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Sperm fragmentation.

Started by robbyb, 2009-12-17 19:35

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robbyb

Hello MensFe admin and guests.

I have a query for you.

Looking back at the history of my case, I'd like to give you a few facts then open my problems up to you.

A year ago I was diagnosed with azoospermia, when the NHS microbiologists found no sperm in my ejaculate.  Depression followed but moods were picked up somewhat when a specialist unit centrifuged my sample and found sperm.
They told us at the time that there were perhaps six or seven (no, not million; just six or seven) sperm found.

At that point we underwent our first cycle of IVF with ICSI.  Around then I also started drinking much less caffeine, much less alcohol, taking more exercise and taking sperm friendly supplements.  On the other hand, work was tough, my Masters degree picked up and obviously I had all of this to deal with.

I have now had three failed cycles and here are the statistics.

Cycle 1:     11 eggs collected.
                9 ICSId.
                3 eggs fertilised, 2 of good quality, 2nd day transfer.
                failed test.

Cycle 2:     9 eggs collected.
                7 ICSId.
                7 eggs fertilised, 7 of good quality.
                Progressed to blastocyst... 1 progresed to a late cleaving blastocyst, day 6 transfer.
                Failed test.

Cycle 3:     17 eggs collected.
                16 ICSI'd.
                7 eggs fertilised, 5 of good quality, day 3 transfer.
                Positive test, miscarriage at 5 weeks (two weeks post transfer).

SO MY QUESTION IS THIS...

After my first cycle my consultant said that the appalling rate of fertilisation was possibly due to simple chance but she also queried the possibility of genetic damage.

As I am lead to believe, if you have fragmented sperm DNA then you will get poor fertilisation and possible implantation followed by early miscarriage.

I also understand that sperm DNA fragmentation testing is in its infancy and that the results may or may not be relevant.

If I have awful DNA fragmentation then my wonderful wife and I could go through IVF cycle after IVF cycle, each one doomed from the outset, and she will become more and devestated and, well, depressed by repeated miscarriages.

I WOULD REALLY VALUE YOUR OPINION...

Given the above facts regarding our IVF so far, do you feel it would be worth us going to London for sperm fragmentation testing?  Obviously this will involve money, travel and stress.

My wife is understandably really concerned.  Do you feel we have reason to be concerned at this point or do you think there is more likelihood it is just bad luck and chance?  I am trying to stay positive, thinking that this is probably just bad luck, but my wife is really worried and I am becoming more so.

The last thing we want to do is try and try and try only to find out that we never had a chance in the first place.  If we are doomed then we want to make the necessary mental adjustment and progress to donor sperm sooner rather than later.

Thanks so much for your considered opinion, any information you may have is very welcome.

Kind Regards,

RobbyB

chrisd

Rob

I do not know anything about sperm fragmentation but prior to our first IVF I went on a detox for 3 months, no caffeine, no alcohol, lots of zinc and iron and the results were amazing.  I went from having 4 million good quality sperm to having 19 million which the embryologists were amazed with.

I know our situation is different as it is my partner who has bad egg quality but those results spoke for themselves.

All the best.

Chris

robbyb

Just wanted to bump this thread.

Dear Doctor, can you help?

mensfe_admin

Hello RobbyB

Sorry for the delay in this responce however please allow me 24hours to speak to one of our specialist clinician's and Geneticist's.

robbyb

Brilliant... thanks.

mensfe_admin

#5
Hello Robbyb

In answer to your questions: Firstly we must highlight that your clinician (we trust a specialist) has your full case history and he/she should be in the best position to advice on treatment options.

However we hope the following questions, that you require answering by your consultant (if not already), is an aid for your clarification. In our view essential to inform your decition making process however difficult this may be.

Clinician (1)

(i) Have you had genetic tests i.e. Karyotype, Cystic fibrosis, Y cromosome microdeletion ?
(ii) Has your partner had a Hysteroscopy for completeness ?

The above tests are relevant for a clearer diagnosis - then if required

(iii) DNA fragmentation tests may then be relevant as to your treatment options.

The advice that is offered, taking into consideration the limited information available is to confirm:

Have you had the tests mentioned above and if so have the results and treatment options been discussed in depth and specifically to your understanding ?
If the answer is "no" consider undertaking them and seek a second opinion after the tests have been done.

Clinician (2)

Hi having looked at the information you have given us, I would like to repeat what has already been said with reference to your own clinician. He/she is the person who can answer your questions knowing all aspects to your case.
Your first cycle you had 33% fertilisation. The second cycle you had 100% fertilisation and the third cycle you had just over 45% fertilisation. You mentioned after the first cycle your consultant used the word "appalling rate of fertilisation" this actually does not appear to be the case. Overall you had 50% this is not appalling - best case is 65-70% fertilisation.
Your question: is it worth doing sperm fragmentation testing? the question for you to ask your clinician is: Is there enough sperm to carry out this test (as one needs quite a lot)? ditto sperm aneuploidy?

Suggestion:
As previously mentioned, and on the genetic side:
Have you had genetic tests - Chromosome - Cystic fibrosis - Y deletion.
One may consider PGD (Post genetic diagnosis) for aneuploidy, if there is sufficient good quality embryos.

If all the above has not been discussed and/or considered, suggest second opinion to inform yourselves as to the treatment options available.
Hope this helps - Good Luck.