How likely are we have to bio-kids?
March 14, 2017 5:44 PM   Subscribe

Five years ago I started hormone therapy as part of my transition to living as a woman. My loving parents were nice enough to pay for me to bank sperm before I started HRT, because I knew I wanted kids. Five years later, and I am panicking that there is no way in hell that any kid we have will have my DNA. How do I go about figuring this out?

As a 21 year old, I was not very cognizant of the difficulties people can have trying to get pregnant. Additionally, I was broke and couldn't afford to bank more if I wanted to. What I do know (from my chicken scratch notes that I attempted to take while on the phone with the sperm bank ages ago) is that I have four vials of sperm, at apparently 6.8 million per mL, and 1.0% motility.

I have googled and visited about a million conception forums, and I am not sure if it's my panicked confirmation bias or not, but it seems like this is a ridiculously small number of vials and if there are any difficulties conceiving, my fiancee and I are screwed. Is this right? How do we bug a doctor with these questions if we're not ready to start trying for kids yet?

Because the secondary factor is, if this isn't enough sperm to be a sure thing, I want to know now so I can then go on to my next set of questions to the internet and doctors. Which is, is it too late to stop taking my HRT for however long it takes to get some fertility? I have no idea if anyone even knows this answer to this, and I am really scared that I am never going to have a kid of my own. Which isn't the worst thing in the world, but at the same time it kind of feels like it is right now.

Please point us in the right direction? How do we start figuring this stuff out?

Also we're getting married in freakin 24 days and that probably isn't helping my stress right now so I'm sorry
posted by motioncityshakespeare to Health & Fitness (12 answers total)
You can totally bug a doctor with these questions even if you're not ready to start trying for kids yet. My partner is trans and while he ended up not transitioning, we met with several doctors and even made some deposits of sperm even though we had no idea whether he'd need them or not. We also talked through the possibilities with the doctors at the reproductive facility clinic where we'd have had to do the IVF. Never met a single one who was dismissive (and if there was one, it would be their issue, not yours). I think these are excellent questions to ask a specialist at an IVF clinic. Call up the place where you banked your sperm, ask for a short consultation, and you'll be able to get an informed picture and stop worrying.

(Also, congrats on the marriage!)
posted by forza at 6:05 PM on March 14 [2 favorites]

Are you sure about that 1% motility? That sounds very off.

Also, you haven't said how old your fiance is. This will make a big difference.

Given that you have a limited number of chances, I would suggest that at the very least she have fertility testing done before you get started, especially if she is older.

If you want to go all out aggressive, I would A) Bank your fiancee's eggs immediately if you don't plan to start trying right away. Younger is better. Maybe do several cycles worth of banked eggs so you have plenty. I saw a news story about a bank in NYC that specializes just in banking eggs (they dont do any fertility treatment, they just retrieve and store eggs) and this is somewhat cheaper than doing it through a fertility clinic, but still not cheap. Younger eggs are better. Like a lot better. Seeing the older and younger egg results compared on graphs is the most depressing thing ever.

The advantage to this is that however many eggs she ends up with, they can ALL be fertilized from one vial. Given you have a limited number of vials available to you, it makes sense to do the kind of in vitro where they don't just put the eggs and sperm together in a dish and hope for the best, but instead take one sperm and physically inject it into each egg. (I'm not expert, but it seems logical that if motility is an issue, this would counterbalance that since there's no need for sperm to swim up to the egg).

Unless you absolutely cannot afford in vitro, and especially if you want more than one kid, I don't think it makes sense to blow your vials on IUI. Basically with IUI you'd have 4 chances, with maybe 4-32 eggs (how many eggs they allow your fiance to ovulate at once will depend on her age and what they know of her fertility, but if they allow more it's because they think the chance of any one being fertilized is low, so it's not really better odds). Lots of couples having regular old sex take more than 4 cycles to get pregnant. With in vitro you can use one vial for all the eggs she can stockpile, make as many embroys as possible and still have 3 vials to try again with more eggs if necessary.
posted by If only I had a penguin... at 6:07 PM on March 14 [2 favorites]

Is there any reason to think your fiance has any factors that would complicate getting pregnant? I got pregnant twice with donor sperm via IUI (which doesn't necessarily involve the kinds of hormone prep that result in multiple ovulation—in my case, because there was no reason to think I'd have trouble conceiving, we basically just inseminated). If you're on assisted conception forums, you're most likely talking to people who are moving on to IUI, in vitro, hormones that lead to multiple ovulation, and so on, because they've been trying to get pregnant and weren't able to without assistance. In my case, it was just that my partner was a trans man, and I had no difficulty getting pregnant. We bought three vials, and after our second kid was born still had one left over. Not everybody is as quick to kindle as I was, but IUI (where the sperm is inserted directly into the uterus via a catheter) on a woman who has no fertility issues and who is definitely ovulating, well, the odds are pretty good.

Your motility number sounds really off and I'd double check to make sure you got it right.

I'd like to reassure you, as well, that as important as DNA feels to you right now, it will probably work out OK if you have to make another decision. We've got two kids who are my biological kids via donor sperm, one we adopted as an infant, and one we adopted as a young adult (a trans kid who had been kicked out by their biological family), and I gotta tell ya that love is love, and the day to day ins and outs of parenting are what really bind you together. I don't mean to disparate your desire for a biological child, and I totally support you in figuring out a way to make that happen. I just want to say: it's going to be OK.

Congratulations on your upcoming marriage, and all my best wishes to you and your fiancee.
posted by Orlop at 6:22 PM on March 14 [14 favorites]

I know about some fertility stuff but not that much about sperm. Assuming your vials are relatively normal for a vial of sperm, assuming your fiancee is around your age, and assuming she has typical fertility, there's a good chance she'd get pregnant in four cycles of IUI, but also a good chance that she wouldn't (or would get pregnant but miscarry). I definitely would not rely on anyone having a child with four chances at IUI.

