How to improve the chance of pregnancy in case of a semen infection?

Patient's Query

Hello doctor,

I am a 45 year old male, and my wife is 26 years. We have been trying to have a baby for the past seven years. I had a sperm analysis in 2011. My count was 68 m, all the parameters were good except the presence of Proteus spp. bacteria. The doctor injected me with gentamycin once, and nothing more. In 2015, I had another sperm analysis. The parameters were still good. The count was 75 m, but pus was seen, and the doctor gave me Ciprofloxacin 500 mg and Tinidazole 600 mg for seven days. Just a week ago, I got another sperm analysis test with sperm count 70 m, but abnormal form 18 % with epithelial cells, bacteria and a moderate growth of staph aureus, sensitive to Rocephin and Augmentin.

My wife's hormonal assay says prolactin is 34 ng/mL when the normal range is 5-25. Also, the vaginal swab shows creamy, non-crystalline, pus cells 3-4, HPF epithelial cells, yeast, bacteria, gram positive, moderate growth of staph aureus, sensitive to Rocephin and Augmentin. Also, my wife was prescribed Parlodel drug (bromocriptine) to normalize her prolactin. In what dosage and for how long should she take this? Is there an alternative that is better than Parlodel? Also, can it be taken together with the prescribed Augmentin and tablet Pan 40? Please advice.

Should I take some sperm-boosting tonic occasionally? What are the antibiotics each of us should take? Should we both take Rocephin and Augmentin simultaneously for it to be more effective? In what dosage, and for how long? We are confused and yet to start taking the medications. Is it safe to make love when we are still under medication? She will be ovulating again from next week. Also, they put both of us on 5 mg Folic acid and her on Ovacare and me on Addyzoa. Should we discontinue these when we take the course of antibiotics? I have attached mine and my wife's reports for your consideration.

Answered by Dr. R Balakrishnan Menon

Hello,

Welcome to icliniq.com.

How are you doing? I have seen your reports (attachment removed to protect patient identity). Let me start on a positive note by saying that she stands a very good chance of pregnancy, but there are some small issues in your infertility treatment which I will try to clarify. Let me explain.

Your age is no problem, as men can father a child at any age, the oldest father is 95 years. Your sperm count is great, but the infection is affecting its health, and it is getting transmitted to your wife.

May I suggest no sex till the infection has fully subsided, which I predict will take a month. If you continue to have sex while still under medication, the infection will keep spreading to each other. So, the sperm will not move well, and will be of poor quality, leading to an abnormal embryo. So, there will be lesser chances of pregnancy, and even if pregnancy occurs, there is a chance of an early abortion.

Also, if the infection in the wife is not controlled, it can damage the inner lining of the uterus and the tubes, which will reduce the chances of pregnancy.

I suggest the following:

Capsule Augmentin 625 mg twice a day for 14 days.
After this 14 days course, tablet Erythromycin 500 mg thrice a day for 14 days.
You can continue the Folic acid and Addyzoa. They will just improve health.
Let your wife have only Augmentin for 10 days.

You need medication for longer because it takes longer to remove the infection from the inner layers of the testis. So, taking a half-hearted treatment of a day or week is not enough.

Get a semen analysis after this one-month treatment is complete. Sperm cycle is such that it takes three months for sperms to come from the testis to the exterior. So, the result of this treatment will be seen only after 2 to 3 months.

Now about the prolactin, I feel that the prolactin is at the upper limit, but does not need treatment. If you start these medications, there will be confusions in pregnancy. I would be more worried about FSH of greater than 7 IU/mL, but it does not seem to be properly done by the lab. For a 26 year old lady with regular cycles that result is wrong, so forget it.

Kindly see if the following checklist of investigations is done.

For the husband: Semen analysis, at least two of them, done four weeks apart, preferably in an infertility center, with culture too and an examination by an andrologist, blood sugars.

For the wife: Blood Sugars, thyroid profile, ultrasound scans to evaluate the uterus, ovaries, and adnexa. Confirm tubal patency, which is the most important. The tube is the connection between the uterus and the ovaries. It is the bridge where sperm meets the egg and forms a baby. It is the size of a hair follicle and cannot be seen on scans. Being such a small opening, the tube can get easily blocked. So, check with hysterosalpingogram, which is an X-ray with dye, or sonosalpingography, which is a scan with a dye, or laparoscopy.

If all this is done and found to be normal, then nothing can stop a pregnancy with God's will. Let me again reassure you that you will get God's bundle of joy, a baby. Be patient and never lose hope. Hope I have cleared your query, do write back. All the best.

For more information consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

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