Post # 1
We just got DH’s SA Back and he has poor morphology (3%). Everything else was ok though concentration and motility on lower side. Concentration 23 M/mL, volume 4.4 mL, total motility 57%. My AMH is low for age (1.64 ng/mL) FSH 8.4. The nurse at RE’s office told us not to be concerned about the morphology but naturally it has me worried and RE has assured me previously that my AMH/FSH has no bearing on me being able to conceive without intervention.
We’re in our early thirties, have a 2 year old from spontaneous pregnancy. Have been TTC since August and NTNP for about 5 months prior to that so going on a year now total. RE is suggesting we can try Clomid + TI if we want but wasn’t pushing us to do to it.
I’m not really sure where to go from here. We’re going to call RE this week as I was not satisfied with nurses answer about morphology not mattering and that most of the people they see have 1-3% (I feel like that may be true for IVF with ICSI but not someone trying to conceive spontaneously). I’m not opposed to Clomid and my insurance doesn’t cover any fertility treatment so this would obviously be a very cheap option compared to something more invasive like IUI or IVF but DH feels like if they’re telling us everything is ok and we don’t absolutely need to do Clomid, then we should just keep trying in our own.
Any insight or shared experiences would be so appreciated! Thanks for reading 🙂
Post # 2
You should post on the February infertility board as there are a lot of people who can give you insight on things like AMH, FSH, etc.
My husband has 2% morphology. I also had ovulation issues so we did IUI (it was covered by insurance for me) although we could have just done letrozole + TI. When all our numbes came back normal except for my husband’s morphology (and my lack of ovulation), I also expressed concern to my RE about the morphology. My RE said it wasn’t a problem. I did end up getting a second opinion on it because after 3 IUIs, I wondered whether I should continue or go to IVF. The second RE was much better and explained that morphology is actually a really subjective assessment. He said that one person in the lab assessing a sample could come up with a totally different % than other person (and some of the people he knew in the lab always gave a low %). His guidance was that we should continue with 6 IUIs and if that doesn’t work, maybe there is actually a morphology issue.
A long-winded explanation, but I guess, in your situation morphology could be an issue since it’s been more than 6 cycles or it also could not because it’s a subjective rating (and might be some of your other numbers). I would ask the ladies on the infertility board about your other numbers.
FWIW, I do think clomid + TI is probably worth a shot don’t want to move directly to something else. Clomid might give you more follicles and increase your odds of getting pregnant. Will your insurance cover monitoring? Sometimes the REs can just code it as diagnostic so it doesn’t come up as “inferility”. I do think the monitoring gives you more insight into what is actually going on (how many follicles you have, are they mature, how thick your lining it) so you can figure out if there is some other issue.
Post # 3
Personally, with low morph and moderately low AMH and trying for a year, I would just move on to trying a couple IUIs if you can afford it. Ours were like $700 each out of pocket. But we were feeling pretty impatient at a year in.
I agree that the nurse’s opinion that low morph is irrelevant, is wrong. It’s not as bad as low counts or you not ovulating or something, but it’s still a hinderance to conceiving.
I don’t anyone who regrets taking more aggressive action on fertility. A lot of people regret waiting. Even when you start fertility treatments, it’s pretty common to still be doing them a year or more later, unfortunately.
Post # 4
thank you! That’s very helpful. I should especially look into whether they could somehow code Clomid monitoring as diagnostic for insurance purposes! I will definitely try posting in infertility board too. Thought that was just for POAS! Thank you for your insight and I hope IUI works for you!
thanks for your advice! That’s sort of how I feel. DH is pretty steadfast in thinking that there isn’t anything wrong other than than that it’s taking a little bit longer this time. His feeling is that in the absence of any of his numbers technically being considered low (other than morphology), I’m overreacting and trying to find a problem when there isn’t one.
Post # 5
Your numbers are similar-ish to my husband and my numbers. What we didn’t know is that my tubes were almost totally blocked as well. We still managed to conceive naturally after close to a year (ectopic) and conceive twins with only one tube (one ectopic one utero) doing IUI after that. So tubes aside, we did not need a lot of intervention. In your shoes, I would try what the doctor suggested or IUI if you are growing impatient. The fact that they didn’t jump to anything more complex for treatment says something, because believe me, that’s where the big dollars are for them.
Post # 6
I just wanted to mention that I think clomid is pretty inexpensive. Though I would be a bit nervous to take it with no monitoring and relatively normal sperm numbers because you could get multiples.
Post # 7
I can’t comment on the morphology but i agree with the previous bee about not doing Clomid unmonitored. It only cost me $30 for two months worth of meds but I had four follicles develop this cycle. I was also on a small amount of gonal-f but the Clomid is mostly responsible for developing that many. I actually had 10 follicles total but only four were mature. due to my age it’s unlikely that I’ll get more than two to stick and I’ve since been diagnosed with another condition, but I wouldn’t want to risk Clomid if you don’t have any known issues. Id either ask for monitoring or ask for femara instead. I only developed one follicle per month on that.
Post # 8
Why did your husband not want to try clomid? Was he concerned about multiples? I believe the risk of multiples is higher clomid vs. letrozole.
Post # 9
that’s helpful to know that you were able to conceive naturally and with IUI under similiar circumstances! And you’re right about the $$ component and that it may be saying more that she’s not recommending anything more invasive at the moment.
@Scarlett11: @piscesinsc: thank you for sharing. Yes would only do Clomid with close monitoring. I guess I was hoping some of the u/s and visits could somehow be covered by insurance but either way, would still do with close monitoring!
it’s not super clear to me tbh. I think from his perspective, unless RE explicitly tells us that she thinks we’d be better off doing some sort of intervention, he thinks we should keep trying on our own for a while. The way RE left it with us at the last visit was along the lines of “if you start getting impatient in a few months and want to try something , let me know”. That was before the SA results so I think it’ll hopefully good to hear from RE directly this week if her opinion on timing and our odds of another natural conception have changed at all with these new results.
Post # 10
My husband had 2% morphology and I think we are very lucky that we concieved on month 6. I think the name of the game with low morph is to make sure you are BDing very diligently for several days leading up to confirmed ovulation. With low morph (as long as there aren’t other issues) most of the sperm are not good at penetrating the egg, so you have to combat that with sheer numbers and hope some of the normal guys are already poised and ready. Sending you so much luck and hoping your BFP is around the corner!