Sperm DNA Fragmentation 38% - IMSI Failed today

[amandamary]

Sorry about the long post..This was my first IVF cycle..I came to know the hard reality today that the cycle failed even before Embryo transfer..I am not yet able to get through this phase..people who has undergone through the same phase as mine can easily relate.I was undergoing IVF with IMSI..this is how it went..17 eggs collected, 11 matured, 8 Fertilized, 6 looking ok on day 3. On day 5, 3 got arrested 3 remained at early blastocyst stage..day 6 morning, received call from clinic the 3 that remained not suitable for transfer..end of story..

I had a natural conception a year back, sadly ended up in a miscarriage..since all my fertility assesment tests came out normal, male factor was analyzed in detail and found that there was Sperm DNA fragmentation(38%..based on this Male fertility consultant recommended IVF with ICSI or IMSI..

Given today's news of failed cycle, I am not sure what next..

We both maintain a fairly good lifestyle..no alchohol, no smoking, healthy diet plan given by dietitian and so on..DH was on supllements including proxeed plus and impryl for almost 5 months now..

Is there anything that can be done to improve the situation..I understand testicular extraction is an alternative..but then the very question I had before doing this IMSI still remains - how embryologist will be able to avoid fragmented DNA sperm so that we do not end up in another disaster? any proven techniques or protocols for this? Any other treatments/medications to be done to improve Fragmentation based on any of your experience?

And finally, any of you had success stories going through the similar situation as mine?

Hi, our 1st IVF went similar to you with embryos ok until between day 4-5 when they arrested which indicates a sperm problem. My husbands dna frag came back at 52%!!! He is also healthy, eats well, never smoked and had given up all alcohol and caffeine for the ivf and was taking supplements.

I strongly recommend you get a referral to a urologist even if you have to pay privately. Jonathan Ramsey is the top person in the U.K. The urologist we saw diagnosed a varicoele that my DH couldn’t even feel. He had it embolized. I also put him on 200 of ubiquinol. We got intolerance testing done and he came back intolerant to eggs and dairy both of which he gave up. His dna frag has now dropped to 24% which is normal and his count and morphology have also improved. I would say it’s largely due to removing the varicoele. In our last round of ivf we only got 2 eggs and both made it to blast.

Re surgical removal. This was also our next step if we couldn’t get the dna frag levels down. The sperm becomes fragmented during ejaculation so removing it surgically reduces fragmentation a lot. Dr Ramsey apparently also does stuff around timing of ejaculation. Clinics recommend 2-3 days before then day of egg collection but apparently he will get your DH to give samples and analyse them to see when the dna frag is less so maybe it would be that your DH needs to ignore clinic advice and do it the day before collection and give his sample on the day to minimise frag.

Just to add, I would not do another ivf until you at least try get frag down as you will likely have the same outcome and no point in putting yourself through it.if you can’t get it down then push for TESE.

@Thiswillbeaneverlastinglove - thank you very much for your reply.
It was lovely to know that you had two successful blasts on your next cycle.

Sorry, I did not mention in my post it was Mr Ramsay who was looking my DH's case. As you said, without doubt, he is top-notch. Physical examination for varicocele was done and no signs. And abstinence was 12 hours for ICSI. And we both were on supplements including ubiquinol for the past 3 months. Still this result!

Wondering if we should try intolerance testing?

I am exploring all possible options, to see anything that we can do to bring the fragmentation level down.

Including TCM by Dr Zhai..

It could be worth trying intolerance testing but in my DH case I do think the varicoele was the cause and reason we got a better result.

If you are with doctor Ramsey and he is suggesting TESE then I would go with that. There was a thread on here ages ago where women were posting saying they only got pregnant when they went to surgical removal when no cause for frag could be found.

I would do this instead of spending lots of time trying alternatives unless you are young? My DH took TCM for 3 months at one stage but it actually made his results worse.

Sorry to hear this. Our IVF story with ICSI is very similar -our numbers aren’t a million miles away from yours either. We got 5 5 day blastocysts in the end, transferred 2 which failed and subsequent tests said all 3 were abnormal. Like you, we have done the whole ubiquinol and antioxidants, plus starts with an egg etc etc. DNA fragmentation test the other week said 35%. So we are at a loss

TESE is something l have heard of.

@EL8888 sorry to hear about your situation too. I would recommend you try TESE. A lot of women get nowhere until the sperm is surgically removed and my consultant said it’s similar risk and pain to egg collection so it seems like a sensible option to me if frag can’t decrease otherwise.

