IVF Journey: Remedies for Male Factor Infertility – Azoospermia

[continued from Donor Eggs.]

Update: in real time, offspring #1 is at 32 weeks, with two months to do. He is reportedly very active during the day, but sleeps at night, which is very helpful so his gestational carrier (GC) can sleep. #2 is frozen in pre-launch until his GC is ready, probably next month.

Now for my part of the tale: my sperm tests came back stamped “azoospermia,” which is the condition of having no spermatozoa in your semen sample. This is rare for older men (who usually have at least a few feeble wrigglers), but is common for any man of any age who has been on testosterone replacement therapy for a length of time.

July 30 2019

The saga continues. World-class LA IVF doc refers me to either a Beverly Hills or Century City urologist-fertility specialist. They turn out to require an office visit starting with a $400 phone consult to come up with a treatment plan (and there are no promises you’ll get one.) Meanwhile, I find sources online, especially a comparative study of treatments. (These were funded in an effort to test use of testosterone itself as a male contraceptive; it does quite reliably induce temporary sterility, but they were doing baseline studies to see what (patentable, easier, more targeted) molecules they might find.)

So the treatment is: 1) Stop T, wait. Most men restart sperm production in a year. 2) Accelerate recovery using the same kind of hormonal manipulation used on egg donors. Notably, clomiphene citrate (cheap, easy to get) and injections of hCG (expensive, hard to get, subject of a silly diet craze as well.) I can find bootleg sources of both but it would sure be nice if our legitimate system wasn’t such a clusterfuck. Something like 80% of the men in studies recover in 2-3 months (but they were on average much younger.)

So I called the most prominent of three Eisenhower medical group urologists. No appt until Feb (7 months.) Not useful.

It’s amusing that all healthcare types think the patient is central and should have informed consent, but then make it an exercise in paying gatekeepers and wasting time no matter how informed the patient might be. I’ve had a few doctors with enough experience and intuition that they can quickly judge and decide matters. But much more commonly I can research the narrow subject of my rare condition and know as much or more about it than they do in a day or two. But thousands of dollars and hours of wasted time are the price of lost freedom. The rest of us must pay in time and $ so that stupid people can be protected from their mistakes.

BTW, there are websites where you can order up lab tests from Labcorp and Quest for cash prices. The full battery of STD and other blood tests the IVF doc wants costs about $450 cash there. Given only a few of these would be covered under our grossly expensive ACA-monopoly insurance policy, may just pay cash. I can’t get my primary care doc’s staff to do anything. Tomorrow I see my doctor and four tests that were supposed to be done for a 1/18 appt I had to cancel have never been set up so we won’t be able to discuss results as is their plan; Eisenhower is a nonprofit run by doctors and they are trying to make all patients over 40 come in three times a year and constantly undergo screening for bp and cholesterol, pushing everyone onto medications and keeping those office visits (and revenue) coming in. “Nonprofit” doesn’t mean no one is making money.

In hindsight, it was a mistake not to go to the Beverly Hills fertility specialist. My primary care doctor helpfully prescribed the hCG (available from a local compounding pharmacy — a few months later, the FDA forbid such compounding, and after that I had to use GoodRx coupons to get it from a regular pharmacy: both products start from encapsulated powder which has to be mixed with distilled water, so what the compounding pharmacist used to do, the patient now has to do. The injections are simple — subcutaneous (just under the skin, into a fat layer) and water-based so small-needle insulin syringes can be used. My doctor had me on 25 ml every other day, which seemed to be enough.

The full regimen I went on included more drugs (oral):

    Clomiphene, 50 mg / every other day – inhibits the feedback loop that suppresses natural testosterone. It’s a “selective estrogen receptor modulator (SERM)”

    Anastrazole, 1 mg /day – suppresses estrogen production via aromatase inhibition.

    hCG, .25 ml / every other day – chemically similar to luteinizing hormone, so shields testosterone and sperm production from negative feedback loops. Restored my levels of FSH (follicle-stimulating hormone) to normal in six months.

To cut to the chase, I ceased t-supplementation in early August and after failing to fertilize a single egg from the first batch, went to the Beverly Hills fertility guy (via Zoom, since the pandemic caused him to waive his usual requirement of examining new patients in person.) That world-renowned expert recommended what I was already taking, plus use of a Zymot sperm-sorting chip to select the best spermatozoa for ICSI (more about that in a later post.) We had to wait months for our egg donor’s second donation before trying again, but this time it worked — more than a year since I started rehab, we had four new frozen embryos (my children-to-be) that passed all screenings.

The graph showing my hormonal recovery:

FSH and T graph 5-13-20 showing recovery to normal levels

FSH and T recovery graph