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Really Disheartening Fertility News From Doctor

This is a continuation of this thread https://www.professionalmuscle.com/forums/index.php?threads/still-infertile.168260/

I just got my semen analysis back and after 4 months of HCG and FSH and coming off testosterone I'm azoospermic. I didn't want to delay so I pulled out all the stops early, adding the FSH and taking away the testosterone. My leydig cells seem to be responding very well. After 2 months my total testosterone was 550 and now after 4 months my total is 850. My sertoli cells don't seem to be responding.

I've been taking ~1000iu HCG + 75iu FSH 3x per week. My blood work has been done on a Friday morning, after a Thursday morning dose of these medications. In both tests my LH has been undetectable (makes sense) and my FSH has been 2.7 (range 1.5-12.4). I do not know how high the FSH would be if I tested the day of injection.

Here is the very disheartening aspect:
Me: I know it can take time, I've heard you can get detectable levels before you get testicular size back. Is that your experience?
Doc: I don't think you'll get the size back.
Me: None?
Doc: You can see that in adolescents but generally not in adults
Me: Wait, do you mean I can get normal levels of sperm back and not see testicular size come back?
Doc: No, I don't think you'll get normal levels back
Me: What? Isn't that the point? Then what is the goal?
Doc: Well I'm hoping you can get levels up to a point where you can get IVF done
Me: I'm so confused. I've seen dozens of studies showing a return of normal sperm
Doc: I have too, I've seen them, but I don't think that will happen. Your body seems to be resistant. I've seen people come back just by going off of testosterone or going off and adding clomiphene. You're taking medications to hasten it and we don't see any response.
Me: So, we're just trying to get enough to possibly do IUI?
Doc: No, we can't do IUI. For intra uterine insemination you need at least 10 million.
Me: So we're just trying to get detectable levels for IVF??
Doc: If we see no sperm at all there is a surgery where you go into the testicles and hope to find some viable sperm under a microscope.
Me: Should I up the doses?
Doc: No, you're already taking the recommended amount


This was completely shocking to me. This guy has to be around 70 and I'm hoping he is just wrong. At one point he couldn't think of the name for Sertoli cells and just said "the...uh...sperm producing tissue" but I could be grasping for straws there, he's obviously been doing this for a very long time. I didn't mention that I've also read dozens and dozens of anecdotes on the forums but I of course have. Dr. Thomas O'Connor and Dr. Rand McClain have both said in their videos that they have 100% success rate with JUST HCG, hell McClain doesn't even have his patients come off TRT (O'Connor does).

I know GotGame left the forums but has in depth experience with this, if anyone who still talks to him could pass this along I'd be very grateful. Any insights would be great. My wife is going to be crushed when she hears I'm still at zero.
Give it some more time. I went through this last year but without all the tests that you have taken. Got my sperm checked at the doctor, and he told me I literally had zero. I came off trt all together at that point, so it took from February to basically the end of June early July to even show a noticable amount of sperm. First week I actually triggered one of those at home tests to say that I was fertile was the week I got my girl pregnant. Test levels never came back like yours though, mine were between 300 and 350 at the highest, and stayed that way for a year never increasing.

Also not sure if this made a difference, but we used that pre-seed lube, not sure if that helped, or if it contributed, but that was def the lube we went with.
 
Give it some more time. I went through this last year but without all the tests that you have taken. Got my sperm checked at the doctor, and he told me I literally had zero. I came off trt all together at that point, so it took from February to basically the end of June early July to even show a noticable amount of sperm. First week I actually triggered one of those at home tests to say that I was fertile was the week I got my girl pregnant. Test levels never came back like yours though, mine were between 300 and 350 at the highest, and stayed that way for a year never increasing.

Also not sure if this made a difference, but we used that pre-seed lube, not sure if that helped, or if it contributed, but that was def the lube we went with.

So you were showing some sperm after about 5 months though. Did your balls increase in size? Were you on medications to help the process along? What was the at-home test you took?
 
Give it some more time. I went through this last year but without all the tests that you have taken. Got my sperm checked at the doctor, and he told me I literally had zero. I came off trt all together at that point, so it took from February to basically the end of June early July to even show a noticable amount of sperm. First week I actually triggered one of those at home tests to say that I was fertile was the week I got my girl pregnant. Test levels never came back like yours though, mine were between 300 and 350 at the highest, and stayed that way for a year never increasing.

