have you do an HCG injection, which gets the follicles to mature and eventually release their eggs. However, with IVF since they're collecting the eggs, they don't want your follicles to release them and instead will put you under anesthesia and use a needle through your uterus to withdraw all the eggs from the follicles. With a situation like yours they would probably do ICSI, where DH's sperm (presumably obtained by another biopsy) would be directly injected into your eggs. Then they grow them in the lab for 2-5 days before they transfer them back to your uterus (through a small catheter through your cervix). Mosst RE's will have you on progesterone to support the pregnancy after the embryos are transferred back - that's either a vaginal suppository or a daily shot. Then you wait for 2 weeks and take a pregnancy test.

The hardest part I think is the emotional part - you invest so much time and energy and money and desire into the process that it's pretty stressful. The sub-q injections, which for me were the Lupron and the stimulants, weren't really painful at all, though one of my stimulants burned a little going in. The intramuscular shots, for me the HCG and the progesterone, were only tough toward the end. I was on progesterone for about 8 weeks total and by the end of the 8 weeks my behind was a bit bruised.

I'm not sure what you've been going through with adoption, but that's my IVF story. I was lucky in that it worked the first time, so I'm pretty positive about it. I think it's a very personal decision and you should definitely talk to your RE, particularly with your specific situation because a lot more may be involved in terms of retrieving the sperm. Good luck whatever you decide!

[Kelbell]

The biopsy or TESE is not a treatment for azoospermia, often times men with azoospermia have sperm in their testes, but for various reasons it is not present in their ejaculate. It all depends on your husband's etiology, like whether he has absence of the vas deferens, or if he possibly has sertoli-only cell like syndrome, varicocole, etc. It sounds like you both should really go sit down and talk with a reproductive endocrinologist who will be able to fully educate you on your options and what all the procedures are and what they cost. And speaking of cost, if that is something you are worried about, it should be noted that adoption is often MORE expensive than an IVF cycle (not that I am discouraging adoption, it is a wonderful thing and is something I would never rule out).

[anilorak13ska]

Originally Posted by Kelbell

The biopsy or TESE is not a treatment for azoospermia, often times men with azoospermia have sperm in their testes, but for various reasons it is not present in their ejaculate. It all depends on your husband's etiology, like whether he has absence of the vas deferens, or if he possibly has sertoli-only cell like syndrome, varicocole, etc. It sounds like you both should really go sit down and talk with a reproductive endocrinologist who will be able to fully educate you on your options and what all the procedures are and what they cost. And speaking of cost, if that is something you are worried about, it should be noted that adoption is often MORE expensive than an IVF cycle (not that I am discouraging adoption, it is a wonderful thing and is something I would never rule out).

Well, adoption being more expensive than one IVF cycle doesn't really make me feel any better, bc I know it's not as easy as one IVF cycle = success. One of the reasons we went with adoption over IVF (assuming that's our only other option) is bc w/ adoption, a baby is guaranteed at the end (though we don't know when that will be), whereas with IVF, it isn't.

And I certainly now realize that though I had the best intentions going into adoption, I'm really very selfish about the whole thing. I thought I'd be somehow helping a child by adopting, but the adoption route we've been pursuing is not all that noble at all - if we find a bmom wanting to place with us, sooooo many others would also give that child a loving home if we didn't. We're not open to older or special needs kids, nor can we afford int'l adoption.

So our intentions were good, but the reality is, we won't be any more noble if we adopt than if we don't. Another reason I'm revisiting our fertility. I no longer feel selfish for doing so.

[Kelbell]

of course you shouldn't feel selfish...its only natural to want to have your own biological children...don't lose faith yet...find out your husbands diagnosis and see what your options are. There are certain azoospermic conditions that are treatable. Definately go talk with your doctor before making decisions that you can't necessarily make at this point.

[anilorak13ska]

Isn't surgery a possibility depending on what the problem is? Like if there is an obstruction that can be corrected....?

[Kelbell]

karolina,
Yes surgery is a possibility depending on what his diagnosis is. If it is an obstruction, like a varicocole, it could possibly be fixed and you may be able to concieve naturally later on. What did your doctor say about your husband's bloodwork? That can sometimes be an indication of what is going on, depending on the FSH, testosterone, and sometimes prolactin levels. Did your doctor order a urinalysis to check for sperm in the urine to make sure he's not retroejaculating? These are just questions to ask the urologist to make sure he's covering all his/her bases, especially if he is not a fertility expert, and if he is not, please go to a reproductive endocrinologist who can refer you to a urologist who is! We are lucky to have an RE and a urologist that work pretty much as a team, so coordinating between the two has been really easy.

A website that is an excellent source of information is Male Infertility - Cornell University - Center for Male Reproductive Medicine & Microsurgery
And from what I hear on this forum, Cornell is really the leading medical center in the country on male infertility, so this is up to date and correct info.

[anilorak13ska]

Kelbell,

Thanks for your feedback. DH did have all his bloodwork done, checks for FSH & LH, sonogram/ultrasound, etc. - all his hormones/bloodwork seems to be in order. We expect that the urinalisis will be next, though DH wants to insist on a biopsy (?) to check to see if the swimmers are in there.

Thanks also for the link. I'm checking it out next. Another week before the UR apt.... thanks for the suggestions as to what to ask...open to further suggestions.

Karolina

[Kelbell]

Karolina,
That's good that his blood work is normal...my husband's was normal with the exception of a normal/high FSH, and my RE was very optimistic about finding sperm with my husband...and we did.
Are you starting to think about IVF as an option or still pretty against it?
I'm starting my first cycle in two weeks and I am TERRIFIED but I know its our only option
I really hope that it works out for you guys and it ends up being something correctible!
Keep us posted

[anilorak13ska]

Kelbell,

We went to ur apt, but were told we had to meet with a specialist (I couldn've told them that!) They didn't charge us for the visit, but we're now waiting for the specialist (who's moving practices) to call to schedule a mtg with him. Expecting call this week.

Meanwhile, is here. Still, miracle is possible. I'm still very against IVF, but I would do IUI. Ur said using testicular sperm is possible for IUI depending on the individual situation.

Also meanwhile, we may have gotten an adoption lead... waiting to see if bmom calls back. She's due within the next 2 months.

One way or another, I just know a baby's coming!

Major and for your first IVF! I hope it's all it takes for you guys!

Karolina

[Kelbell]

Karolina -Thanks I hope its all it takes also! But who knows, I am trying to be realistic about the odds.

Thats fantastic about the adoption lead though! I will be for you; one way or another you will get your baby!!!

[SFBaygirl]

Hopefully this is not the case for you but IUI after an azoo diagnosis is not too likely unless the cause is a blockage (obstructive azoo). If the blockage can be removed then you have more options.

With non-obstructive azoo if sperm are found at all with a TESE or mTESE then they are usually way too few so IVF/ICSI is needed. From what I understand it takes at least 10 million sperm with good motility to do IUI.

If you haven't already checked out the 500+ page azoo thread on the male factor infertility page I highly recommend it

[anilorak13ska]

Well, all dh's blood tests show no probs w/ hormones, so we're thinking it's a blockage of some sort (best case scenario).

So the TESE that I'm reading about is for non-obstructive azoo?

At last apt, we were told the next step was a testicular biopsy, and that the assumed cause is obstructive azoo. But we'll have to get clarification from the spec. I hate speculating right now.