IVF for high dna frag - recommendations?

[charlotte444]

Hey,

This is my first post on mumsnet after reading everyone's messages for a long time. I'm 35, my partner is 32 and we've been TTC for 2 years with 3 chemicals, and one missed miscarriage at 10 weeks in the summer.

Everything seems OK with me - although low AMF for my age. Tubes clear, bloods fine etc. I'm being referred to the recurrent miscarriage unit so hopefully they will have some answers.

On my partner's side, he had good concentration (340) and motility (52) but low morphology (2.5%). After trying for a year we made some drastic changes - cut caffeine back to 1-2 cups a day, alcohol to 1-2 drinks a week, changed underwear to baggy ones, cut long cycles etc. We also both went to acupuncture and a whole host of vitamins - proceieve Max, C0Q10, Zinc, and a few others. In the summer my partner saw Dr Ramsay and we did some more tests. Unfortunately, there was high dna frag (37%) which we think could have caused to miscarriage.

We are now looking at a private IVF round as the NHS will only fund one after 3 years. I'm very tentative because if the issue is the sperm, how do we know which has low dna frag? Thinking the only option would be IVF + ICSI + Zymot or TESA. I can't really find any places in London other than Care - has anyone had any experience with this one or with this issue?

Mentally I'm pretty broken, the fertility journey is a rollercoaster - trying to start calm and happy but when you tell people and all they say is 'you need to reduce stress' I want to scream! If they only knew everything we had to go through.

Anyway sending lots of love and kindness for anyone reading this now or in the future, I get you.

Also Dr Ramsay is on sick for an unspecified amount of time, so not sure whether to go and see another urologist - has anyone got experience with Minhas or Tet Yap?

Hi :)

You probably already have an answer to this but it's my understanding that although DNA frag can't be seen under a microscope, the healthier the sperm in terms of other parameters, the less likely the sperm is to have fragmentation. This is why ICSI is the recommended treatment. My hubby has 33% DNA frag and we have been told that TESA is an option but that the procedure can cause damage to the sperm in other ways so it's not the first thing they try. We're going for ICSI. I also have low AMH for my age and we have also had 2 miscarriages so I'm hoping IVF will help us nail down a healthy embryo! x

Thanks for coming back :) I wasn't aware that TESE can also can fragmentation, that's good to know!

I hope the ICSI goes well, I will look into that more xxx

Following along as I'm on a similar journey.
@charlotte444 so sorry to hear about your losses 💔💔 you poor thing.

Have you found a clinic?

@Koalie sorry about your losses 💔💔
I've heard about Tese too, but I've also heard it can through their testosterone off balance, so I'm not sure about it.
Have you started your cycle?

A little bit of background on me:
I'm 35, he's 32 and we've been TTC for 2.5 years. Had a natural pregnancy last year, but ended in miscarriage at 11 weeks 💔.
Decided to get my husband investigated as we'd spotted a varicocele, but didn't know if it was. Clinic & gp were dismissive of it, so we went private.

His DNA frag was 37% and it turned out the varicocele was 5.4mm - v large, so we got it embolized in Sept. I should say all his other parameters are totally normal & there was no infection or hormone imbalance - just the varicocele. So, DR Ramsay is confident we'll conceive.

We're just about to start an ICSI cycle with the NHS in Feb and I'm soooo nervous and afraid it won't work 😬
I'm already feeling like it's gonna be a dud and we need to find a private clinic who specialise in male fertility. I should be hopeful though

xx

Hi @JeanieJ :) sorry to hear you’ve been struggling. Have you re tested DNA frag since your OH had the varicocele treated? We have started our first cycle of IVF but couldn’t do a fresh transfer, as I’ve developed OHSS after egg collection. We do however have 7 blasts in the freezer. My OH’s sperm was good enough on the day for us to try half ICSI and half IVF and the IVF group actually did better than the ICSI. We are fully aware though that highly graded embryos don’t necessarily mean they don’t have chromosomal abnormalities and unfortunately our clinic doesn’t do PGT-A testing so we’re just gunna have to transfer and hope for the best 🤞🏼I’m happy to share all of the things my hubby did in the run up for IVF to improve his parameters if you think it would help? ☺️it sounds like you have every chance of IVF/ICSI working for you though! X

@Koalie that's promising to have 7 blasts 🤞🏻 annoying about the OHSS though - are you ok now? Are you NHS or private?

No, we haven't done a 2nd dna frag test since the procedure.
When we spoke to Dr R about it, he said wait a minimum of 4 months post embolization to do the ICSI, but if the ICSI fails, then to do another frag test.
We'll be 5.5 months by the day ofEC, so fingers crossed. My husbands been totally alcohol free since Sept, wears baggy boxers, we're both veggie & he's been taking impryl.

What's your husband been doing?