Also not sure if this made a difference, but we used that pre-seed lube, not sure if that helped, or if it contributed, but that was def the lube we went with.

ahaha too funny with the pre-seed we used that for our first kid and just bought some recently. Good stuff!
 
So you were showing some sperm after about 5 months though. Did your balls increase in size? Were you on medications to help the process along? What was the at-home test you took?

There are a few at home tests you can find on amazon. They are certainly not comprehensive but the idea is to tell you if you have an acceptable level of sperm. I think usually they trigger if you are over 10,000,000
 
It may have been posted but I found a 2021 article talking about PDE-5 inhibitors helping improve indicators of semen quality.


Phosphodiesterase-5 inhibitors (PDE-5) have several effects with most being minor and the major effect be vasodilatory of the mostly arterial blood vessels. Be weary of articles published in Pubmed especially if you (or anyone) doesn't understand how to interpret the complicated statistics, study design, etc.
There are a few at home tests you can find on amazon. They are certainly not comprehensive but the idea is to tell you if you have an acceptable level of sperm. I think usually they trigger if you are over 10,000,000

I wouldn't trust a sperm count assay on Amazon anymore than I would trust Mussolino.
 
"His testicles were of a low volume (2 to 3 mL) but were firm and nontender. There were no varicoceles present."

That does seem tiny. I wonder how they measure that?

ultrasound.
 
Phosphodiesterase-5 inhibitors (PDE-5) have several effects with most being minor and the major effect be vasodilatory of the mostly arterial blood vessels. Be weary of articles published in Pubmed especially if you (or anyone) doesn't understand how to interpret the complicated statistics, study design, etc.


I wouldn't trust a sperm count assay on Amazon anymore than I would trust Mussolino.

I wouldn't use it as an all encompassing fertility guide but it's a decent tool to know if you are shooting blanks more than anything. From what I've seen it's but used as a guide in that manner more than knowing if you are optimized, so to speak.
 
So you were showing some sperm after about 5 months though. Did your balls increase in size? Were you on medications to help the process along? What was the at-home test you took?
The tests I was using were called "Spermcheck Fertility Home Test for Men" I was actually getting to buy these with my FSA card in Amazon, it was a covered product. My balls did get larger during the 5 months and the amount of cum I produced also increased significantly, however, those increased months before my sperm count caught up. No medications to move it along.

Also, those at home tests are much better than people make them out to be. I remember taking one of the test in late May, and unlike the previous 2 tests I took in March and April, the line in the test strip was faintly present. (This meant I was technically fertile at this point) The next month, in June when I took the test for a confirmation the line in the test strip was present immediately after putting the sample on it. The month before it was barely visible, and took nearly the whole 15 minute test window to see the line, but now, the line was bold and visible instantly.
 
The tests I was using were called "Spermcheck Fertility Home Test for Men" I was actually getting to buy these with my FSA card in Amazon, it was a covered product. My balls did get larger during the 5 months and the amount of cum I produced also increased significantly, however, those increased months before my sperm count caught up. No medications to move it along.

Also, those at home tests are much better than people make them out to be. I remember taking one of the test in late May, and unlike the previous 2 tests I took in March and April, the line in the test strip was faintly present. (This meant I was technically fertile at this point) The next month, in June when I took the test for a confirmation the line in the test strip was present immediately after putting the sample on it. The month before it was barely visible, and took nearly the whole 15 minute test window to see the line, but now, the line was bold and visible instantly.

Yea so in 5 months you became fertile again and saw size increases. This is in contrast to what my doctor and others have reported, that sperm count increases before any size gain. I'm not even sure how your testicles could have increased in size before sperm count increased. My guess is the sperm count was increasing during this time but you just weren't detecting it yet on your at-home test. And you were on no medication. I'm taking HCG, FSH, and enclomiphene now.

Pissbrain259, can you elaborate on why you said "The is anchoring with complete BULLSHIT."?
 
Yea so in 5 months you became fertile again and saw size increases. This is in contrast to what my doctor and others have reported, that sperm count increases before any size gain. I'm not even sure how your testicles could have increased in size before sperm count increased. My guess is the sperm count was increasing during this time but you just weren't detecting it yet on your at-home test. And you were on no medication. I'm taking HCG, FSH, and enclomiphene now.

