PCOS + Mild MFI? Help with understanding semen analysis results

[lovein17]

I’m trying to understand my husbands semen analysis results. I’ve reached out to male infertility on Reddit about it and got mixed messages on if his results are ok for natural conception or not.

We are ttc going on 5 years with the last 1.5 years being pretty regular menstrual cycles. I have PCOS but started to get it managed with diet change. Before then, I was only getting 1-3 periods per year. I also lost about 50 lbs over 2 years and am now on the edge of a healthy bmi weight. I’ve had 12 periods in the last 1.5 years and in a day or two onto 13.

We have been seeing doctors for almost a year now and an RE over 6 months. We are on letrozole cycle 2 now and I’m about to get my period. I have had RE pre-treatment blood testing and an HSG all coming back normal minus the blood work confirming I have pcos.

My first letrozole cycle was monitored with a trigger shot on 5 mg for 5 days and I grew 2 dominant follicles but the trigger shot failed and I ended up ovulating a few days later. It was a weak ovulation though as my progesterone was low but showed ovulation.

This recent letrozole cycle, cycle 2, was 5 mg for 5 days unmonitored plus 500 mg metformin starting after my period. I ovulated on CD 14/15 and my progesterone on 7/8 dpo was 22 ng/ml. I know pcos can cause a lot more problems than just ovulating but I’m still unclear if we are dealing with possibly mild male factor and if IUI is going to be a much better option for us than timed intercourse.

Here are my husbands semen analysis results:

Volume (ml) = 2.4

Color = Normal

Liquification = Normal

Viscosity = Normal

PH = 8.0

Concentration (x 10[sup]6/ml)[/sup] = 21.5

Motility (%) = 46

Progression = 3-3+

Total Motile Sperm (x 10[sup]6)[/sup] = 23.7

Agglutination = None

Round Cells (x 10[sup]6)[/sup] =

 

[s3anreilly]

@lovein17 Looks like a normal SA.
Here anything above 10mio total motile sperm count is considered normal (but here they only count progressive motility, and I'm not sure what they did here - but generally 20mio TMSC is considered normal elsewhere) and you have >20mio pre wash and >10mio post wash.
Since these are normal values that shouldn't be a barrier to conception.

Weak ovulation isn't really a thing though. And why do you think your trigger shot failed? Because it's normal to ovulate to days after the trigger shot.

 

[lovein17]

@s3anreilly Thanks on the semen analysis review. Do you also mind telling me what his sperm count is? Is it the same as concentration? Is there a math equation to figure it out?

As for the trigger shot, I had an ultrasound on CD 12 that cycle showing two dominant follicles and was told to trigger two days later on CD 14 in the morning. On CD 22, I did a progesterone draw and it was under the amount to confirm ovulation. I had LH surges on CD 15-17, the dates I should have ovulated on at some point from the trigger shot. I usually temp and did so still then and didn’t get a thermal shift though like a usually do so I thought that was strange but knew it didn’t necessarily mean anything either because of the meds. I had begun ovulating around CD 18-21 naturally often so I continued to check my LH then. I also had some body signs of ovulation then as well. On CD 19 I got another positive LH test and it was stronger than CD 15-17 LH positive tests. I mentioned this to my clinic after the CD 22 progesterone test results came in and got another progesterone test done on CD 26 which confirmed I ovulated but the progesterone amount was low at 3.5 ng/ml, enough to show ovulation though. The trigger shot was also almost out of my system by CD 22.

I choose to try an unmonitored cycle for cycle 2 letrozole for a few different reasons but one was the situation with the trigger shot. I advocated to get on metformin and was able to for this cycle 2 and with metformin and letrozole unmonitored, I was able to ovulate without a trigger shot on CD 14/15, I had an LH surge on both days. I don’t get a multiple day surge if I catch the surge testing naturally. My progesterone on 7/8 dpo was great at 22 ng/ml.

I want to do more unmonitored cycles with metformin and letrozole before moving onto IUI but I don’t want to waste time if the semen analysis showed timed intercourse wouldn’t work. At this point, I’m feeling like something other than ovulation is the problem but IVF isn’t in our cards for certain reasons so I’m willing to try as many rounds of ovulation induction as I can and can handle emotionally and a few rounds of IUI if it comes to that.

 

[s3anreilly]

@lovein17 The total count isn't listed, you can calculate that by volume X concentration. Total motile is volume X concentration x motility but that's listed.

I always had a later than usual temp shift with a trigger shot and opk's can turn positive fun the HCG of the trigger shot. You're supposed to ovulate try days after trigger. I would not trust opk's in a modified cycle. How many days after trigger did you get your period?

Progesterone gets secreted in pulses so the value varies a lot from hour to hour. As long as you ovulated and got a corpus luteum there is enough progesterone.

 

[lovein17]

@s3anreilly Thanks. Yes, I was aware about the trigger shot turning positive the OPK and it did do that on CD 15-17 in the morning. It was only up to a little over 1.0 on those days in the morning and wasn’t positive later in the day. It wasn’t positive in the morning on CD 18 but was on CD 19 and was more than it was on CD 15-17. My clinic told me I didn’t ovulate according to my progesterone blood test on CD 22 but my progesterone on CD 26 confirmed I did but later. I was put on progesterone after CD 26 that cycle so I don’t know when I would have gotten a period naturally. I stopped the progesterone on CD 33 as I got a negative pregnancy blood test on CD 32 that cycle. If the trigger shot worked but did later, it would have been 5 days after doing the shot. I know it’s extremely rare for the trigger shot not to work but there are a good few stories out there of it not working. I’ve heard a range of 91-99% effective for the trigger shot.