DNA fragmentation test- what did it change?

[Blueskycat]

Hi everyone,
We had 3 failed FETs of good quality but untested blastocysts last year (no implantation). We’re both 35 with completely unexplained infertility. Before our next transfer (4th and final blast from our first egg collection), we’ve been doing tests to rule more issues out (various bloods including clotting/thyroid, hysteroscopy with biopsy for endometritis, specialist ultrasound for endometriosis (I know this isn’t definitive), karyotyping.

We’re NHS so they only recommend tests with a strong evidence base, and I know it may just be a numbers game and we seem to be able to make blasts, so not willing to go down the NK cells/immunology route at this point (£££).

The one further test I’m thinking about paying for is DNA fragmentation, but my question is if you had a high frag result, what did it change about treatment? I’d be interested to hear from people that have done the DNA fragmentation test and what it changed for them.

Thank you all

Not quite the person you’re asking to answer, but I feel it’s relevant— DP 2% morphology and long standing varicocele (that was embolised) so a good change for high dna fragmentation. Also multiple embryos perfect at day 3 stalling by day 5 (another possible indicator). We were advised (in self funded rounds) that it wouldn’t change much about treatment (already icsi, already healthy lifestyle). That the tests can give hugely varying answers month to month.

however, as I’m v low amh, I needed something practical to do. TESA was weakly suggested but would equate to the same as shorter abstinence time before sperm collection. So DP evacuated 12 hours before collection in order to make sure everything collected was as fresh as possible which is would reduce fragmentation. His numbers were good and I make so few eggs that it wasn’t an issue.

My consultant (NHS) basically said if DNA fragmentation is high, you do ICSI. With 3 failed FETs I would probably consider PGT-A testing. You’re already looking into uterine environment which is good. Have your clinic adjusted your meds each transfer or done the same protocol?

did you have your progesterone tested before transfer?

sending you so much luck! Xx

Ah thank you both so much for sharing your experiences, that’s really helpful. Sounds like you both got similar advice that a high DNA frag result wouldn’t have changed the treatment in your circumstances.

We didn’t do ICSI for our first egg collection but our consultant has said we can do it for our next one… she actually didn’t suggest it, but I asked and she said “something isn’t working so I’m happy to try it”. It really does feel like a lot of coin flipping, even among the experts 😂

The fertilisation rate was a bit low last time so ICSI might improve that (19 mature eggs, 12 fertilised normally, 7 made it to blasts, 4 good enough to freeze).

I will ask about whether fresher sperm might help nearer the time, thanks for that suggestion.

In terms of protocol changes between FETs, they upped estrogen for the second and third because my lining is on the thin side, it only just gets to 7mm. Progesterone was tested before each transfer and always high. But this time they are making lots of changes- medicated to natural cycle, adding a blood thinner, steroid and an injection (not sure if it’s additional estrogen or progesterone?). Maybe cos it’s our last blast from the first egg collection, they seem to be throwing everything at it!

Our NHS clinic don’t do PGT-A, even as a paid add-on, so we’d have to move any embryos somewhere else which would be a huge hassle… but I’d consider it, after we’ve crossed the bridge of this transfer (🤞🏽🙏🏽), if we do another egg collection.

Thanks again for your replies

my low amh meant nhs were only willing to try the highest protocol on me, which included down regulation and maximum meds. In the second round I only made one egg. Conversely, I did “mild ivf” (privately) short protocol and low meds and got 5 eggs, which just goes to show it really is guesswork. I’m glad your nhs clinic are willing to tweak and change, that’s great! I’ll also add, the only round that gave us a high quality (untested) blast was the last, where we got lowest stims (just a step away from no stims ivf). I do think egg quality is affected by stims, but also think it’s unpredictable how exactly they’ll be affected. But all the better that your clinic are on their feet trying things out. A round without a pregnancy isn’t actually a total loss, as you get so much information about your body from it. Best of luck :)