Pissbrain259, can you elaborate on why you said "The is anchoring with complete BULLSHIT."?
I have come on and off trt numerous times now, and my balls always get back to size after a few months. I only tried getting pregnant once so maybe I am fluke, I feel like my balls come back once my natural test kicks back in, which is usually anywhere from 2.5 - 4 months. I remember watching a video on this topic a while back on J Cutler Tv YouTube channel, and the trt doctor said that virtually all of his patients sperm came back in under a year (over 20k patients). This is kind of the reason I didn't bother going back to the doctor, I figured I would see if he was correct, and save the money, cause if wasn't, I would need to start getting ready to pay major cash if I wanted to father a baby from my own sperm.

Mind you all of this is based on you being able to get someone pregnant in the first place, I personally knew I was capable of this since I was total dirt bag in college and needed to pay for several abortions with random woman. Getting old sucks, mid 30s on trt I shoot blanks, mid 20s on cycles shoot massively fertile loads lol

Time marker 2:20
 
I have come on and off trt numerous times now, and my balls always get back to size after a few months. I only tried getting pregnant once so maybe I am fluke, I feel like my balls come back once my natural test kicks back in, which is usually anywhere from 2.5 - 4 months. I remember watching a video on this topic a while back on J Cutler Tv YouTube channel, and the trt doctor said that virtually all of his patients sperm came back in under a year (over 20k patients). This is kind of the reason I didn't bother going back to the doctor, I figured I would see if he was correct, and save the money, cause if wasn't, I would need to start getting ready to pay major cash if I wanted to father a baby from my own sperm.

Mind you all of this is based on you being able to get someone pregnant in the first place, I personally knew I was capable of this since I was total dirt bag in college and needed to pay for several abortions with random woman. Getting old sucks, mid 30s on trt I shoot blanks, mid 20s on cycles shoot massively fertile loads lol

Time marker 2:20

Thanks yea I've seen him discuss it. I don't know if I'm an outlier or just impatient, we will see. It's now been 5 months, I think I'll do another test in 2 months. If after that 7 months I'm still azoospermic that will be very disheartening as I'm taking everything possible to improve fertility. At that point I would ask my doctor to check other possible causes of infertility and discuss ICSI which is also extremely expensive.
 
Phosphodiesterase-5 inhibitors (PDE-5) have several effects with most being minor and the major effect be vasodilatory of the mostly arterial blood vessels. Be weary of articles published in Pubmed especially if you (or anyone) doesn't understand how to interpret the complicated statistics, study design, etc.


I wouldn't trust a sperm count assay on Amazon anymore than I would trust Mussolino.
I know how to interpret studies. Trust me, I can show Big A my degree. Just wanted to do a quick look and see what I can find as it seems that any little possible thing can help the OP.
 
Pissbrain259, can you elaborate on why you said "The is anchoring with complete BULLSHIT."?

I don't have much time these days for the boards; too busy raising my daughter. And I don't want to put words in anybody's mouth, but I think what my friend Pissbrain is referring to here is the effect of anchoring bias on medical decisions.

The first thing your elderly doctor learned about you was that you were a testosterone user who was azoospermatic and trying to regain your fertility. He immediately took a very dim view of your chances of success, and thus set the bar very low, only hoping to get just enough sperm for ICSI or IVF.

In other words, your doctor essentially gave up on you before you even started. Although in his defense, he did prescribe you the meds that would allow you to try for success. But when the first semen analysis came back badly, that confirmed his pre-existing biases, and he gave up on you completely, neglecting other possibilities that we all know exist from the examples of men (like me) on this board who have fathered children while still using testosterone.

Since your doctor is willing to prescribe HCG and FSH, take the prescriptions from him, but don't take everything he says as the word of God. He's just an elderly doctor who already has his mind made up, a mortal man just like the rest of us, just as prone to making mistakes as the rest of us.

My fertility doctor didn't believe that I would regain my fertility and father a child while still using testosterone.

My daughter is almost 21 months old now, and we took her to the zoo and for her first pony ride last weekend. She is happy and healthy and running around the house all day long. So I guess I proved him wrong.

By the way, my fertility doctor, who was morbidly obese, and who constantly criticized me for having high levels of testosterone, dropped dead of a massive heart attack last month at the age of 43, may he rest in peace.

I'm 53, still using way too much testosterone, and I take my daughter to the playground every day and watch her slide on the slides, swing on the swings, and run around in the sun.

So while many doctors are knowledgeable, some even brilliant, don't ever believe everything someone says just because they are a doctor. We are all just human beings, flawed and fragile.

