Aspermia?

[Marco1975]

Hello,
after 3 years from TC, a wedding and 2 years of happy marriage, we decided to have babies (the goal was 2 or more...).
Back in 2004 i had a bilateral non-nerve sparing L-RPLND, which meant, as we knew, retrograde ejaculation. Having banked sperm back then, i wasn't worried, not until recently our first in vitro insemination failed after transpant: even though there are less than 40% of probability to get pregnant (every "try"), failure was unexpected because embryos translplanted were VERY good (three embryos: A A B). My wife is young, every other analysis was OK, so we thought (hoped) it was goign to be realtivly "easy".
After this first try, the doctor requested an analisis of my semen, believing it could be affected by (as they call it) "DNA fracture" (which is not chemo related but should be genetic), and fracture of the DNA in sperm lowers probability to less than 10% every "try". So he wanted a sample of my semen to perform a "Tunel test" to see if, indeed, there could be this problem.
So, suffering from retrograde, I had to collect semen through urine. Well, at least i tried because (and finally I get to the point) analysis showed that in my urine there is NO semen!!! Where is it gone? Where does it go? I believe that neither chemo (BEP in my case) neither RPLND have the "ability" to transform a sperm producing man in a non producing individual, or am I wrong? RPLND could (if bilateral) give retrograde eiaculation, not aspermia! And if it's not in the urine, where is it? Does sperm remain in the testicle, or maybe somewhere in my body? Or simply am i not producing it anymore?

Thanks in advance for you thoughts, I am quite worried because I have only 20 pallets in the "bank" (maybe good for 6 or 7 more tries) which means (if DNA fracture is confirmed) 6 or 7 time a little 10% of probability to be a dad.

[LoneNutTheorist]

Are they doing IUI or in vitro? I thought that with in vitro they can produce multiple embryos in a single attempt.

I am looking at the possibility of in vitro if this current IUI doesn't work out, and it was my understanding that many more attempts could be done via in vitro than via IUI.

In other words, I have fewer pallets stockpiled than you, but I was told that they could get many more IVF attempts out of it if needed than by using IUI.

[Margaret]

Marco,

First of all, there is a chance you could be sterile...but I am not sure if even if you are sterile if sperm fluid would show up. Second, and I hope that first is not the case, I have heard they can collect from your remaining testicle. Ask about that and if you need further information I may be able to research it for you.

I pray for lots and lots of healthy babies and many answers for you.

m,

[Marco1975]

@LoneNut
Thety're doing in vitro, considering that i have a few pallets and, probably, little chances of producing more of them.
In the first (only) attempt they made three healthy embryos (A, A, B which is: very good, very good and good) from one single pallet, but it depends on the "quality" of the frozen sample: it may take up to three pallets to produce three healthy embryos. Usally they implant two embryos not three: this depends on how healthy (how young, basically) is the woman. Implanting three embryos may give three babies (or even more...), which is a risk for the woman's health. So "grown up" ladies usually get two embryos implanted (this could lead to two or three babies too...).
Even if the quality of the embryos was excellent, the doc told us that maybe they didn't "attack" because of the possibility of fractured DNA, and this is why we should need more tests.

@ Margaret
Thank you for your prayers! It's sad that, when you think that the worst is over, when you think that you've been through possibily everything nasty that can happen to you, when you think that things can only get better, then you realize that "fate" hasn't done with you yet (in the meantime we had my father in law struggling a two year battle against throat cancer).
As for the possibility to collect it from the reaming testicle, i'd prefer not to.. Even after TC you never get used to needles. Of course, if necessary, i'll o through that, but it would have been nicier the easy way.

Today I'll ask my doc. I'll keep you informed on "the truth of bilateral RPLND". Thank you!

[LoneNutTheorist]

Interesting,
Our fertility specialist told me that they would try to produce as many embryos as possible at the offset to reduce the cost of future IVF attempts, if needed. Since the IVF is not covered by insurance, maybe they try that "all at once" approach?

I think in my pre i/o deposit, I left 7 small vials (is that a pallet?) We haven't used them yet, but they are sitting in cryo just in case. If this current attempt is not successful, we will either use the frozen sample for IUI or a new sample.

I guess the best that any of us can do is to explore every avenue, and if that means needles, probes and other such humiliations, so be it. Then, if we are lucky enough to have kids and if they end up making us crazy, we can tell them "do you know what your mother and I had to go through just to have you? can you cut us a little slack?"

Although I doubt that brings the desired response.

[Marco1975]

Maybe it has to do with countries' legislation. Here in Italy you must implant in utero every embryo that you produce. I don't know how many embryos you can get from 1 vial (pallet) but, here in Italy, the maximum per pallet is two or three, because, if you suceed in creating the embryo, you must implant them all (and implanting more than three embryos is dangerous for the woman): for example it is not possibile to use one pallet to generate 6 embryos, put 4 of them in the fridge and implant 2 of them... This is why many italians go abroad (Spain).
I don't know how is the legislation in trhe US, hopefully you don't have the same problem and 7 pallets are enough, if you wish, to "generate" a whole football team (and i mean an american football team, not soccer!).

[Already Bald]

analysis showed that in my urine there is NO semen!!! Where is it gone? Where does it go?

Hi Marco,
Right off I want to wish you and your wife the best of luck in your family planning. Just like Margaret, I'm praying that we will be Aunts and Uncles again - So I toast some nice red wine to you!

I'm curious- when you wrote that the urine had no semen- do you think they meant no sperm? Or no fluid what-so-ever?

[Lori]

LoneNut, having just completed an IVF cycle, I can confirm that they will produce as many embryo's as possible and you can choose to freeze those you don't use. Basically, the woman takes medicine so her body can produce as many eggs as possible. Those eggs are extracted and only the mature ones are used for fertilization. They then fertilize the eggs with the sperm. Some eggs may not fertilize or if they do, the embryo's may not continue to grow.

Here is what happened with us. I produced 10 eggs; 7 were mature; 6 fertilized, 3 continued to grow and on transfer day we 3 embryo's. If you have to go the route of IVF you should also discuss ICSI and assisted hatching. ICSI puts a sperm into each egg to increase the chances of fertilization. The assisted hatching part is really only for woman over 35 so not sure if that applies to you guys.

Hope that helps!

[Marco1975]

I'm curious- when you wrote that the urine had no semen- do you think they meant no sperm? Or no fluid what-so-ever?

In the sample they found zero "nemaspermic cells".
Doesn't sound good to me.

[LoneNutTheorist]

It's definitely a good thing that you banked, no matter what the present situation is.

You mentioned that some people go to Spain for treatment so that more embryos can be produced at one time, and perhaps that's something worth looking into. You might find that even after lodging and travel, that you might end up saving money compared to doing the in vitro from scratch each time, and you may be able to get more attempts from the sperm that you have already banked.

[Karen]

Lori,
Have you had the transfer? How are you doing?

[Lori]

Hi, had the transfer and now just waiting for news. Feeling good! Thanks for asking!

[Mom]

Lori, I am keeping my fingers crossed. I so much want this for you. Dianne

[Already Bald]

Good luck Lori!

[MRMRSU]

Hi Lori: Happy thoughts for you and Jon!