MFI and DNA fragmentation

[Piapea]

Hi everyone
I'm looking for some advise or positive stories from couples with MFI. My partner has just had his semen analysis results back. His count and morphology are low. He had a varicocele treated about 3 years ago and had a normal SE last year, so I'm struggling to understand what is going on. The varicocele could be back I suppose, I have no idea how common that is. So it is recommended that we have ICSI. I am now getting stuck into these boards and reading everything I can about IVF with MFI and I have a lot of questions about DNA fragmentation. I am really worried that we will start IVF and everything will fail because maybe the DNA frag is high. I called a couple of clinics yesterday and they said they don't offer the test to outside patients. If anyone has any stories /advice, I'd really appreciate it. I just can't decide what our next step should be.. DNA frag first or just do IVF and see what happens

@Piapea hi Op, I don’t know if it helps, but if you visit then Examen Lab website they have a list of providers. Is he under a urologist at the moment?

We had it done as per advice on here because we were not in a position to waste our one round of funded ICSI, and our funds for private will run down quickly if we have to keep doing this. Anyway, we saw a urologist who did run that test, DH’s results came back with 0% high frag results (this was in July after 3+ months on supplements including impryl and ubiquinol, not sure if that made a difference) despite his low motility and he cleared us to start ICSI. We have now just done our first round of ICSI and had a positive fertilisation and embryo outcome so far. 13 mature eggs, 9 fertilised and 4 embryos in the freezer. He’s 40 and I’m 38. Obviously if we’d gone ahead without that appointment we would have had the same outcome because no high fragmentation was found but I’m glad we did it in case it had been another outcome and we’d have wasted our funded round and had to move straight into private.

Totally your call but with a low count I’d probably want to get them checked a little further if possible to make sure what’s their is in good shape, we didn’t have that issue, ours just didn’t like moving.

Hi @thislittlebird, thanks so much for getting back to me.
This is exactly what I'm thinking.
I really don't want to waste my one free round on the NHS. As you said, it would be good know the true situation before we start and get our hopes up. From what I have read so far, it seems that if the DNA frag is high, then the only real hope is taking supplements. I guess I'm a bit afraid of losing the little bit of hope that we have right now.

We are thinking about going private as I'm 37, my referral was made 5 months ago and I still haven't heard anything. I guessing this is normal but it feels like a long time right now. I'm having a private scan this week to check the state of my eggs, I guess I'll be in a better position to make a decision after that.
Thanks again for getting back to me and the very best of luck with your transfer x

@Piapea it’s hard, but you’re probably better off with all the info even if it’s not the best news. Our route to get this far was very long, and very exhausting, but I am glad we spent the time waiting with DH on all these supplements as I will assume they helped in terms of dna quality and antioxidants etc. Definitely see where you stand before you spend any money privately, and the wait until your nhs round might give you time to improve some results. Hopefully you have good results from your tests too. Good luck!

Waiting is the worse! Every time you think you're off to the next step, there is something else you've got to wait for... pff

I know! I'm really feeling the pinch with time at the moment. I was referred for fertility treatment by my GP back in October but I haven't heard anything back. I had a baseline scan today in a private clinic, now I have to decide if I should jump on board and just pay for treatment to start soon or keep waiting for the NHS. It could be an opportunity to fill my partner up with supplements to give his terrible swimmers the best shot for the next few months but....it's a lot of money🙈

Hi @Piapea , do you not even have a date for your initial appointment? I was referred mid Jan and was sent a date for a phone consultation but it was booked for July which I couldn't believe and was pretty upset about. I called them and they said call up every now and then as they can put you in a a cancellation slot. Maybe you could give this a go? I have just had my appointment and because of low count and morphology we would be eligible for IVF straight away (this isn't the case if it's unexplained). They are applying for our funding and we just activate when we need to. X

@FlyOnTheWall89 can I ask what area you are in? July seems like a long way off, I can see why you were upset!
I saw my acupuncturist on Monday. She specializes in fertility so sees a lot of people in my situation and she was surprised I haven't been contacted, at least initially yet. She said that in my area (south west), she has heard of people being contacted much sooner.
I didn't know that MFI would be accepted for treatment sooner, that gives me some hope I guess!

