The emotional numbers game of counting follicles, oocytes, hopes, and dreams.

Today is day 1 after my oocyte (egg) retrieval (known simply as OCR in the IVF community). The phone call with my fertility clinic is scheduled for 9am to receive some details about yesterday's events. At 9am I dial the number that I found on the document that I received after my oocyte collection. I turn on the speaker on my phone to make sure that my husband does not miss any information. A very kind voice answers the call and the woman introduces herself as our embryologist. After a short identification process, she informs us that she found two mature oocytes out of the five that were collected yesterday, and one of the two was successfully fertilised.

I am speechless. That is not the news I expected. She must feel my disappointment because she quickly continues. She will go back and check on the other three oocytes again later today to see if they also matured. If they have, they will be fertilised, too. She also let us know that our embryo transfer (ET) is scheduled for Monday, four days from now, at 7.30 in the morning. She kindly wishes us a great weekend and we hang up the phone.

I am sitting on the couch, trying to recall every single word of the conversation. My summary is this: yesterday we had five oocytes collected, two of them were definitely matured, but only one of the two was fertilised. However, there is still a possibility that we might have more fertilised oocytes by Monday. All of these facts play an equally important role.

I don’t allow myself too much time for an emotional breakdown. My analytical mind needs to inspect every fact that I have learnt today. It is time to turn to my best friend: Google. Here is what I learnt and why I call this the Numbers Game:

• There is a set number of follicles before the OCR. In our case this number was five follicles. BUT
• Some oocytes may be partially or completely damaged. I do not have any information on whether this has happened to our oocytes, so let’s just say that the number stays at five oocytes.
• There is a possibility that some of the follicles were empty, meaning, they did not contain any oocytes. In my case, each of my follicles had an oocyte inside of it, so our number is still five. BUT
• There is a chance that some of the collected oocytes were immature at the time of the OCR. Furthermore, some of them could be overly mature, as well. In our case the embryologist found two mature oocytes after the OCR but she will wait and see if the others will mature by the time of our embryo transfer. BUT…

An unusual story to reassure you that there is no need to fear the oocyte retrieval procedure.

We woke up very early on the day of the oocyte retrieval (OCR). We had to be at the clinic by 7.30AM, as my OCR was scheduled for 9.30AM.

I followed the list of instructions I received by the clinic: slippers, robe, and ID cards ready to go. The only thing left to do was to iron my favourite nightie. My husband did it for me because first of all, he is much better at ironing than I am, and second of all, as he said, it was his participation in the oocyte retrieval. I was not allowed to eat, drink, or smoke after midnight, because the oocyte retrieval might be performed under general anaesthesia. The clinic also asked me to remove nail polish or artificial nails (but I don’t wear any so I did not have to concern myself with that).

I could not believe that altogether the whole procedure took only 10 minutes. I would not call it the most comfortable experience of my life, but I would definitely not call it painful either; if anything, it was absolutely tolerable.

We arrived at the clinic on time and as planned. After a quick check-in, during which we filled out several forms, we were asked to say goodbye for a while because we both had important tasks to fulfill separately. We had enough time for one more kiss and a “it’s going to be alright” hug - reassuring each other that everything will go smoothly.

A very kind nurse guided me to one of the preparation rooms and asked me to change and get ready for the procedure. When I stepped out of the bathroom in my freshly ironed nightie, I met a doctor in the room who wanted to have a last consultation with me before the oocyte collection. He informed me that due to the COVID-19 situation the hospitals are ordered to minimise the number of anaesthesia procedures (probably because the anaesthesiologists were busy with seriously ill Covid patients). He proceeded to explain to me that general anaesthesia is not absolutely necessary in my case because of my low egg count. He reassured me that all will be fine and promised me that there is nothing to worry about. I was not able to answer anything other than a very weak “OK”.

I asked for just five minutes to calm myself down a little bit. I laid down on the bed and tried my best to meditate (thank God I could finally use what I learnt in my online meditation classes). After a little while I got to take anti-anxiety medication prior to surgery. I would have preferred to take a few more than just one but the kind nurse reassures me that one would be enough.