The intelligent man realizes how much he doesn't know. The humble man is willing to admit it. Find an intelligent and humble doctor.

Sides



https://www.verywellmind.com/what-is-the-anchoring-bias-2795029

"When people are trying to make a decision, they often use an anchor or focal point as a reference or starting point. Psychologists have found that people have a tendency to rely too heavily on the very first piece of information they learn, which can have a serious impact on the decision they end up making.1 In psychology, this type of cognitive bias is known as the anchoring bias or anchoring effect.

"People make estimates by starting from an initial value that is adjusted to yield the final answer," explained Amos Tversky and Daniel Kahneman in a 1974 paper. "The initial value, or starting point, may be suggested by the formulation of the problem, or it may be the result of a partial computation. In either case, adjustments are typically insufficient. That is, different starting points yield different estimates, which are biased toward the initial values."

What illness is responsible for a patient's chronic pain? The anchoring effect can influence a physician's ability to accurately diagnose an illness since their first impressions of a patient's symptoms can create an anchor point that impacts all subsequent assessments.4"


https://psnet.ahrq.gov/web-mm/anchoring-bias-critical-implications

"Multiple cognitive biases contribute to anchoring. The first is confirmation bias, the tendency to selectively seek information that supports initial impressions. In a study of medical students presented with hypothetical patients, the students overwhelmingly sought nondiagnostic data that fit their initial impressions, while only 17% of students correctly looked for further information that could distinguish between major diagnostic possibilities.(8)"

https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-016-0377-1

"Results

All studies found at least one cognitive bias or personality trait to affect physicians. Overconfidence, lower tolerance to risk, the anchoring effect, and information and availability biases were associated with diagnostic inaccuracies in 36.5 to 77 % of case-scenarios. Five out of seven (71.4 %) studies showed an association between cognitive biases and therapeutic or management errors. Of two (10 %) studies evaluating the impact of cognitive biases or personality traits on patient outcomes, only one showed that higher tolerance to ambiguity was associated with increased medical complications (9.7 % vs 6.5 %; p = .004). Most studies (60 %) targeted cognitive biases in diagnostic tasks, fewer focused on treatment or management (35 %) and on prognosis (10 %). Literature gaps include potentially relevant biases (e.g. aggregate bias, feedback sanction, hindsight bias) not investigated in the included studies. Moreover, only five (25 %) studies used clinical guidelines as the framework to determine diagnostic or treatment errors. Most studies (n = 12, 60 %) were classified as low quality.

Conclusions

Overconfidence, the anchoring effect, information and availability bias, and tolerance to risk may be associated with diagnostic inaccuracies or suboptimal management. More comprehensive studies are needed to determine the prevalence of cognitive biases and personality traits and their potential impact on physicians’ decisions, medical errors, and patient outcomes."
 
Great post Sides, thank you for all of that. That's a shame about your doctor, that is very young, but love hearing how great fatherhood is going for you.

I agree my doctor is old and has his bias. I was surprised to then hear the younger more informed endocrinologist confirm his statements though.

I did watch that video of Dr. Rand McClain someone posted, I've seen it before and have actually talked to him. I know he says he has 100% success rate which is hopeful and that's apparently with only HCG, as I know he doesn't typically use FSH/HMG. I'm still holding on to hope. Every time I feel my balls and see they are the same size I get a little bummed but I know you and others have said you didn't see much increase there either.
 
I don't have much time these days for the boards; too busy raising my daughter. And I don't want to put words in anybody's mouth, but I think what my friend Pissbrain is referring to here is the effect of anchoring bias on medical decisions.

The first thing your elderly doctor learned about you was that you were a testosterone user who was azoospermatic and trying to regain your fertility. He immediately took a very dim view of your chances of success, and thus set the bar very low, only hoping to get just enough sperm for ICSI or IVF.

In other words, your doctor essentially gave up on you before you even started. Although in his defense, he did prescribe you the meds that would allow you to try for success. But when the first semen analysis came back badly, that confirmed his pre-existing biases, and he gave up on you completely, neglecting other possibilities that we all know exist from the examples of men (like me) on this board who have fathered children while still using testosterone.

Since your doctor is willing to prescribe HCG and FSH, take the prescriptions from him, but don't take everything he says as the word of God. He's just an elderly doctor who already has his mind made up, a mortal man just like the rest of us, just as prone to making mistakes as the rest of us.

My fertility doctor didn't believe that I would regain my fertility and father a child while still using testosterone.