However, as If I only had a penguin... says, IVF is different. If you do IVF, then all the eggs your fiancee produces can be fertilized with your sperm, and if she's young-ish & doesn't have significant fertility issues, she is very likely to get pregnant from a few (or even one) cycle of IVF. My understanding is that freezing embryos (really blastocysts) is better than freezing eggs, so egg freezing wouldn't necessarily make sense. Depending on her current age and the age when you'd want kids, embryo freezing might or might not make sense.

The last I read about it, there wasn't any good research on trans peoples' fertility, other than knowing it varies. One thing to keep in mind is that you don't need to have a "typical male" sperm count for succesful IVF - they just need to be able to fertilize a couple eggs. You could consider visiting a fertility doc soon-ish and asking for a semen analysis of some kind; they might be able to tell you if you're currently producing any viable sperm. If you are, you could consider freezing embryos now, if that's something your fiancee is interested in doing.
posted by insectosaurus at 6:32 PM on March 14 [1 favorite]

Fiancée is only 25, so luckily age isn't as much of a concern right now. And we have no reason to assume she'd have fertility issues, but also no reason to assume she wouldn't..

The concerns we have with ivf, freezing eggs, or freezing embryos is the same for all of them, finances. We are currently scraping by on my salary and student loans while we both go to school full time. We have essentially no money.

However, your advice and perspective is all appreciated. I knew logically that those forums wouldn't be the same as our situation, but it's hard to keep that in mind when you're reading emotional stories about not being able to conceive.

What is the "normal" range for motility? And if the 1% is actually correct, does that make IUI more off the table?

With IVF, so long as her eggs are young enough, it doesn't really matter when we do that, does it? If we have the money to do it three years when she's 28 and we're out of school, the sperm aren't going to be negatively affected by the years of being frozen? And we do just want the one kid so hopefully that would make it cheaper.

We'll definitely do fertility testing before we start the process, regardless. Orlop, I hope we are as lucky as you. Thank you for sharing your story, it's nice to be reminded that sometimes it is just that easy. And if we end up with kids that aren't mine or aren't ours, I know we will love them just as much. I just hope that I can be selfish for this one thing.
posted by motioncityshakespeare at 7:05 PM on March 14

What is the "normal" range for motility? And if the 1% is actually correct, does that make IUI more off the table?

Where I did IUI, they wanted motility to be somewhere around 40%. There was a lower percentage requirement for morphology (and there are different methods for determining that - this place went with something called "strict morphology"), more around 3.5%.

I don't know about long-term viability of sperm in a cryo situation, but if you end up doing IVF, they can basically just inject a single good sperm into an egg and be fine.
posted by LionIndex at 7:19 PM on March 14

To clarify the motility number - I never reached 40%, but we did the IUI procedure a number of times (unsuccessfully). If 1% is your motility number and not your morphology, I don't think IUI is in the cards for you.
posted by LionIndex at 7:21 PM on March 14

if she can, she should have her fertility testing done NOW, so you know how urgent an issue this will be eventually. If you're grad students presumably you have health insurance which presumably would cover this. It's covered by provincial health insurance in Canada. Maybe in the US she'd have to say she'd been trying to conceive for a year.

There's a blood test your fiance can get that predicts how many years she is likely to have before menopause and more importantly, how many years before her fertility is near nil (I didn't know this, but apparently that happens well before menopause). Obviously you want to get in on the baby-making well before the "near nil" stage since it declines well before that. Anyway, the blood test costs about $40 even if you have to pay out of pocket, as I recall, so it seems like definitely something worth looking into. I don't remember what it's called, but essentially it measures her stock of eggs by measuring how many eggs are developing at any given point. It can be done at any point in the cycle.
posted by If only I had a penguin... at 7:52 PM on March 14

LionIndex is correct, the procedure is called ICSI and they inject the sperm directly into the egg. I had IVF using this procedure last year and the result of it is currently sleeping in his crib.

Your mileage may vary of course but what we were told was that 'male factor' issues are much, much easier to fix than problems on the female side. In our case, my results were all fantastic and we were blessed that it worked on the first try.
posted by ficbot at 7:59 PM on March 14

I would double check the 1% figure for motility - 'normal' is 32+%, although it is possible that this is correct.

It's also possible that 1% is the percentage of normally shaped sperm (morphology), where (depending on testing criteria) 4% is the 'normal' cut off.

In either case this is likely to be enough for 4 rounds of ICSI - then only a single motile sperm is needed per egg, with decent chances of success as others have said.

The damaging part of the process is the freeze and thaw, you can expect to lose around 50% of the sperm through this, but length of storage doesn't seem to affect survival (and half of 1% of 6.8million/ml is still a lot of sperm relative to egg numbers).

Congratulations on your marriage!
posted by limoncello at 12:23 AM on March 15

The usual blood test done for ovarian reserve is anti-Mullerian hormone (AMH).
posted by treehorn+bunny at 10:41 AM on March 15

I don't know anything at all specific, but you went to a sperm bank for the stated purpose of preserving your future fertility. And what everyone's saying is that 1% motility is really really really unusually low, to the point where it probably won't work.

If the sperm bank is remotely competent, someone would have flagged that for you when they gave you the results, which suggests to me that your handwritten notes are just wrong. Can you call them and check their records, rather than worrying about what your notes say? That seems like the first step before fretting about it.
posted by LizardBreath at 1:30 PM on March 15 [1 favorite]

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