IVF Disasters: No sperm on day of egg retrieval

June 23, 2010Carole 2 Comments »

Once or twice a year, we would have an IVF case without sperm on the day of retrieval. This problem is rare and happens less than one percent of the time. Anxiety about being able to produce a semen sample on egg retrieval day is something a lot of IVF patients worry about. Fortunately, problems can be avoided with a little planning.

First, if possible, become familiar with the collection room and collection procedures before the day of retrieval. Hopefully, you’ll have a semen analysis before you go ahead with IVF. Many fertility labs will also perform your diagnostic semen analysis and you’ll have a chance to collect a specimen on-site before the day of the retrieval. Once you know where you’ll be to collect the specimen, know whether you’ll have magazines, videos or DVDs at your disposal, hear the spiel about semen collection and figure out that the collection door locks securely behind you, you should feel less anxiety about the big day, because it will be old hat by then. Even if your IVF team doesn’t do semen analysis, having had to “perform” once before to produce a diagnostic sample can be helpful in reducing your anxiety on the big day.

If you can’t do a practice run, don’t worry. The basics of semen collection are similar everywhere and not really that scary, in spite of the way the movies play it.

Registration: You’ll be asked to register or log in when you arrive. The formal registration process is for billing purposes and also ID verification. Sometimes, the front office staff does the billing registration and then you are off to see the lab. Sometimes the lab does both.

At the lab: You’ll likely be asked for a photo ID to make sure you match the labeling and paperwork prepared for you. You might be asked to put your name on your own collection cup or verify that the pre-labeled name is you. The collection cups are sterile plastic cups that you’ve probably seen before if you have ever given a urine sample. And -NO!!- you are not expected to fill the whole cup. If you did, we’d refer you to the urologist because your semen fluid volume is abnormally high. Most samples are only a teaspoon to tablespoon full.

Collection Room Etiquette: You’ll typically be shown into a small room dedicated to sample collection. Less often, you might be sent to a public bathroom but hopefully this is not the case. In fact, not having a private collection room for semen collection may be a good reason to seek another provider.  One of the lab staff or sometimes a nurse may give you a few instructions before you are left on you own. There may be more forms to fill out. You might be instructed to wash your hands before collection and to use masturbation to collect the sample. Don’t be embarrassed. The clinic staff have given this spiel a million times before and it’s no big deal to them. They really aren’t looking at you funny- well, unless you start in with the off-color jokes or asking the staff for “help you”  in the collection room. Then you might just get a funny look.

Collection rooms  are typically a small bathroom which may have a separate sitting area with a DVD player, video player or magazines. There may be a radio to provide background noise so you can’t hear the clinic traffic. You can usually dim the lights. You can always lock the door for privacy. You can ask in advance what materials are available to help you. It’s a fair question and you certainly won’t be the first to ask. Some patients bring their own magazines, videos or DVDs.

A tip for the ladies: Generally speaking, if you want to make semen collection difficult for your partner, accompany him into the collection room. It almost never helps and often causes problems. What should be a simple plumbing exercise is turned into a big emotional thing. He knows you want to get pregnant and this is all very important to you. Reminding him of that just adds to his stress. Increasing his stress increases the chances that you won’t have a semen sample for your IVF case. What should take 15-30 minutes takes 45 minutes to an hour and a half. Sometimes, it never happens. It’s best to let him fly solo on this one.

Plan ahead. Wives and girlfriends almost always make the semen collection appointments for their partners. You can ask the staff on the phone when you call what materials are available to your man (magazines?, videos?, DVDs?) and if he can bring his own materials from home. Often, once he knows that he will have some visual materials, he relaxes about needing you to come in with him.

Collection Condoms: Sometimes for various religious, cultural or personal reasons, patients refuse to use masturbation and ask to use a non-spermicidal collection condom with their partner to collect the sample. The clinic will have to provide you with a collection condom in advance.  Collection can occur at home or at a hotel nearby if the collection room is not outfitted with a couch. Using a collection condom and traveling (should be less than 30 minutes away) with the sample is sub-optimal for the best sperm quality but is certainly better than no sample at all.

Second, Collect and Freeze a Back up Sample. If you are still worried that you might have problems on the retrieval day, you can ask the lab if you can come in, produce a sample and have it frozen and stored at the lab for a back-up. If you have an really poor sample and are expecting to need ICSI on the day of the retrieval, freezing may not be a good option since freezing and thawing typically results in loss of half of the living cells in the sample. Your lab should be able to advise you.

Some couples may have a donor back up sample on hand as back up if the partner’s sperm sample is particularly poor. Obviously, if you have a donor backup on hand, be sure that you are really comfortable with having donor conceived children, because it may be necessary to use the donor sample. Don’t order a donor sample if you don’t want the lab to use it in an emergency.

In my experience, back-up samples are almost never needed because no-sperm disasters are rare. However, having a back-up sample might have been helpful insurance against needing it by providing some peace of mind about the day of retrieval. You will likely have to pay for preparation of a back-up sample so ask for a cost estimate in advance.

Third, when all else fails, freeze the eggs. When looking for a fertility clinic, ask about egg freezing. Do they offer this service? How much experience does the lab have with egg freezing? Have they ever had a birth using frozen eggs? If yes, what is the birth rate using frozen eggs? Fresh is always the best way to go, but freezing eggs in a pinch is not the long shot it once was. In some labs that are very experienced with egg freezing, the pregnancy rates are very comparable for IVF using fresh or previously frozen eggs. Freezing the eggs buys you the time you need to produce a semen sample on your own terms, without stress. Once you have collected and frozen a specimen, a second IVF attempt can be arranged a month later. The female patient is primed for a frozen embryo transfer.  Eggs and sperm are thawed and used for IVF and hopefully, you have an embryo transfer and pregnancy.

© 2010, Carole. All rights reserved.

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