My daughter is almost 21 months old now, and we took her to the zoo and for her first pony ride last weekend. She is happy and healthy and running around the house all day long. So I guess I proved him wrong.

By the way, my fertility doctor, who was morbidly obese, and who constantly criticized me for having high levels of testosterone, dropped dead of a massive heart attack last month at the age of 43, may he rest in peace.

I'm 53, still using way too much testosterone, and I take my daughter to the playground every day and watch her slide on the slides, swing on the swings, and run around in the sun.

So while many doctors are knowledgeable, some even brilliant, don't ever believe everything someone says just because they are a doctor. We are all just human beings, flawed and fragile.

The intelligent man realizes how much he doesn't know. The humble man is willing to admit it. Find an intelligent and humble doctor.

Sides



https://www.verywellmind.com/what-is-the-anchoring-bias-2795029

"When people are trying to make a decision, they often use an anchor or focal point as a reference or starting point. Psychologists have found that people have a tendency to rely too heavily on the very first piece of information they learn, which can have a serious impact on the decision they end up making.1 In psychology, this type of cognitive bias is known as the anchoring bias or anchoring effect.

"People make estimates by starting from an initial value that is adjusted to yield the final answer," explained Amos Tversky and Daniel Kahneman in a 1974 paper. "The initial value, or starting point, may be suggested by the formulation of the problem, or it may be the result of a partial computation. In either case, adjustments are typically insufficient. That is, different starting points yield different estimates, which are biased toward the initial values."

What illness is responsible for a patient's chronic pain? The anchoring effect can influence a physician's ability to accurately diagnose an illness since their first impressions of a patient's symptoms can create an anchor point that impacts all subsequent assessments.4"


https://psnet.ahrq.gov/web-mm/anchoring-bias-critical-implications

"Multiple cognitive biases contribute to anchoring. The first is confirmation bias, the tendency to selectively seek information that supports initial impressions. In a study of medical students presented with hypothetical patients, the students overwhelmingly sought nondiagnostic data that fit their initial impressions, while only 17% of students correctly looked for further information that could distinguish between major diagnostic possibilities.(8)"

https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-016-0377-1

"Results

All studies found at least one cognitive bias or personality trait to affect physicians. Overconfidence, lower tolerance to risk, the anchoring effect, and information and availability biases were associated with diagnostic inaccuracies in 36.5 to 77 % of case-scenarios. Five out of seven (71.4 %) studies showed an association between cognitive biases and therapeutic or management errors. Of two (10 %) studies evaluating the impact of cognitive biases or personality traits on patient outcomes, only one showed that higher tolerance to ambiguity was associated with increased medical complications (9.7 % vs 6.5 %; p = .004). Most studies (60 %) targeted cognitive biases in diagnostic tasks, fewer focused on treatment or management (35 %) and on prognosis (10 %). Literature gaps include potentially relevant biases (e.g. aggregate bias, feedback sanction, hindsight bias) not investigated in the included studies. Moreover, only five (25 %) studies used clinical guidelines as the framework to determine diagnostic or treatment errors. Most studies (n = 12, 60 %) were classified as low quality.

Conclusions

Overconfidence, the anchoring effect, information and availability bias, and tolerance to risk may be associated with diagnostic inaccuracies or suboptimal management. More comprehensive studies are needed to determine the prevalence of cognitive biases and personality traits and their potential impact on physicians’ decisions, medical errors, and patient outcomes."

Get out of my mind, Sides! :p
 
Get out of my mind, Sides!

Too late, I've taken up permanent residence. Whether I'm a parasite, poet, parent, philosopher, or prophet depends on one's personal viewpoint and purpose. Do as I say, not as I do. But though I see through a glass darkly, in the land of the blind, the one-eyed man is king.

"Sweet silver angels over the sea
Please come down flyin' low for me
One time I trusted a stranger
'Cuz I heard his sweet song
And it was gently enticin' me
Tho there was somethin' wrong
But when I turned he was gone
Blindin' me, his song remains remindin' me
He's a bandit and a heart breaker
Oh, but Jesus was a cross maker
Sweet silver angels over the sea
Please come down flyin' low for me"

 
Dreading on going off trt to get fertile. Ugh I wish I didn’t have to. Also, there are so many conflicting protocols out there. Assuming I have access to everything and I don’t want to wait for spontaneous recovery, what do you recommend out of the gate? HCG/HMG and Enclomiphene?
 

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