@Piapea I'm London. Absolutely - I didn't think that would be the outcome of my conversation with the doctor either. I presumed maybe they'd refer my partner or something but no, you should be able to get your situation moving. I would also be concerned why they've not been in touch... maybe you've been missed or something. Definitely follow up! X

@Piapea what kind of supplements are you thinking of? Have you checked asda pharmacy or amazon prices?

I got Proxeed for both of us but I've also heard good things about impryl for MFI. They are about ,£30-£40 for about 30 days so are pricy. I just bought from amazon.

@Piapea ye it's expensive, but it will either improve things prior to medical intervention, or it will improve things for a BFP so it's worth it. Impryl is really good too - some clinics recommend a day of Proxeed and a day of Impryl on alternate days. Reviews of both are very good, so I guess try one and see how you get on! Xx

Hi everyone, I know this is a bit of an old thread but I am interested to know if anyone else is in our situation. My husband has really bad dna frag and SA. We get 2-3 euploid embryos every time but still haven't been successful. Just wondering if anyone else with high dna frag gets a good amount of euploids but still doesn't work? Thanks and very sorry that we are all in this boat.

Hi @Penny19 - we are not quite at this stage yet but presumably your OH has been checked for a varicocele and you're doing ICSI? Have you not been given any reasons why perhaps it isn't working?

Oh yeah we've been doing this for three years so have had all the tests done. We do ICSI / IMSI due to his high frag. The drs just say that even though they're euploid we don't know if there is dna damage in them hence why it's not working. Hoping it's just a numbers game but that was why I was interested to know if people have had euploids transferred with highly fragmented sperm. All so complex!

Hi @Penny19, as @FlyOnTheWall89 said, my partner and I aren't quite at the starting stage yet.. hopefully another month or 2.

This is my biggest worry at the moment. That even going through ICSI, there will be some unexplained reason that it just doesn't work.

Has your partner been taking supplaments like

Try not to worry as so much of it is random, it could be a problem with me that I am miscarrying euploids. He has been on all the supplements and diets recc'd by Mel Brown the fertility specialist. It didn't improve much but it didn't get worse. For our last round we did TESE (operation to extract sperm directly from the testes) and we have 4 euploid embryos on ice from that so we shall see if that made a difference. They did another frag test on him before the operation and it had got much better in that only 18% were highly damaged - which is our best result. This time he took in 300mg of coq10 (must be in ubiquinol format) to his supplements as this wasn't initially recommended- so I strongly recommend that as I think that must have been what made there difference. I think next steps is full investigations into me before we transfer anything. Happy to answer qs you have if you're v early on in the process - not much i don't know now we are 3 years in!

Hi @Penny19 myself and another online friend found we weren’t making embryos or embers of any kind of good quality until the DNA frag was reduced. I was told DNA frag can cause poor quality embryos and increase chance of miscarriage even if one implants so I would be surprised if dna frag was causing your issues when you’re managing to get embryos good enough to be biopsied and also coming back as normal which should hugely reduce chance of miscarriage.

How many transfers have you done? And have you investigated anything from your side as to why they might not be implanting?

Yeah, I think you are right @HiltonB that is the typical issue but the drs won't rule out that the euploids have dna damage and could be causing issues later on in the development. i have done 4 transfers - we are now doing all the immunes etc. had most other investigations done after 3 miscarriages but now going to go next level up. Where are you at in the process if you don't mind me asking?

Hi @Penny19 I’m now pregnant but it took 5 years and 6 rounds of ivf. I just reread your last message and think it’s great you did TESE as I’ve heard of it only working for some women when they took the sperm out surgically as that helps lower DNA frag.

For you alongside immunes I would recommend checking if your implantation window is correct (ERA), checking for infection/bacteria in your lining (Emma/Alice or menstrual sample via Serum in Athens/Fertility sis). Checks on sufficient progesterone levels (this test should be done alongside ERA). And ignoring any consultant who pooh poohs this stuff as for me and several others it was only after this a transfer worked and cost is less than half the cost of a round of IVF!

