Is a sperm dna fragmentation test worth it?

[Goldendoodlelover]

Hi all, been TTC for a year now and never been pregnant. My bloods and baseline are all normal, going for a Hycosy next week. DH’s sperm analysis all normal (although on the low end of normal). Was listening to a podcast earlier and it said sperm DNA fragmentation is a really common cause of unexplained infertility, and so I’m wondering whether to book the test - it’s £500 so not cheap and part of me wonders if all of his other sperm results are normal what the chances are that this would be the problem. If anyone had any thoughts or has been in a similar position would love to hear them!

@Goldendoodlelover

Would you mind sharing the podcast? If you partner is open to it I would definitely recommend to rule it out. We have been TTC 2 1/2 years unexplained infertility. We just did our first bog cycle and only got two embryos out of 17 eggs, First transfer failed got one more left but dr has recommended we test before trying another cycle x

IVF cycle not Bog 😂

@NatW2021 it’s called ‘Don’t Tell Me To Relax’ (great name!) and they had a recent episode called ‘why we need better fertility investigations for men’ - it really advocates for better testing for sperm and how the focus is always on women when it comes to fertility investigations - it also says that one study said 80% of unexplained infertility cases turned out to have high levels of dna fragmentation?! If it’s so common though I have no idea why doctors don’t suggest it, but I have also read that it can unfortunately affect IVF results. I’m really sorry to hear that your first round of IVF failed, wishing you lots of luck for your next transfer 🤞🤞🤞

Yes, do it. We have been doing IVF due to my husband’s high DNA frag so I know quite a lot about the subject. We even saw Mr. Jonathan Ramsey, the urologist they mention in the podcast. If the DNA frag comes back high you should look into sperm selection techniques (PIMSI, IMSI, PICSI), Zymot and maybe TESE (if frag is very high) as options to increase your chances of success with IVF.

If your partner does have high DNA frag but you don’t test (and therefore don’t have the data point) it’s likely doctors will recommend standard IVF (instead of ICSI) which with DNA frag is not the right thing to do, as it is likely to lead to low fertilization and blastulation rates, i.e. fewer (if any) embryos, and increase your chances of miscarriage.

By the way, everything they say in that podcast is absolutely spot on.

@giraffesauce - did you have this checked before you started IVF? We are on our first cycle and had 17 mature eggs, 5 fertilised abnormally (2 sperm) then 10 normally fertilised, 8 looking good on day 3/4 then only 2 good enough to freeze on day 5, first transfer failed this week. Planning on next transfer in Jan.

Spoke to my Dr today who suggested we check this in advance of our next cycle then it's likely icsi.

How are you improving the dna frag? I know we don't have any results yet as it's not been checked by trying to get ahead as much as we can now.

Thanks x

I’m interested in people’s experiences of this, as I’m worried about DNA fragmentation since we’ve had 2 MC since DH has been on Sertraline, which is known to affect sperm quality.

Hi @giraffesauce that’s really interesting to know, thanks for sharing. I feel like my doctor is very much just telling me to keep trying and wait until we feel ready for ivf without considering other options (eg clomid/Letrozole, progesterone etc) and isn’t really fussed about trying to find the root cause.

When did you get your husband’s DNA fragmentation checked? Before IVF? Were his other results normal? Trying to get my DH on board but at the moment he doesn’t think it’s necessary as a) the doctor hasn’t specifically recommended it and b) his other results came back normal. Need to get him to listen to this podcast!

My husband got normal results from the basic sperm analysis but was found to have high levels of DNA fragmentation. We were advised to have the test by the consultant I was seeing for recurrent miscarriage. I was getting pregnant easily but having first trimester losses.

We then saw Jonathon Ramsay, who was great. If you have DNA fragmentation they’ll check for infections (which can be treated by antibiotics) or anatomical causes (such as a varicocele, which can be treated with surgery).

You can also improve DNA fragmentation through lifestyle changes. My husband was found to have narrow tubes which was causing heat damage and oxidative stress but it was just at the cusp of when they’d operate on it, so he was recommended to address it through lifestyle changes.

We saw a nutritionist who gave us advice on diet and supplements. Then it’s all the usual stuff to improve sperm quality (reduce cycling, cotton boxers, reduce/eliminate caffeine and alcohol, healthy Mediterranean diet plus lots of nuts).

We tested again after three and six months and my husband’s DNA fragmentation was significantly reduced. We were actually able to have normal IVF instead of ICSI in the end, and got good results.

So it was definitely worth it for us.

Hi @sweetpea2000 thank you for sharing your story and I’m glad things improved for you. It’s amazing how many success stories seem to involve Jonathan Ramsey, I’ve never heard of someone so highly recommended! My issue seems to be getting pregnant in the first place - all signs suggest I’m ovulating and we DTD frequently throughout the month so I’m sure we aren’t missing it - and I have no anatomical issues eg fibroids etc so I’m not sure where we are going wrong. I have heard DNA fragmentation can cause implantation issues but I don’t know if I’m just grasping at straws because I’m desperate to have a known cause / something to ‘fix’ before resorting to ivf!