While waiting for my painkiller injection, I started to recall everything that I have learnt about the oocyte collection procedure. The doctor will use an ultrasound probe with a needle attached to it, and he will insert the needle through the vaginal wall into my ovaries in order to reach my follicles. Afterwards, they are going to use the needle to suction out the fluid from the follicles and, hopefully, the oocyte will be retrieved along with it.

I have decided not to call my husband and tell him that I will undergo this procedure without general anaesthesia as I did not want to worry him during his semen collection. So I just continued to relax and meditate until it was time for the oocyte retrieval.

The nurse returned to let me know what the team was ready for me and she showed me the way to the surgery room. It looked similar to a normal gynaecology room except that everything looked and smelled very sterile. I was asked to lay down on the bed and they double checked my name and my birth date to make sure that all my oocytes were going to be labelled correctly. My doctor promised to explain everything to me throughout the procedure. He even showed me the monitor where, like he said, I could check if he was doing his job properly. On the screen I saw my five amazing follicles - they looked like little berries inside of a balloon.

The doctor then asked for my final confirmation to make sure that I was ready and he began the collection. I could only feel a slight sting during the insertion and right after that I could see how he reached the follicles one by one. After just a few minutes he told me that I did a great job and that we were DONE. My five incredible eggs came out of their follicles and they were ready to go to the lab to meet the “boys”. Mission accomplished!

I could not believe that altogether the whole procedure took only 10 minutes. I would not call it the most comfortable experience of my life, but I would definitely not call it painful either; if anything, it was absolutely tolerable. The main trick is to remain still and not move despite the discomfort.

I know that my story is a little bit unusual because 95% of you are going to have an oocyte retrieval under general anaesthesia, which will allow your surgeon to take their time to collect all of your oocytes - and hopefully it will be a greater number than in my case. Nevertheless, I felt like it was important to share my experience to reassure you that there is nothing to be afraid of during an oocyte retrieval.

If we cannot conceive naturally, it’s good to know which options we have in the world of artificial reproduction treatments (ART).

When we are confronted with the fact that we are not able to have a child in the natural way, we are directed to a fertility center. At the clinic it’s easy to get overwhelmed with all the new information we have to take in. As beginners, we didn’t even know which are the ways to consider or what are the differences between the different forms of fertility treatments. The most commonly known fertility treatment is IVF, but it’s not the only one. But which are real options for us, and which direction should we take?

"We also have to talk about the classic in vivo fertilization. Simply put, have sex because anything can happen at any time."

The first two are relatively simple solutions to treat infertility, such as Planned Intercourse and Artificial Insemination.

The simplest fertility treatment is called Planned (or Timed) Intercourse. In this procedure a mild ovarian stimulation can be involved, promoting the growth of 2-3 follicles ideally. If the follicular growth is optimal (the doc checks it though ultrasound), ovulation can happen naturally or can be provoked by a trigger injection. By the end of the process the doctor will determine the days when it is most recommended to be together (have sex). This is a relatively natural fertility solution with some extra help. I think it’s an option for couples with good test results.

The second option is Artificial Insemination. The treatment starts with hormonal ovarian stimulation, and followed by a trigger injection. Even the most fertile days are determined by the doctor. However, the fertilization doesn’t take place by natural intercourse. By the end of the stimulation phase the male partner is asked for sperm collection. Sperms that have been washed and concentrated are placed directly in the woman’s uterus, cervix or fallopian tubes around the time the ovaries release one or more eggs to be fertilized. Insemination is usually recommended when everything is fine with the sperm and the woman’s fallopian tubes (or at least one of them) are permeable. The procedure is completely painless, it’s less expensive compared to IVF, but the success rate is lower: only 15-20%.

The next option is IVF (In Vitro Fertilization), which I think is the most known fertility treatment type. The main difference compared to the previous treatments is that the fertilization happens outside the body – ‘in vitro’ means ‘in a test tube’. The procedure is longer, more expensive, more complicated and involves a higher hormonal load than insemination.

What are the main stages you are going to undergo during an IVF treatment?

