Infertility - Next Step?

We have been officially TTC since my surgeon gave me the ok last August.  My cycles were like clock work and my ovulation signs were like flashing neon.  When I didn't get pregnant right away went to my gyno and she said everything looked great and suggested DH get tested.  His counts were very low with issues with what he is producing.  He went to a urologist who suggested his out of control diabetes was probably the cause.

Everyone has been telling me to be calm and wait and it will happen.

He has been doing better (taking his meds and eating somewhat healthier) but his A1C is still high and I am still not pregnant.  I am 35 and am starting to panic. 

Who do I go to talk about our options?  Do I go to my gyno?  Does he go back to the urologist? 

I would take a copy of his lab analysis and have a consult with a fertility doctor.

Your hubby needs to be working with an endocrinologist that is experienced in fertility issues in males.  You two are BEYOND a regular gyno, get to a reproductive endocrinologist fast.  Not to scare you but if you need to get on a regiment of drugs it will take a few months to be evaluated thoroughly, administer the drugs to hubby and get new counts.   I'm surprised the urologist did not suggest that to you.   "It will happen" is not the appropriate answer here.

Plenty of diabetics are able to impregnate.  Unless his A1C is up around 10; is he having trouble getting erections?   That would be an indicator.  Due to the acidity in what he's putting out you two might be creating a "hostile environment" in your vagina in which his sperm cannot survive to make the roadtrip to that egg.   That's a possibility.  Cutting the carbs in his diet will definately regulate his hormones and make everything operate better.  It's the same premise as when we had our WLS and the hormones raged the first 6 mos. when we were at our strictest carb limitations.  Those were also the months it was easiest to get pregnant, even with 2 forms of BC!

DO NOT let his docs put him on gel testosterone.   That acts like birth control and kills the swimmers (lowers the count drastically) and a good RE would know that.  He'll need injectibles; that will increase the count and the motility.  I had to give my hubby 3 shots a week in his thighs while we were trying as he had a zero count.  I swear it hurt me more than it hurt him; at least that is what he told me.  Because he had a child in a previous relationship we thought he was fine and because he was on testosterone for low volume due to prostate issues we thought that would help (his urologist put him on gel and never mentioned it would kill the swimmers within the volume, we had not mentioned that pregnancy was our goal, we wasted 6 mos. trying on our own, 1 IUI and almost a second before my RE did an SA).   As soon as he got on the injectible his counts went right up, within 2 months they quadrupled.   Secondly, if you are able to afford it or have the insurance coverage you could do ICSI.  Here's a site with an explanation:  http://www.infertile.com/infertility-treatments/icsi.htm   Basically, it's the next step after IVF, wherein they harvest from both of you, put everything together in the lab having chosen the best and brightest of the samples, grow them out some and then go back and implant in you.  That would give you a child with both your genes if that is the goal. 

Best of luck, it's more difficult than usual but it is not impossible.  You have options and your age is still in your favor!

His A1C is down to about 10, he was over 14 last year.  He is refusing to go on insulin. 

He says he doesn't care if the child has his genes or not but I want to know what all of our options are before we make any decisions.

Thanks for the info.  Guess I need to find a specialist.

My husband's sperm count was fine, but his testosterone was on the low end of normal.  My husband was put on the gel testosterone and his sperm count shot up even higher and we got pregnant on that next cycle.  So, as far as the gel testosterone the other person posted about, we were recommended to try that by 4 different drs and it worked quickly! 

The fact that your husband's sperm count was fine is why the gel worked for him (and I'm happy it did)...his testosterone was low, not his sperm count...our husband's sperm is low....totally different issue.  Testosterone does alot of things in and for a man's body; it gives him energy, strength, keeps his bones solid (not having high levels of testosterone in a man can lead to him developing fatty breasts (even breast cancer), osteoporosis, even neurological issues.  It is what gives him his erections but being able to get it up does not mean that what he *********s is viable (thus the term "shooting blanks").   Our husbands ********* but it is empty liquid.   If you've got low testosterone and low sperm that's another issue.   You may need cialis AND injections. 

Both the websites for AndroGel and Testim, the two popular gels, warn against prolonged use if the intent is reproduction as high doses cause lowered sperm counts because gel products are quick acting and have a short life in your bload and you must use them more often to keep them in the blood stream to get erections.  Also, DO NOT go near a newly pregnant woman when the gel is wet as the hormones involved can transfer and cause birth defects in a developing fetus.   The injectibles have a 10-14 day life within the blood stream making the sperm count levels more consistent throughout the month and more dependable for trying to conceive. 

As I posted to the original question, this stuff is complicated and shouldn't be handled by just any gyno or urologist as it is more in the reproductive endocrinologists realm.   Just wanted to clarify my earlier info, feel free to check the websites.