@Goldendoodlelover
Just to offer another perspective we decided to do the test and all was clear. I was glad we did it just for peace of mind.

That test did result to other sperm markers changing though from previous tests so we ended up doing ICSI as a result of that.

No harm if you can afford it I think.

@Blossomofhope I think you’re right, even if it is clear it’s not a waste of money because we would have ruled it out and if we do end up going down the IVF route I would want to know. I’m just wondering why my doctor hasn’t suggested it already?

@Goldendoodlelover - they are all so basic and will let you fail miserably before suggesting additional testing. I'm hoping this isn't our issue but if it was done before out cycle it could have saved us potentially lots of heartbreak and money.

Have you had your thyroid checked aswell? I have subclinical hypothyroidism and I'm on levothyroxine it's not made any difference to getting pregnant but it's useful to rule out and I wouldn't have known I had untill getting tests for fertility.

I think they wait awhile. We had a few failed iui cycles before she suggested it ahead of an ivf cycle. 😕

Hi @NatW2021 yup I’ve had my thyroid tested and all normal. I do worry that sometimes my tests come back borderline - my progesterone was 25.3 for example and doc said 25 is indicative of ovulation, and similarly my prolactin was like 494 and the upper limit is 496. Doctor said no need to retest and I never want to push for fear of coming across neurotic / obsessive, even though I probably am 😂

It is mad though that they don’t offer more testing because as you said it could save so much money and heartbreak in the long run!

@sweetpea2000 do you mind sharing what supplements your DH took?

@NatW2021 sure, he took Impryl, Vitamin D, Omega 3 and Grapeseed & Pycnogenol Complex throughout. Then L-Carnitine Powder and Acetyl L-Carnitine from when I started stims to egg collection.

@Goldendoodlelover just wanted to say, your situation sounds like mine. My husband and I have been trying for 4.5 years, we started a referral back in 2021 (sadly had to pull out due to Covid-related job loss), so we've had all the tests previously and infertility is unexplained.

I have regular cycles and no obvious issues with husband's sperm. DNA fragmentation test could be a good option for us, but with me being 35 and current NHS waiting times, we might need to put any spare cash in to a private consultation.

Hi ladies, hope you don’t mind me joining.. We’re currently looking at getting dna fragmentation testing after recurrent miscarriage and I was wondering if anyone has since got results/would recommend the test?

All my tests so far have come back normal, other than underactive thyroid/Hashimoto’s which I’ve known about for a couple of years - makes it tricky to know what testing routes to go down because it’s so expensive and there’s so many!

@Blueskies4 yes I ended up getting it done in December with Fertility Solutions. It’s not cheap (it was about £500) but I wanted to get it done before considering IVF as I‘ve heard it can negatively affect IVF outcomes. DH’s results all came back normal , so I think he thinks we were probably a bit anxious in getting it done, but it has at least given me peace of mind / another thing to tick off! I totally agree though about not knowing which tests to have - when you don’t know what the problem is it’s all a (very expensive) stab in the dark!

Hi all
Hope you don't mind me messaging on this thread and thanks for updating.

Is there any point in getting DNA fragmentation done if sperm analysis already abnormal?
DH has low motility on 2 samples and borderline/ low morphology. Counts are OK but lower end of normal range.

We've been told IVF likely ICSI in 6 months if no conception. Would DNA fragmentation add anything do you think?

@Englishrose35 maybe ask a doctor / clinic for advice but I would have thought yes it’s still worth getting it done, as high sperm dna fragmentation can be caused by all sorts of things - an underlying infection, varicocele, lifestyle factors etc - which may all be able to be ‘fixed’ or at least improved before IVF/ICSI. I’m of the opinion that having more information / data to go on is always better but they’re obviously very personal and there’s also the associated cost which really doesn’t make things easy. We are unexplained and if we do end up going for ivf I want to rule as many things out as possible first…

@Goldendoodlelover thank you for replying :) glad your husbands tests came back normal, it’s one less thing to contend with isn’t it. And I agree, it’s worth it for the peace of mind (if you can afford the test price that is, appreciate may not be an option for everyone).

I just thought I’d throw this in here for anyone that is reading this thread also looking for answers… I listened to a really good podcast on AMH last week where a fertility acupuncturist/expert debunks some myths/info and she really rates DNA fragmentation testing, alongside a couple of other things which are rarely explored bu the sounds of things. I’m saving to have one of the tests she’s recommended;

Podcast; https://podcasts.apple.com/gb/podcast/dont-tell-me-to-relax-a-fertility-podcast/id1663536357?i=1000609969697

Her Instagram (has info on DNA drag testing);
alex_explaininginfertility

Hope everyone gets answers or a positive outcome soon xx

God sorry about the typos on that last post, sausages for fingers!

Any updates? Xx