1. Ovarian Stimulation. The goal of ovarian stimulation is to achieve multifollicular development by administering daily hormone injections, hoping more follicles, more eggs will be available for fertilization. There are several different medication protocols in use to achieve this. In the case of short protocol, the stimulation starts on Day 2 or 3 of the menstrual cycle, and takes about 7-11 days. The long protocol can take up to 4 weeks. It starts on Day 20 of the menstrual cycle with a 10-day long medication which helps to shut down the ovaries first. In step two the same ovarian stimulation starts as in the short protocol.
2. Trigger Injection. If the follicles are sufficiently mature, the Trigger helps the growth and maturing of eggs.
3. Egg retrieval, and Sperm Collection. 36 hours after the Trigger Injection the Egg Retrieval is going to take place. Using ultrasound, the fluid containing the eggs is collected from the follicles through the vagina with a needle. At the same time sperm is collected from the male partner.
4. Fertilization. After collection, the eggs and sperm are cleaned in the embryologist’s laboratory, then a group of sperm is put together with the eggs to be fertilized. Practically the same thing happens in the incubator as in nature. There is no special intervention, they just organize a date between the eggs and sperm.
5. Embryo development. The fertilized eggs spend 3-5 days in a special incubator at the embryology lab. The embryo divides and multiplies its cells. The embryologist selects the most viable embryo(s) for transfer by the end of the process.
6. Embryo transfer. 3-5 days after fertilization, the most viable embryos are transferred back to the uterus with a simple, quick and painless procedure.
7. 2-week-wait. The time period from embryo transfer to pregnancy test. If all goes well, implantation takes place during this time, and the embryo attaches to the uterus lining and continues its development there.

It’s also good to know about ICSI (Intracytoplasmic Sperm Injection), as a special type of IVF treatment. It is practically one of the methods used in egg fertilization. It is usually recommended when sperm quality is not the best, or only a few eggs are available for fertilization. During ICSI procedure the embryologist selects the most beautiful and healthiest sperm and injects it directly into the egg. This can increase the chances of successful fertilization.

We also have to talk about the classic in vivo fertilization. Simply put, have sex because anything can happen at any time. We can meet a million wonderful stories; I also have several close friends who once had a baby arriving magically. Yet they had a paper about that impossibility. Never give up!

It’s time to take our part of the fertility journey: let’s boost the little guys.

There are very few men left on the planet who don't need any help to boost their fertility. I am not one of them, so I decided to do as much as possible to improve my sperms’ health. I am going to have very little to do during our IVF program compared to my wife, so this is the least I can do to increase our chance of success.

"With any positive changes, we can do a lot to consciously improve our fertility."

Let’s continue to learn more factors which can affect the health of our sperms and male fertility.

1. Ideal weight: Both too much and too little fat have a negative effect on hormone production, and sperm health and count. Moreover, in overweight men, fat pads warm the testicles, and as we learned, sperms don’t like heat. Weight is something that we cannot change overnight. Making a significant and healthy change on it, can take months (sometimes even years). Losing or gaining weight should be part of a well-planned preparation. I have 4-5kg extra weight on me, and it is impossible to lose (in a healthy way) in 4 weeks (at least for me).

1. Caffeine: The most popular stimulant. That's how I start the day every morning. But keep in mind that energy drinks and cola also contain caffeine. Funnily caffeine can be a double-sharp weapon. In a small amount it stimulates sperm production in small amounts. Great news! However, in larger quantities, it can be one of the causes of sperm deterioration, and also can reduce its quantity. Another important fact that is important to remember, that beverages that contain caffeine, have diuretic effects and may cause dehydration, which is not good at all when we try to conceive. I am a coffee lover but fortunately I am not a big fan of energy and soft drinks. So, it will be easy for me to be a good boy on this.

1. Exercise: Sport is one of the best things in the world if you do it within normal limits. It relieves tension (so you can reduce stress), creates good conditions, and makes you balanced. It can help you reach your ideal weight as well. But you don't want to be Schwarzenegger for now. Do not touch anabolic steroids, muscle and weight gainers. Firstly, your testicle can get smaller (you will look stupid), secondly, you can even reset your sperm count with them.

