December 30, 2008
1) Semen Analysis 11/2007 indicated
SEMEN VOLUME 1.2L
Sperm Count 0.2L
Total Sperm Count 0.2L
Total Sperm Motility 0.0
Sperm Viability 80%
Sperm Fructose Positive
"Very few sperm noted in concentrated specimen. No motile sperm observed"
2) Urologist lab retest 1/2008
Motility: Less than 10% (low)
Forward Progression: Sluggish
WBC .1 - .2
only rare sluggish motile sperm seen
count 0.6 L
morphology: unable to do morphology because of low count
Testosterone 123 LOW
Urologist basically said my case was beyond his expertise and referred me to endocrinologist
3) Endocrinologist 2/2008 labs
T-3 Uptake 34.1
T07 (FTI) 3.41
SHBG Sex hormone binding glob 22.9
Free Testosterone 13.9
Insulin Like Growth Factor 1 90 (low)
confirmed hypogonadism IGF 1 low suggesting pituitary abnormality
4) MRI results indicated no pituitary abnormality
5) Even though we and explicitly indicated we were trying to have a family, endocrinologist prescribed androgel to treat low testosterone...
6) Endocrinologist lab 5/8/08
not sure what some of these are but just in case
RBC 4.17 low
HGB 13.3 low
HCT 38.0 low
Free Testosterone 50.3
At that point endocrinologist increased androgel dose to 7.5mg
Once we learned of androgel's impact on fertility we immediately discontinued and never returned to this endocrinologist as he never listened to us as to our primary reason for seeing him in the first place
5) Went to reproductive endocrinologist who told us to discontinue androgel and immediately (same day) start taking clomid
I have been taking clomid for over 3 months 1/2 pill a day
6) internist tested testosterone level with regular lab work 8/18/08 now 403
7) retest 11/21/08 now 421
8) while I have not seen this reported, I have had sexual side effects to clomid
a) difficultly maintaining erection
b) difficulty achieving orgasm
c) low sex drive
tested this by stopping clomid for several weeks and side effects went away. I have not read that others get this but making it difficult to achieve desired results.
9) Reproductive endocrinologist did not order new sperm count ever and did not recommend we return (just keep taking clomid) and suggested my side effects may be transitional from shifting from androgel.
10) Intent on not returning to that reproductive endocrinologist, we went to a regular endocrinologist recommended by internist who was very nice and listened to everything but he said that endocrinologists do not treat this sort of thing and never before last week (when the same thing happened) has he had a patient come to him for this - he said to go to a urologist or reproductive endocrinologist.
My wife is 35 and frantic that it is almost too late.
1) My research indicates that either an endocrinologist that specializes in hormonal imbalances or an "Andrologist" which I'm unable to find in my city would be the proper doctor to address my issue.
2) Can you explain in clear english based on lab results I provided what it appears my diagnosis is - I have SOME sperm that have SOME motility, right?
3) Can I go to someplace like a sperm bank to provide lots of samples where they can then freeze and accumulate my sperm to take the low amount of motile sperm and combine it?
4) What is the best kind of dr for me to see. I fear going to reproductive endocrinologist that their training is mostly in female reproductive organs which is why I much prefer urologist or endocrinologist but everyone we go to see we get 'I'm not the right person for this and don't know who is'...further my insurance does not cover infertility/reprod. endocrinologist but DOES seem to at least partially cover urologist/endocrinologist so financially I might save lots of money going to one of those - what are the right questions for me to ask when calling to establish new patient appt to make sure I am calling a doctor with the EXPERIENCE to properly treat me
5) Based on my lab results does it appear that HCG injections have a (high/low) chance of success to achieve pregnancy (my wife's reproductive system has been checked out - she had a small amount of endometriosis which has been removed)
6) Finally, since my FSH is in normal range am I still considered Hypogonadotropic hypogonadism?
I don't know if I'm allowed to mention cities/locations but if so I'm in Dallas TX. Thank you.