Change of plans?

Miles went in to get another Kruger (semen analysis) done a couple weeks ago. I got the results back last week. They were as follows:

Normal Miles

Volume > 2 ml 3.7 ml

Concentration 20 million per ml 31 million per ml

Total count 40 million+ 114.7 million

Progression 2.5 2

Motility > 50% 38%

Total Motil count 20 million 43.59 million

Kruger morphology 15% 13%

Although I don't remember exactly what his numbers were last time (and don't feel like looking for the records), I know that they were not concerned about the numbers involving count (volume, concentration, total count) but were more concerned about motility/movement (motility, total motil count and progression) and the morphology (Kruger). It was because both of those were lower than normal that we did IVF with ICSI (Intra Cytoplasmic Sperm Injection) last time. When we met with the doctor in May to discuss moving ahead with a second round of IVF, he stated that we should do another Kruger to see if anything had changed enough that we wouldn't need to do ICSI. (ICSI is where they take the egg and inject the sperm inside for fertilization rather than allowing the sperm to do it on their own).

After the nurse read the results to me, I specifically thought that the Kruger didn't sound that far from normal and wondered what his previous results were. She looked it up and said, "Wow. It was 3% last time. That's a big improvement. Did he do anything special to make such a big change?" The only thing that we could think was that the last time he was tested, he had been in school and had a laptop on his lap all day everyday for over a year. Recently, he has also been holding his phone in his shirt pocket rather than his pants pocket, but I'm not sure whether or not that actually makes a difference. However, the lack of heat on his lap for the past two years certainly could have. So I asked her what that meant and whether or not we would be able to do IVF without ICSI or even consider something like IUI (intrauterine insemination), which would be so much cheaper. She said she would ask the lab and doctor about it and get back to me.

A couple days later I heard from a different nurse who left a message on my phone. She said that the lab was still suggesting ICSI, but that the doctor she reviewed it with was still debating that. And that it might be adequate for insemination attempts. So I was very confused to say the least. It seems like if the lab is suggesting ICSI, that means they are saying that not only should we do IVF, but that if we do, we still need to do the highest level of fertility treatment by doing ICSI. BUT it could be adequate for insemination? Huh?

I called back and left another message asking for clarification. I spoke with a different nurse the next week and she agreed with me that it was confusing and was also curious about where to go from here, as she had never seen that much of an improvement in someone's morphology before. So she did some research and talked with their andrology specialists and with our doctor, Dr. Heiner. She called me back a couple days later and said that the lab is suggesting ICSI because, "Once ICSI, always ICSI." She said that they feel if it was successful one time, then you shouldn't take chances on not doing it and ending up with potentially 0% fertilization. She said that they also take into account not just the Kruger, but also the motility. And Miles's progression (the direction the sperm are swimming in, not just that they are moving and possibly going in circles) was lower than normal. However, it could be possible to do IUI, but the "take home baby" rates are a lot lower (about 15% as opposed to 50-55% with IVF) and it may take multiple tries to be successful, if successful at all. SO...she basically stated that we should meet with our doctor to discuss our options and decide together what we would like to pursue.

We have an appointment set up with Dr. Heiner this afternoon. But I thought I'd go ahead and document our recent "adventures" in infertility so that I can remember all the fun roller coaster rides we get to go on throughout this process. I was pretty hopeful at one point that IUI could be our next step and we could potentially save a lot of money and not have to worry about saving so much money for each subsequent child. But at this point, I think Miles and I are resigned to the fact that IVF will likely be our best option and give us the best odds. I guess we'll see after our appointment today.