1. Toxins: Unfortunately, improper nutrition already delivers a lot of toxins into our bodies. We can come into contact with many toxins at work and home (solvents, cleaners, pesticides) as well. Try to avoid them if it is not possible, or at least use appropriate protective equipment.

Obviously, there are many things listed above that are difficult to change. These are just some important factors – at least - to be aware of. With any positive changes we can do a lot to consciously improve our fertility. And if we were “accidentally” keeping these lifestyle changes for the long term and living healthier by the way, we could hold not only our own child, but hopefully even our grandchildren in our hands. Is it enough motivation? Is there more motivation than that?

Step 1 of preparation: speak the IVF language.

I believe that self-education is a very important step for IVF preparation. You can find plenty of articles and studies to read. One topic is going to lead to another, giving you endless information about IVF and all its details.

"To be honest, it was very difficult for me to understand the comments at first, because of these almost code-like short form terms. It is like a secret language which is spoken by our special community only."

Visiting fertility or IVF forums can be really helpful as well, and these are a great source of information especially for a new bird like me. It helps me to know what is going to happen with me, and I also can gain knowledge from other’s experience (and sometimes learn from other’s mistakes, for example: why don’t take a pregnancy test too early).

I don’t know how much time you have spent on IVF or fertility blogs, but if you have visited at least one, you might have noticed that it’s full of acronyms. To be honest, it was very difficult for me to understand the comments at first, because of these almost code-like short form terms. It is like a secret language which is spoken by our special community only.

To make the life of the new birdies – as myself – easier, I decided to collect the basics of the IVF vocabulary. Have fun, learn a lot, educate yourself!

2WW: 2 weeks wait (from embryo transfer until pregnancy test)

AF: Aunt Flo, Period, or Menstrual Cycle

BCP: Birth Control Pills

BA: Baby Aspirin (low-dose aspirin to improve chances)

BD: Baby Dance (sex)

Beta: HCD pregnancy test

BFN: Big Fat Negative (negative pregnancy test)

BFP: Big Fat Positive (positive pregnancy test)

CB: Cycle Buddy (someone who is on IVF at the same time)

CD: (menstrual) cycle day

DE: Donor Egg

DH: Dear Husband

DI: Donor Husband (sperm donor)

DPO: Days Post-Ovulation

DPR: Days Post-Retrieval

DPT: Days Post-(Embryo)Transfer

DP5DT: Days Post 5-Day Transfer

DW: Dear Wife

EPT: Early Pregnancy Test

ER: Egg Retrieval

ET: Embryo Transfer

Frostie: Frozen Embryo

FSH: Follicle-Stimulating Hormone

HCG: Human Chorionic Gonadotropin (pregnancy hormone)

HPT: Home Pregnancy Test

HX: History

IF: Infertility

IUI: Intra-Uterine Insemination

IVF: In Vitro Fertilization

LMP: Last Menstrual Period (first day)

LSP: Low Sperm Count

MC: Miscarriage

MF: Male Factor

O, OV: Ovulation

OB/GYN: Obstetrician / Gynecologist

OHSS: Ovarian Hyperstimulation Syndrome

PCOS: Polycystic Ovarian Syndrome

PG: Pregnant

PMS: Pre-Menstrual Syndrome

POAS: Pee On a Stick

RE: Reproductive Endocrinologist

RPL: Recurrent Pregnancy Loss

SA: Semen Analysis

S/S: Signs/Symptoms

TTC: Trying To Conceive

TX: Treatment

US: Ultrasound

WNL: Within Normal Limits

How you can improve sperm quality and quantity with some changes in your daily life and habits. Beware, you might notice positive changes in other areas of your life as well.

If you are like me, you never really paid attention to your sperms (I mean in a scientific way). It completely changed when I received my sperm analysis result, and it’s not too great a number. I felt like it’s time to learn more about them (especially when it comes to their parameters).

"Studies show that a smoker has 15% less sperms compared to a non-smoker, and more lazy sperms with abnormal shape."

I read about many factors which can cause sperms with abnormal shape, not enough quantity or pure concentration. BUT I also learned that actually there are many things that I can do, and make improvements on these parameters. These are mainly lifestyle changes, and most of them don't cost too much, I just need to pay a bit more attention and be willing to change.

