5 replies to this topic

[HopeAlways]

We learned of my DH's low sperm count (between 0 and 7 mil/mL), low motility, and poor morphology two years ago, and we began IVF immediately. After two repeated FET miscarriages (at 8wks and then 6wks), we learned that my DH has 59% sperm DNA fragmentation. We're planning to try one last FET with our current batch of embryos -- we have 6 left and we're PGS-ing them now. If this third FET doesn't work, we're planning to do a PICSI diagnostic test, to see if PICSI is even an option. If it isn't, we're going to look into sperm mapping and then use testicular sperm for IVF with ICSI. 

 

We started trying to conceive three years ago and began IVF 2 years ago. I'm beyond exhausted. And, I can feel myself battling the immense waves of sadness, hopelessness, and anger. If anyone has any words of wisdom or sources of encouragement, please share! Thank you!!

[Tabatha]

Hello Marie;

 

I don't have any answers for you, as I don't know what my partner's DH fragmentation is (our RE said there was no point in doing the test b/c we required ICSI anyway).  However, we did CCS on our embryos.  Unfortunately I appear to be having a rare cornular ectopic pregnancy but that doesn't seem to have anything to do with the quality of the embryo.

 

Were you advised that PGS could help with the dna fragmentation?  That makes sense to me, as dna fragmentation and aneuploidy appear to be correlated (there are several research papers on this).  PM if you like and I can get you their titles.  

 

What is sperm mapping?

 

Good luck!

[HopeAlways]

Thanks Tabitha,

 

First, I'm so sorry to hear about your ectopic pregnancy. My miscarriages were incredibly painful, both emotionally and physically. I hope you're getting the best of care right now.

 

We've been told that the PGS testing will not factor out the DNA fragmentation variable, only chromosomal abnormalities. In other words, by doing PGS on our remaining 6 embryos, we can at least remove those with any chromosomal abnormalities. Unfortunately, there is no test that can tell us the degree of DNA fragmentation of an embryo. And, there's no way to test the DNA fragmentation level of viable sperm -- they must kill the sperm in order to attain this value. Also, the effects of sperm DNA fragmentation don't generally show up until after a positive pregnancy test, when the embryo's cells are dividing at a faster rate. Fragmented DNA doesn't typically affect fertilization rates. 

 

We are considering using testicular sperm, since this sperm is generally younger and less fragmented. However, because my DH has a very low sperm count AND sperm can cluster inside the testicle, we would need to do what's called sperm mapping first. Sperm mapping provides a "map" of the sperm in the testicle and allows the surgeon to know where the clusters of sperm are located, before cutting into the testicle. Blindly cutting can cause permanent damage and decreased testosterone long-term. If you google sperm mapping, you'll find a good amount of information online. 

 

Thanks again for reaching out and I wish you all the best too! We must keep believing, right?! #IBelieveInMiracles

[Tabatha]

Hello HopeAlways,

 

Thanks for your kind words and response.  It is a difficult time but I'll get through it

 

Thanks, also, for the information about sperm mapping.  I hadn't heard of that before.  

 

I think you should take some comfort if you get PGS normal embryos that the chance of those embryos having DNA fragmented sperm will be reduced.  At least, that is what the genetic counsellor at my clinic says.  I have an appointment with my RE this week and I'll ask him that, too, and if I get any further information I'll let you know.

 

Are you at a Canadian clinic?  I wonder if the US ones aren't more proactive on the sperm DNA front.

 

I'm keeping my fingers crossed for good PGS results for you!

 

T

[HopeAlways]

Thanks Tabitha! Please let me know what your genetic counselor says. We were under the impression that PGS testing can only reveal chromosomal abnormalities -- not sperm DNA fragmentation, which they say is impossible to detect in the embryo. Ugh. If you learn anything, please let me know. We're in the U.S. and sperm DNA fragmentation is still newly studied, but there's a good amount of strong research out there now. Doctors are looking at it more and more. Best of luck!!

[Tabatha]

Hi there;

 

I wanted to follow up.  Spoke with both the genetic counsellor and the RE (I'm in Vancouver, Canada).  Anyways, they both agree that PGS cannot test for fragmentation in the embryo.  However, they both said that, in their experience, when sperm DNA fragmentation is an issue their patients don't get blastocysts.  They said that every 5 or 6 months they'll have a couple with male factor whose embryos crash on day 3 after looking good, and no blasts are obtained.  Their view is that if sperm dna fragmentation is going to be an issue, it's almost always going to be lethal to the embryo in its earliest stages of development.  If it makes it to blastocyst, then it's likely to have a chromosomal abnormality because sperm aneuploidy and DNA fragmentation are linked (that's their view, anyways).  So, they are telling me that they don't think it's an issue for us because 1) we got 7 blastocysts and 2) we got some euploid embryos.  I asked them point blank if sperm DNA fragmentation could cause a miscarriage with an euploid embryo and they didn't think so.  

 

This probably isn't helpful to you, but I thought I'd share the information.  

 

With our PGS testing (done by Natera lab in California) we were told whether the embryo aneuploidy came from the egg or sperm and we did have two embryos that were pooched because of sperm aneuploidy.  So that was interesting because it's usually an egg issue but not surprising with male factor.   

 

Have you finished your PGS testing yet?  FX you got some euploid embryos!

 

T