We didn’t actually PGS test our blasts as we only got two. One transferred and negative so they could both be abnormal too for all we know. I respond so badly to the meds we will never get plenty of blasts to test. It’s very tough.

Sorry to hear about your failed cycle. I would highly recommend seeing male fertility expert before your next cycle. We went to Mr Ramsay he's a very known expert here. You got lots of eggs and great fertilization rates, you may try to get sperm to its best quality and ask about PICSI and MACX next time these are methods of selecting healthy dna sperm. Good luck for your next cycle!

@Thiswillbeaneverlastinglove - Thank you for your suggestions on the intolerance testing - understand in your DH's case it was Varicocele, but I think, we'll give it a shot. Regarding TCM, I think, will re-consider going for it, given the kind of result your DH had. And yes, looking forward for the next appointment with Dr Ramsay to understand our next options..

@Viletta - Thank you for your reply.

My thoughts were the same before we actually decided for this cycle. I was wondering how the clinic is going to differentiate a fragmented sperm from the normal ones. AFAIK IMSI will not be able to do that, except for the fact that embryologist can view the sperm a bit more detailed, it will not be able to tell whether the sperm(s) they chose for injection are fragmented or not.

I asked this question to our IVF consultant during our initial consultation at the clinic as to why MACS is not used for which I got the reply, it's not proven. Though I was not convinced, we decided to go ahead as I thought the clinic knows things better and will do everything possible to give the best possible outcome. I wasn't told the PICSI option as well. I'm not saying that had we done PICSI or MACS, results would have been different, but we were not offered a choice or rather we were not told about it.

Waiting for our appointment with Dr Ramsay to see our next steps.

@amandamary ask Mr Ramsey, when I researched these methods there seems to be lots of scientific methods confirming positive results. Both methods were included as free bonus in our cycle however we got too few spermatozoids to use either of the methods. Our DNA fragmentation is actually okay it's the amount of a sperm that's the main issue. Mr Ramsey correctly said that in our case the amount will never increase but we can increase the quality. Our first round before any treatment we had 9 eggs 3 fertilized, 1 embryo looking okay day 3. Second round 9 eggs, all fertilized, 3 embryos good quality on day 5! The last one was the one that worked my due date is today:) good luck for your next cycle, in a way male aspect is somewhat easier to deal with than female.

@Viletta - "my due date is today" - Wow, that's awesome..Warmest congratulations!! Wish you loads of luck, and I'm sure it's going to be all good :-)

Are you aware of any clinics in and around London that is well known for MACS?

And yes, looking forward for our next meeting with Dr Ramsay..

Forgot to add..please reply only when can :-)

@amandamary thank you! we had our second cycle in Reprofit in Czech Republic. They have good success rates and much easier and cheaper than the UK clinics. Also more options like time lapse microscope that monitored cultivation of blasts without having to take them in and out, we also got all updates online. Sorry can't help with clinics in London but I'm sure some of the best ones must be there.

My DH’s DNA frag was 52%, so we went to both a nutritionist and Dr Ramsay. Whilst we are both within the normal BMI range and slim we were put on a mostly organic diet (high green veg concentration) and high protein diet, with a significant reduction of dairy and carbs. Strictly no processed meats and to avoid takeaways and acidic food like curries and heavily spiced food. My DH was taking all sorts of high fat nuts mixed everyday (Brazil, almond, hazelnut, pistachio, macadamia- high in selenium, magnesium), seeds, raw organic makuhu honey, maca root, ashwagandha as well as proxceed on a daily basis for over 6 months before we started IVF. We also changed our hygiene and beauty products too so we weren’t absorbing any synthetic or toxins into our systems (toothpaste, shampoo, creams, lotions etc.), my DH changed all his undies to organic cotton too. I don’t know whether it was OTT or not but this is what we did.

We only met with Dr Ramsay for a first consultation, and he done a physical assessment of my DH’s private parts without washing his hands or wearing gloves which really put us off seeing him again or following up with his recommended assessments (which are btw x4 more expensive than other urologists).

After the dietary changes my DH’s DNA frag came down to 30%, but it takes both a strong egg and sperm to make a strong embryo, and with a nutritious diet and active outdoors lifestyle it did pay off once we started IVF ICSI.

First time IVF. We got 24 eggs, 22 fertilized, 16 made to day 3, 11 made a day 5 blast, transferred 2, froze 9. Now I’m 15 wks with twins :) - btw i really didn’t like my clinic advising me again and again that they would recommend 1 embryo transfer because I am under 35, that’s BS.

I think lifestyle, health, environment, stress are all a major factors in the quality of our cells - including the quality of the egg and sperm, so I would recommend working on these.