1. Smoking: I was a heavy smoker for 15 years, but I quit 15 years ago though. I know exactly how hard quitting is. (This is not the easiest lifestyle change, I know, but I wanted to start with the most difficult one.) BUT you have to know smoking has a huge negative impact on the quality and quantity of your sperms. The problem is mainly caused by the nicotine (so electric cigarettes are not really an option either). Studies show that a smoker has 15% less sperms compared to a non-smoker, and more lazy sperms with abnormal shape. SMOKING + ABNORMAL SHAPE + LAZY SPERM = NOT IDEAL!
2. Alcohol: At this point I started to be worried a bit (I love red wine). Actually, I don’t have to be abstinent (a big release!), I just have to be careful with the quantity. 2-3 glasses of wine or beer weekly won’t do a huge harm on my sperms. A bigger dosage of alcohol would lower the chances of my boys, because they can have an abnormal shape and a smaller army in numbers. It sounds doable to me.
3. Drugs: I cannot share any personal experience about this point, but what I learn for sure: they don’t do any good for our hormones. They can reduce our testosterone level, have a negative effect on the shape of sperm, and the sperms go nuts (as you do) if you are on drugs (I don’t know what does it mean exactly, they might move too fast?).
4. Heat: It never even would cross my mind. Using my laptop on my laps, or enjoying the comfort of the seat heating in the car actually can overheat my sperms. They don’t need too much heat as they are super sensitive. If they get some extra, unwanted heat on their outer layer, it’s enough for them to die. Riding a bicycle, spending time in a sauna can also cause extra heat. It is also better to switch from hot baths to showers for the health of our sperms. I think here I am going to face some difficulties (laptop usage, love of hot baths and bicycling).
5. Stress: I know, it’s easy to say, do not stress these days. At least be aware that too much stress has a huge negative impact on every area of your life. Speaking about sperms: it decreases the concentration, makes them lazy, and will affect the shape as well. So, just take it easy!

There are still a few possible lifestyle changes I would like to share with you in my next articles, but I find it easier to take these changes step by step.

How we won an extra month for IVF preparation. Always see the bright side.

While waiting for the second beta-HCG test unfortunately my period arrived. Of course, I was still hoping that all could still be alright, as you can find many stories of successful pregnancies of women having periods while pregnant. Unfortunately, my blood test confirmed later that the HCG level dropped, meaning the pregnancy ended.

I really needed some time to digest what just happened....

"According to Dr. Lauren Averbuch study, 30-50% of women have had one chemical pregnancy in their fertile years, but many women don’t even know about it if they don’t take a pregnancy test."

The pregnancy was real, that’s for sure. Which is amazing news, because it means I am able to conceive, we are able to make a baby.

I had a ‘chemical pregnancy’, also called a ‘very early miscarriage’, which happens on the fourth or fifth week of pregnancy. Actually, chemical pregnancies are fairly common. According to Dr. Lauren Averbuch study, 30-50% of women have had one chemical pregnancy in their fertile years, but many women don’t even know about it if they don’t take a pregnancy test. This type of miscarriage is usually caused by some kind of chromosomic, genetic abnormality of the developing embryo. It’s somewhat comforting that in almost all articles I read about this topic it was clearly written that it cannot be my fault, I could not do anything to prevent it. I decided to believe it, and not to carry the anxiety with me.

When my period ended, I paid a visit to my doctor. He confirmed that he cannot see anything to worry about. Everything is in great order inside and my uterus lining started to build up again. New month, new chances. ☺ He gave me three good reasons to be positive:

1. This unexpected pregnancy confirms that we are able to have a baby. The egg of mine and the sperm of my husband were happy to meet, and they are ready to cooperate.
2. Because of the hormonal changes caused by the pregnancy, we have a higher chance to conceive again in the next few months.
3. If we are ready, we can start our IVF treatment by my next period.

As we have to wait one more month to (finally) start our first cycle, we decided that we are going to use this extra time for some preparation, and boost our bodies and minds as much as we can.

TIP: Don't drive yourself mental during your fertility journey by getting a diagnosis of your symptoms by Dr. Google. Don’t do this to yourself.

