Sperm: Fresh vs. Frozen

I have a fertility app on my phone called iPeriod. Before we found out Mr.E had zero sperm I was using it to track LH surges, morning basal body temperature, pregnancy tests, etc. Now I mostly just use it to track my period.

Anyway, I was looking at it several weeks ago and realized that Mr.E’s mTESE is scheduled for exactly 6 weeks after my next period is supposed to start. Six weeks is exactly the minimum for how long it takes to do an egg retrieval cycle. So I thought, “Is this a sign? Should we try to do a fresh-fresh cycle?”

What do I mean by “fresh-fresh”? I mean fresh (not frozen-then-thawed) eggs and fresh (not frozen-then-thawed) sperm. What difference does it make?

First we have to define what “success” means. For most, if not all, infertility patients, success would be considered taking home a healthy baby while success in the laboratory might be considered making lots of grade A embryos or simply surviving the freeze-thaw procedure. For this post, “success” means taking home a baby.

I think all studies agree that fresh eggs are always better than frozen eggs. So if possible, you always want to use fresh eggs.

Some studies show that fresh sperm is better than frozen sperm. Other studies show that fresh and frozen sperm have the same chance of success. I think there’s even one that shows frozen is better than fresh (think survival of the fittest).

For us, I think fresh-fresh is going to be the best option. Why?

– not 100% guaranteed that all/any sperm will survive the freeze-thaw
– only 80% of subsequent mTESE procedures are successful (meaning sperm found on the 2nd mTESE)

By doing fresh-fresh, we’ll have the same number of sperm frozen (minus the 8-12 used to fertilize any eggs retrieved), plus we get to do the fresh-fresh. It’s like a two-for-one deal.

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mTESE is Two Months from Today

Me.E’s mTESE is tentatively scheduled for 2 months from today. I get butterflies every time I think about it. I’m not 100% sure what I’m nervous about. Is it that the results might mean we have to adopt? Or is it that it might mean we’re going to have kids?

The second one makes me giggle a little. Before we were infertile, I used to worry all the time about if we could afford kids now, how I wasn’t sure if I could be a stay at home mom like I want to be, how having kids would ruin my ability to sleep in on Saturday mornings, etc. Now those things barely register.

I look at the mTESE as either the beginning or end of something huge. Either someday I’ll get to be the mother of Mr.E’s babies who have his skin, his eyes, his lips, his intelligence, his sweet and generous disposition, or I won’t. Either I will get to experience the joys and pains of pregnancy and childbirth, or I won’t.

And I wonder will Mr.E get the opportunity to feel like a man? I think it’s an animal instinct to want to plant his seed. Men feel like they’ve accomplished something great when they’ve gotten their wives pregnant. I want that so much for Mr.E that it hurts me inside.

No wonder I’m nervous. It’s the beginning or end of fulfilling our dreams, dreams we had long before we ever met each other. I can only hope and pray that giving us this miracle of having biological children is God’s will.

Update 11/19/13:
Scheduling a cycle is like shooting at a target caught in a hurricane. As of today, both Mr.E’s mTESE and my egg retrieval are rescheduled for the following week in January.

For my previous egg retrieval I was on an agonist protocol (HCG trigger shot), but I got OHSS. This time, to prevent OHSS, they want to put me on an antagonist protocol (Lupron trigger shot). This change means we are less sure what day of the week my retrieval will be, which means that the mTESE can’t really be scheduled until 36-48 hours before surgery.

Will keep you updated!

Azoospermia and the Andrology Lab

As you may know, Mr.E has NOA (non-obstructive azoospermia) which means he has no sperm in his semen. The only way to get sperm is with a surgical procedure. We’ve chosen to do mTESE (microdissection testicular sperm extraction). Depending on who you talk to, mTESE has between 50-70% chance of success (finding sperm).

Mr.E’s mTESE is scheduled for January with Dr. Hotaling at the University of Utah. Dr. Hotaling just finished his fellowship with Dr. Neiderberger in Chicago (who is one of the top 3 surgeons who perform mTESE).

We chose Dr. Hotaling for a few reasons:
– U of U is closer to us than Dr. Schlegel in NYC
– the surgery is less expensive in Utah (though truth be told I don’t care how much any of it costs, I just want my miracle babies)
– the U of U has an amazing take-home-baby rate at their reproductive clinic (almost 70% success rate in the under 35 male factor category)
– Dr. Schlegel doesn’t have Dr. Doug Carrell

Who is Dr. Carrell you ask? Dr. Carrell is not an MD, he’s a PhD. He’s the director of the Andrology Lab at the U of U.

I let you in on a little secret: the real stars of the show when it comes to IVF are the people in the lab. If you’ve got seriously low egg reserve, then maybe the star of the show is the Reproductive Endocrinologist that gets your body to produce good quality eggs. But otherwise, the star of the show is the lab.

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