Sperm DNA fragmentation??

[Appleblossom31]

Hi everyone,

I would welcome some advice please.
I recently had a round of ICSI. We also paid for zymot. Out of 15 eggs we only got 2 blastocysts. I had a fresh transfer of 1 embryo which resulted in a chemical pregnancy. At my follow up appointment, my consultant said that they wouldn’t be interested in additional testing until 3 failed rounds - that’s a lot of money I don’t really have just to throw at it!!

Im now 33 with lower AMH so appreciate my eggs will be of poorer quality, however should I be concerned about DNA fragmentation? I’m concerned this has contributed towards poor fertilisation/ number of blastocysts. I don’t want to pay for more rounds and have the same outcome without knowing what the issue might be.
Is DNA fragmentation also likely to be cause for chemical pregnancy?
My consultant didn’t seem to be concerned but I was surprised that she didn’t consider this as a possibility.
Should I be concerned or am I being unrealistic? I know I have one in the freezer but I am losing hope and this constant worry is ruining my life. Also recently heard that an old friend who “didn’t even want kids yet” accidentally got pregnant without trying which is particularly triggering.

I’d welcome anyone’s thoughts.

thanks xx

Hi, sorry to hear it's been so tricky. We had 2 cycles of IVf 7 years ago. The second cycle produced my son plus a FET that didn't work. I had really good egg numbers but poor amount and quality of blastocysts. None with 1st cycle, 2 with second. DNA fragmentation test was never suggested. Recently we decided to try again and paid for the test. Found my husband has extremely low count and motility plus very high fragmentation and a sperm disorder I forget the name of. So looks to be that male factor was key and now we'll use a sperm donor. For us, definitely worth doing the test. For years, I thought it was my eggs when in all likelihood, male factor issues were key too. Wishing you all the best. It's such a rollercoaster.

Hi Op, sorry you had a failed round. Have you had normal sperm testing done, (I.e. motility, morphology and count)? If these all look normal then it probably doesn’t make sense to DNA frag test as well. But like PP’ experience, if these are abnormal then it might lead you to want to investigate the MFI side further.

Also sorry about the friend’s pregnancy news, these things are a real gut punch when they happen and feeling triggered is so so normal. Take care of yourself.

Sorry to hear about your chemical OP - I had a similar-ish experience with our first round, from 21 eggs we ended up with 1 "poor grade" embryo that ended in miscarriage discovered at our first clinic scan, the embryo implanted but didn't survive, after doing some research I found many things saying this was a common theme with sperm issues.

My partner has a scan done and it was found he had a varicocele, which I think can be linking to DNA frag, he did manage to get a varicocele embellishment done on the NHS in September, he started taking Impryl daily and stopped drinking since Christmas. We've just had our second round and we've ended up with 10 strong frosties which is still a complete shock giving our first round. We didn't have DNA frag test done so I can't say for certain if that was the helping factor but I myself do believe it was.

It may well be worth requesting a scan if possible? Ours was all done through the NHS but we were very pushy!

Sending big hugs xx

Hi OP, just to share that my husband’s sperm analysis were all ok (done twice in different labs 6 months apart) but because we were unexplained apart from my low AMH we decided to get his dna frag test done. His overall result was 32% and the % of high damage was twice that of an average male. We got this result a day before my egg collection so my consultant suggested ICSI. Unfortunately, my yield wasn’t great. I got 5 follicles with 5 eggs, all were mature but only 2 fertilised normally despite the ICSI and 1 turned into a day 6 blast. BFN.
My husband was referred to a urologist (Mr Tet Yap). We then found out that he had significant varicoceles which were embolised recently, and his testosterone level was slightly low for which he’s on anastrozole. We are hoping that by doing all these, our next cycle will be better. I know it’s more likely that egg quality is the culprit but hopefully by sorting out what we can from his side, we increase the chance of success.
If you can afford it, I would suggest you do the DNA fragmentation test even when sperm analysis is normal. Good luck.