More and more men are affected by fertility problems. Why is this topic not spoken more about?

To make it short, on the second consultation, we got the green light from the doctor to go for IVF, as our only one chance of having a baby. Actually, the plan was that in a week or so, we will start our fertility treatment.

"It never crossed my mind before how much I can do to improve my reproductive health. To be honest, it did not cross my mind either that I have to do anything for it."

As you could read in my previous article, I am going to face our first IVF cycle with my ‘not too tragic’ but ‘not great at all’ semen analysis result. After the stage of ‘Unbelievable’, I entered the phase of ‘Acceptance’, then I started to think about how I can improve my result.

I dived into the world of ART (Artificial Reproductive Treatments), and came across my new favorite word: fertility awareness. We hear about many different awareness and consciousness, but the term ‘fertility awareness’ was completely new for me. It never crossed my mind before how much I can do to improve my reproductive health. To be honest, it did not cross my mind either that I have to do anything for it.

Fortunately, the sperm production is continuous in our body, and takes approximately 3 months to create a completely new army. It means that with some changes in our diet, lifestyle, and habits, we can do a lot for sperm who will be formed in the future. Of course, this cannot happen overnight. It takes about 3 months to notice significant improvement on the result.

Unfortunately, in my case, I had too little information about this topic, and too little time left for big improvement or to correct my bad result. But, of course, it didn’t discourage me to start some changes, because – I believe - every journey starts with one step.

It would be great if this information wouldn’t reach only those couples who are already participating in IVF programs. It’s scary to read that there’s a tendency for men’s fertility to deteriorate from decade to decade, and moreover, typically, men don’t like to test and face it. How much easier it would be to avoid a lot of setbacks, stress and sometimes relationship problems that come with fertility failures. Fertility awareness is all about avoiding these above.

Edit: Our IVF cycle is postponed, because a little miracle happened. Who knows how, but we were able to conceive naturally. We had a chemical pregnancy, meaning that one of my sperm was able to fertilize an egg naturally, but unfortunately the implantation was not successful. This is proof: we can do it! ☺ We have to wait a month to start our fertility treatment, which also means that I gained an extra month to improve (even a bit) my sperm condition.

Stay positive on the journey, because it’s pretty sure you are going to face some unexpected situations.

As we got the ‘green light’ from the doctor to start our IVF treatment, we don’t have anything else to do just to wait for my period to start, and on the first day to contact the clinic.

"And BOOM! There are two famous lines, the first time in my life. "

It’s the first time in my life actually waiting for my period to arrive. I am sure you know the feeling when you are actually sure your period just started, but nothing happens. I started to have these pre-menstruation symptoms (PMS) one week prior to my normal time. Thanks to my Period Tracker, I know when she should arrive.

Four days before my expected time, I noticed some spotting, which made me super happy as it is a good sign: my period is going to start the same day or next day at the latest. But the following day nothing really changed. I was running to the toilet every 30 minutes to see if there's any change, but all the same. It’s still the same spotting or super-duper light flow, what can be my period, even though it’s absolutely unusual for me.

I don’t want to make any mistake and risk that I don’t start the stimulation in time. I don’t really care if the doctor is going to think I am an idiot and not be able to tell if I am menstruating or not, so I decided to pay a visit to the Clinic. I must be not the first one with this ‘stupid’ question, because my doctor doesn’t give me any strange look. ☺ He does a short ultrasound test on me, and confirms that it’s not my period yet, and we have to wait until the normal flow. (Hopefully I will be able to recognize what ‘normal’ means, but I will try my best.)

The next few days were nerve-wracking. The day of my expected period arrived, but still all the same, and so on the day after.

I really don’t know why, but I got a stupid idea stuck in my mind: I should take a pregnancy test. I ran to the closest pharmacy, bought a super sensitive test. I took it with absolute peace of mind, because as the doctor confirmed a week ago, there is no way that I can be pregnant. And BOOM! There are two famous lines, the first time in my life. I am shocked, and so is my husband. I cannot believe it! I know that it is almost impossible to have a false positive test, but I need a second opinion. Fortunately, there’s a lab close by, where I can get a beta-HCG blood test done today, but I have to wait for the result till next morning.