Thank you @HiltonB and a massive congrats! Gives me some hope it can happen with dna frag, even though I think my husbands is still not great. And thank you for the advice, I am at the Lister under Dr Thum who has already ordered all of the above! Pleased to hear it gave you some answers. Agree re progesterone, definitely one miscarriage I had was due to me suddenly not absorbing the progesterone despite it being tested on day of transfer- so I've been on injectables every since! Thanks again!

@Penny19 I was also with lister and they do all the tests so that’s good. I was very pleased with them. Yes my DH dna frag was 52% and we managed to get it down to 25% but not any further so there is definitely hope. Best of luck with it all.

Hi @Penny19 … I know there have been no posts here for a while but I just wondered if you could tell me how things worked out for you and what your OH’s DNA frag was like when you first started your IVF journey? My husband has high count, low motility and low morphology (both of these have been improved over the month to now borderline levels with Proxeed, Ubiniquol and lifestyle changes) but we have just found out that he also has quite high antisperm antibodies and 33% DNA frag. We are about to start ICSI in Jan, as our consultant doesn’t think it’s worth bothering to check for varicocele or infections or anything else but I’m worried about going head first into IVF if we’re going to end up wasting our NHS rounds. I also have low AMH (10.7 aged 32.) We have conceived naturally twice before but both ended in miscarriage which I just can’t bear the thought of going through again.
Any help or advice you could give would be hugely appreciated! Thank you x

@Koalie firstly I am very sorry for your losses, I know how heartbreaking it is. I will start by saying I have no updates as we have been banking embryos and because I have adenomyosis we are exploring treatment options for that as well before doing another transfer. So I also sympathise with having dual factor. My husband had incredibly high dna when we started 60-70%. We did get it down to about 20-30 with the same things your partner did - esp the ubiquinol really made a difference (300g a day) We now have 5 euploid (genetically tested as normal) embryos that are good quality, which should hopefully give us a fighting chance. I'm afraid I don't know anything about antibodies - but I would be very encouraged that you have been pregnant naturally. Im assuming your partner has seen a urologist based on all the tests you've done? If you are able to see one and get all those tests such as variocole etc. it might just put your mind at rest? Lots of ivf drs want to go dive in, not waste time and see what happens then test later if things don't work - which does make sense but can also be frustrating. On the other hand I would also say no round of ivf is a waste as you will learn so much even if it doesn't work and be in a better position for round 2. The other thing to ask about is IMSI although I don't know if it's done on NHS as not HFEA approved. 30% really isn't bad and our urologist said that's the % they think ICSI can work. Important to focus on you and your protocol so you get a nice batch which will help. At least you know the issue and I would feel very hopeful and excited about starting ivf in the new year. Always here if you want to talk / ask questions - I know how daunting it can feel. X

Hi @Penny19 thank you so much for your lovely message, it has really put my mind at ease a little bit, I’ve been getting myself all worked up. Hubby has an appointment with an NHS urologist in a couple of weeks so we will ask about varicocele etc then and maybe get some more answers (or not, who knows.) That’s an incredible improvement for your OH! I bet you’re so glad you had the frag test done and amazing that you know your embies are genetically healthy. I hope your adenomyosis treatment goes well! One thing I was thinking of looking into is TESA - was this ever discussed with you during your journey at all? Also, was your OH advised to abstain for any certain period of time before egg/sperm collection? I have read that less abstinence can help DNA frag but I’m wondering by how much. Thank you for all your help, it really can be such a minefield 🤯 x

Hi everyone. Hope you don’t mind me joining the thread. Are/were your partners taking proxeed and other supplements as well? My OH’s SA was normal but we weren’t getting pregnant so he started on loads of supplements and the most recent test, his SA was below on all measures. We already have children. We saw a urologist who suggested taking too many supplements can actually negatively impact on sperm so he’s just taking proxeed and vitamin d now but I keep questioning whether we’re doing the right thing or whether he should be taking more.

I have given up on all of mine except pregnacare and vitamin d as well which I worry about everyday. But my consultant said folic acid and vitamin d is all I need and I wasn’t taking any of these fancy supplements in my previous pregnancies and had no problems conceiving. Plus, I was taking them for a year and still no luck and they cost so much money 🥴