Thank you everyone for your responses. I’m sorry that this has been a hard and long journey for us all.
My partners sperm analysis was good apart from morphology which was on the lower side at 5% but considered within normal range.
My consultant did suggest that if we neee to do another round we could try AOA to help fertilisation rates but don’t really see how that would help if sperm (or egg quality) is a major issue. I am all for paying for testing to pin point the issue as so far we have been told we have “unexplained infertility”. I don’t believe my partner feels the same which I am finding frustrating, he just thinks “one day it will work”/ isn’t doing his own research into issues that might be associated with male factor infertility. I just wish it wasn’t this hard and I wish as a couple we didn’t even need to have these conversations (I’m sure you’ve all felt the same way) xx

What number was you on on your day 3 update? We were told in our first round that day 3 is when the sperm takes over, that was our biggest drop in numbers I think we went from 11 on day 3 to 1 on day 5. I was suggest him getting a scan done if possible?

I understand the the frustration, after my results this time I said to my boyfriend "I know you thought I've been nagging you for the last 6 months about not drinking and taking supplements but wasn't it worth it?" and his response was "absolutely" and that's from a very stubborn boy who didn't do a single bit of research, loves a night out and didn't believe anything would help!

It's very unfair but your strong enough, you've got this far 💛

Out of 13 mature eggs 7 fertilised normally and 2 made it to blastocyst. I just don’t believe that to be “expected” drop off numbers?? Surely there must an egg or sperm issue or both.
I am not sure how I would go about getting a scan done. The clinic won’t even discuss next steps until the frozen embryo has been transferred and there is an outcome from that. I’m not feeling very hopeful about FET or whether it will even survive the thaw but guess all I can do right now is wait it out. Thats great you’ve done 10 in the freezer xx

Best of luck on your next cycle! May I ask how you got referred to a urologist? Did they recommend any treatment to improve the DNA or they believe that is purely due to the varicoceles? Xx

Hi OP,

On the drop off rate, when I did my first freezing round at 31 I was told that for my age group (30-35 years):

• of mature eggs collected 80% expected to fertilise
• of those embryos still alive on day 3 30-50% of those are expected to make it to blast
• of those blasts 40-60% expected to be euploid (bit of variation depending on the embryo grade here)

Of course that is from one specific clinic (CRGH London) but hopefully that gives you some context/stats. I also had a very low AMH for that age group but they still gave me those stats - I collected far less eggs than you ~5 each round with some rounds cancelled due to low response so I suspect my ovarian reserve and AMH would have been lower than yours.

good luck!

@Appleblossom31 thank you. I researched online and the two London based urologists that were usually recommended are Dr Jonathan Ramsey and Dr Tet Yap. My fertility clinic consultant (I’m with Lister in London) also recommended these two doctors and was happy to send a referral to whoever we chose. Gp also referred us to an NHS urologist, but the appointment given was not until six months so we had to go private. Dr. Ramsey’s wait list time was around 10 weeks at the time so we went with Dr Yap and we are happy with him.
We know my husband had varicoceles - they’ve been causing him occasional discomfort since around 10 yrs ago so at the time gp requested an ultrasound where this was found. He was reassured they won’t impact fertility though and we were not trying that time so we just sort of completely forgot about it.
Dr Yap is of the opinion that my husband’s dna frag result is most likely due to the varicoceles because they’re quite significant in size and both sides, so he referred him for embolisation. He also did a bunch of other tests. Fortunately all came back ok except for the low testosterone so other than correcting this and recommending to reduce alcohol consumption to 6 units per week, no other treatments were needed it seems. He also recommended adding Zymot for our next cycle.
Can I ask why did your clinic do ICSI+zymot for your first cycle? Did they have any concerns regarding the sperm quality or this is just their standard? To be fair I can also see where they’re coming from as in the first transfer may have just been bad luck but I get what you’re saying that you want further testing to cover all bases. It’s never a straight answer in the world of IVF unfortunately as we’re all finding. Best of luck whatever decision you take.