The difference between home pregnancy test and blood test is that the blood test can detect a smaller amount of HCG (pregnancy hormone) compared to a urine test. The result of the blood test is also more accurate, because the lab test result shows the quantity of HCG hormone found in the blood.

If there is something that I really cannot deal with is the: uncertainty. I never got pregnant in my life before, and now - just a few days before our IVF treatment to start - I (most likely) am.

The next morning finally, we received my result via email: I do have HCG in my blood, so I am PREGNANT, but the level is low. I called my doctor, but unfortunately, he cannot help me too much... He confirms that there is a pregnancy detected, but hormone level is low (which doesn’t mean too much). He asks me to take another test in 3 days, as the HCG should double by then, and will give us more information.

This day leaves us with more questions than answers.

How I learned that sperm analysis isn’t about getting a certificate about my fertility superbness, but showing me there’s room for improvement.

On the next consultation with our doctor, unfortunately it became official, which was only my guess until then: the result of my semen analysis is – let’s say - not ’the best’. The doctor pronounced it clearly: I am involved in our fertility journey as much as my wife is. I am the other 50% in the formula, and the reason why IVF is our only way of having a child together. It didn’t break me, but it was not a comfortable feeling either. I needed some time to digest the situation. I read a few studies about the fact that male fertility has become a bigger problem these days than female fertility. Most of the studies say that minimum 30% (some of them say up to 50%) of infertility problems come from the male side. Studies also show that men’s sperm count dropped, and the capability of fertilization decreased drastically (to its half) over the last few decades in Europe. It surprises me, because if it’s really such a big, common problem, why don't we speak / know more about this?! Knowing that I am definitely not alone with this problem helps me put my mind to ease but it still bugs my ego.

Anyway, let's see what a sperm analysis is about, and my result?

"Most of the studies say that minimum 30% (some of them say up to 50%) of infertility problems come from the male side."

1. During the test, they measure the volume of the semen. The normal parameter is 1.5-6 ml (I had 5 ml, so I was OK with this part). This factor is important to show us how big our army will be to start with.
2. They also check on its pH. The ideal value is 7.2 (slightly alkaline), but it is considered normal between 7.2-7.8. (Mine was 8.)
3. They also check on the motility of the sperms, which is significant because they have to take a long way to reach their goal. If we calculate from the total sperm count, at least half of the little fighters should have good movement. In my case, the progressive motility (when the sperms move in a straight line along a large-arc circle) was 50% (this is ideal). My non-progressive motility value (when sperm moves along a small-arc circle) was 5%. 50% + 5% = 55% in total (which is ok!). I’ve never been a great dancer, but at least my spears are moving well.
4. Sperm concentration and sperm count are also determined. Sperm concentration shows how many sperm are present in 1 ml of semen, and sperm count shows the total number in the whole ejaculation. These indicators are changing so mournfully, that an acceptable normal minimum value is no longer even set. The WHO (World Health Organization) has recently given the normal values at 15 million / ml and 39 million / sample. I had 10 million / ml and 50 million / ejaculation, which are not particularly good values.
5. They also examine the morphology of the sperms (if the sperm head is in the right shape or size). The sperm head, for example, plays an important role in breaking through the egg wall to be able to fertilize it. According to the WHO numbers, at least 4% of the sperms should be in formal order (unfortunately, this was only 2% for me). Interestingly, I also came across a study that showed that 29% of men with 0% normal-shaped sperm were able to fertilize an egg in the natural way (not with IVF). So, sperms with abnormal head shape doesn’t mean that there’s any genetic problem with them.

The official diagnosis of seeing all my numbers together was: oligo-teratozoospermia. Meaning I have reduced sperm count and low sperm motility.

However, there is a significant advantage for men over women. While the number of eggs is given at birth, and from then this number decreases and then runs out, in men the sperms are renewed cyclically. The process of sperm formation (spermatogenesis) takes 74 days. (Because we cannot know which part of this cycle we are in, it is better to calculate with 3 months). Meaning: in most cases, men have a chance to improve their ‘sperm situation’ in three months.