Xx

@JeanieJ yes I’m feeling much better thank you & yes we are funded by the NHS. :) It sounds very promising, I’ve heard of the varicocele surgery making a huge difference for people before so I have everything crossed for you! Sounds like your hubby has already been doing the main bits. My OH also taking Impryl, vit D & fish oil. Other bits he’s been doing:

• 0 alcohol & 0 caffeine
• Eating walnuts and drinking tomato juice every day
• Boxers off when at home lol
• Drinking lots of (filtered) water
• No baths
• Managing stress levels

The other thing he did was only abstain for 24 hours before he gave his ‘sample’ 😆

Good luck! I’m sure you’ll be just fine 🥰

Thanks for all the tips @Koalie 🙂 I'll say it him. You're right that we have alot going for us, but I think I'm just in a negative headspace atm.

He has also been avoiding hot baths & cycling which he's so sad about because he loves riding his bike 💔 (it used to be our main weekend activity)

Did he abstain for max 24 hours before the sample? I've read that with dna frag that daily ejaculation helps, but no one has formally told me this.

The MFI club is so complicated and under-researched 🫤 I really hate that my clinic doesn't have a urologist.

My husband eventually got a referral to the NHS urologist after all his stuff with J Ram, but he went along anyway for a second opinion. The doc is really good, but he didn't even know that our hospital had IVF funding (he works in the same place). My mind is a bit blown that they aren't connected. 😵‍💫😵‍💫😵‍💫

xx

Sorry to hear that @JeanieJ , I hope you're okay. Our stories sound so similar bar the varicocele.

Apparently pomegranates are very high in antioxidants so worth buying 'Pom' juice - Sainsburys sell it.

I've got pregnant again this month but am terrified it might be a 5th miscarriage. I do think all of the changes we've made have really helped. We've also had acupuncture and chinese herbs

Fingers crossed for your IVF rounds, my NHS doesn't cover it until 3 years unfortunately xxx

@JeanieJ I had read about regular ejaculation helping as well but I think every other day is OK.

I know exactly what you mean re NHS urologists not really being connected with the IVF clinics. We also saw a urologist and he didn’t even know what Impryl or Proxeed were which surprised me 🤨

@charlotte444 congratulations on your pregnancy! I really hope it’s a sticky bean 🤞🏼🤍

Thanks @Koalie ❤

Second that re the urologists! It seems like MFI is not really looked into much which is so annoying. Lots of people go through many rounds of IVF to discover much later down the line about dna frag when it should be looked at earlier on. I follow testhim on Instagram, he promotes getting men tested early

p.s I emailed Dr Ramsays clinic and he's off work sick at the moment 😣

@charlotte444 congrats, that's hopeful
Fingers crossed this little bean sticks 🤞🏻🙏🏻

@Koalie thank you 🙌🏻 good luck with your FET when it comes around xx

@Koalie did you have your FET?
Little update from me.
We just did our first round of ICSI, this was 5.5 months post varicocele embolisation. We got three blasts & I had the top quality one transferred the other day.

Tbh, watching the drop off rate from eggs (14) to blasts was a bit mad & I didn't think we'd even end up with any by the time we had our day 3 update, but 3 made it 🙂

We haven't PGD tested any, so we're just trying our luck with this round (it's NHS).

@charlotte444 hope everything is going ok 🤞🏻🤞🏻🤞🏻

Hi @JeanieJ

That’s a great result ! The waiting for clinic calls with drop off numbers is a killer but to have 3 blasts is 👍🏼 when is your OTD?

I am on estrogen right now, my transfer will be either 22nd or 24th. It’s seriously been the longest wait in the world 😩 but nearly there x

@Koalie ooft, that's a long wait, but hopefully any risk of OHSS is gone now 🤞🏻
Will they put you on injections or pessaries?

OTD is the 21st, so fingers crossed 🤞🏻

xx

@JeanieJ ah yes, the OHSS was gone within a week which was such a relief. I’m on a medicated frozen cycle so I will have both injections and pessaries for progesterone.

eeee not long at all for you! Let us know how test day goes? 🥰

Sorry to hear about the long wait @Koalie and really happy for you that 3 made it @JeanieJ that's great news!!

As an update from me - we had another sperm test in January- the last one was 7 months ago and the morphology had gone up from 3% to 5.5% - which we couldn't believe! I think the biggest changes were alcohol, vits, coffee and diet but it's very hard to say.

We've also been experimenting with different days for ejaculating - this time around we DTD every day during the ovulation window and used the clear blue monitor so think these things helped. Melanie Brown said that doing it in the morning is better as the sperm are fresh

We have our 12-week scan on Thursday after a couple of nerve-wracking early scan which were looking fine.

I hope we all get our rainbow babies xxx

We've also been on the progesterone pessaries, higher pregnancy vitamins and aspirin which could have made the difference to get to 11 weeks

@charlotte444 that's great congratulations 🎊
Best of luck with your pregnancy xx

Hey,

Just a little update from me. I've had a positive test from my fresh transfer (IVF with ICSI). I'm very cautious, but hoping it stays around & that we all get our rainbow babies xx

Yaye that's so exciting, congrats @JeanieJ 💕

Oh @JeanieJ that’s amazing news! Congratulations. You must be over the moon 🫶🏼 hopefully my turn next 🤭 transfer on Friday (finallyyyy) x

Thank you @Koalie & @charlotte444 💕
I'm cautiously hopeful 🤞🏻🙏🏻
Best of luck with your transfer @Koalie xx