DNA fragmentation- sperm

[Sugarplummy84]

Please tell me everything you know about this...

We succeeded with ivf a couple of years ago but only had 1 embryo survive out of 20, all the others died after day 3. We want to have another baby and are wondering if dna fragmentation was a factor last time after doing lots of googling but know nothing about it. We want to maximise our chances.

Thank you x

[Sugarplummy84]

Anyone??

[Sugarplummy84]

No one??

[Shellster52]

Hello there.

Not sure I can answer your question specifically, but sometimes an objective opinion is helpful. And I hate to see women's questions go unanswered when infertility is already so lonely.

In return, I will tell you my thoughts based on my research.
From what I have read, if the embryo fails to fertilise, then the problem points towards the sperm. But if the embryo quality is poor, then it points towards the eggs.

Studies show that if a woman has a high protein (>25%) diet in the lead up to IVF, she will have 50% of her embryos make it to blastocyst stage. If you also reduce your carbs to less than 40%, you statistically have an 80% success rate.

I have heard of DNA fragmentation, but what makes you think specifically that this is the reason for your poor embryo quality? I would genuinely like to know as I am about to embark on my 7th IVF (no success to date) and would love to up my chances, so any light you can shed on this I am grateful to hear.

[Sugarplummy84]

Thank you so much for your reply, shell.
This is very interesting indeed. I have read that the energy in the egg takes the embryo to day 3, which is when the sperm kicks in. Our embryos died on day 3, hence my belief that dna fragmentation might be the issue.
It is all so very confusing though.
I wish you so much luck with your next go x

[Shellster52]

That's interesting. I hadn't heard of that before. My last two embryo transfers were at my old clinic where they were done on day 2. My new clinic does them on day 5 so this is the first time I will see how they go over that distance.

Do you have a link to that information you read? Would love to read it. And has it led you to do any research on what can be done to improve the sperm. My husbands sperm is the reason we are having IVF so I am happy to hear any tips on how to have it in tip top shape for his IVF deposit on 26th July.

Here's what I know:

Studies have suggested that DNA fragmentation rates can be improved by frequent ejaculation (once a day) for at least 5 consecutive days (preferably longer) before egg collection  the theory being that getting rid of older sperm will get rid of the most dna damaged sperm.
www.fertilityfriends.co.uk/forum/index.php?topic=283000.0

Also, studies show that the least DNA damaged sperm bind to HA during the selection process. So I am paying extra this cycle for the added step of HA sperm selection.

[eurochick]

My clinic told us what sugar plum mentioned. I've also read that sperm frag can be responsible for miscarriages.

[Sugarplummy84]

www.tdlpathology.com/services-divisions/tdl-andrology/sperm-dna-fragmentation
This is just something I've read. I have read loads over the last year or so and will send you more links as and when I find them. X

[Shellster52]

I never knew this. Thanks so much for the link. Really shows as you say that high sperm DNA fragmentation does not appear to affect fertilisation or the initial embryo stages but can cause problems at around day 3 as you say.

I read a study that women with previous IVF poor embryo quality were put on a high protein low carb diet for 3 months before repeating IVF. The embryo quality improved, the % of embryos that made it to blast was 50% and the preg rate was 80%. So I thought it showed the embryo outcome was in my control which I was relieved about since my husband loves junk (hence, his sperm is the reason for our needing IVF!). I have been on a high protein/low carb diet and am now on day 6 of an IVF feeling confident my embryos will be great quality because of all my hard work... until I discovered this today!

If that was your cause Sugarplummy, you can only do what you can do to fix it. Did your specialist give you any suggestions at the time? My personal plan for this IVF was to not assume one thing is the cause and have tried to fix everything; supplements, acupuncture and special diet for me for egg quality and endometrial scratch for increased implantation success. I have also done supplements for hubby and trying to make my junk loving hubby healthy lunches and dinners as often as possible. Going to do the two things mentioned above for sperm fragmentation.

Do you have any set dates for another go at IVF?

[Sugarplummy84]

I pray your cycle will work, shell. Have your embryos been transferred? At what stage were they transferred?

I am not sure what one can do to improve DNA fragmentation but I do know that by extracting the sperm, their dna quality may be better. It's super confusing. We were incredibly lucky last time in that our one surviving embryo is now my little DD, but I do wonder if it was fluke on the clinics behalf. I just feel they shouldn't have put us through all that treatment before testing everything. They should have tested for DNA fragmentation before we went through the treatment as apparently it is a common problem with men with low sperm counts.

We are hoping to embark upon another treatment cycle this autumn but want to find out about dna fragmentation beforehand. X

[Shellster52]

Today is day 6 of my cycle so I haven't laid my eggs yet! The only thing I have read to improve DNA fragmentation is the two things I listed above.

So your husband has low sperm count and that is associated with higher DNA fragmentation? I assume you are going to see a specialist and get the DNA fragmentation test done then. Sounds like a good idea before putting your DH through testicular biopsy sperm retrieval! My hubby was told that they would do this if he couldn't produce a sample on the day and it made him cringe at the thought and affected his performance on the day!

[Sugarplummy84]

Yes we will get the fragmentation test done first. I just feel if I hadn't done my own research we'd never have known about dna fragmentation.
Is the sperm retrieval procedure a one day thing? Do anything about it?
Really crossing everything for your cycle x

[Shellster52]

Yes, I too have done so much research and discovered so much that not one doctor has mentioned to me. I started IVF with just 5 antral follicles and only got 2 mature. It was my own research and efforts that had me start this 7th IVF with 19 antral follicles.

I was so calm at the start of this IVF cycle as I truly thought I was responsible for embryo quality once the sperm fertilised it and I knew I had worked hard so was confident they would be top notch. This thread has put me in a bit of panic mode. My previous transfers at my old clinic were all day 2 before this male genome kicks in at day 3. This will be the first time they are grown to day 5, so I am now paranoid that all my embryos will die off at day 3.

The only thing I know about the testicular sperm retrieval is this. My husband had to ejaculate while I was having egg collection. If he couldn't produce a sample, they would have done testicular biopsy. So it seems it must be a very quick procedure seeing as they would have required the sperm an hour or two later once my eggs have been collected and assessed.

You certainly have reason to want to fix things. 19 out of 20 dying at day 3 sounds unusually high. Were they all top quality at day 2 and had divided into four cells before suddenly bombing out at day 3, or were a good few of them poor quality at day 2? Thanks for answering all my paranoid questions, just wanting to know what to expect over the 5 days after EC.

[Sugarplummy84]

I am so sorry to have set you in panic mode. Remember that one embryo is now lying next to me in bed as I type this. It just takes one!
In answer to your question, the other embryos appeared healthy to the embryologist before arresting :( Remember knowledge is power!! Stay positive- you sound like you have an excellent chance x

[Sugarplummy84]

www.conceptfertility.co.uk/news/sperm-dna-fragmentation-is-it-clinically-relevant/

Shell, I'm hoping this will make you feel more positive. It makes me feel better x

[Shellster52]

No need to apologize for setting me in panic mode. Emotions are always high at this stage of IVF so I think I would be panicking now regardless. It's exactly as you say. Knowledge is power. So I am grateful to have learned this information and at least I will have a reason if this happens to me instead of feeling like all hope is lost. I don't know that your situation is that common though to have a whopping 19 eggs die at day 3, so I am hoping that it won't apply to me. I went for a day 10 scan today. I started with 19 follicles on day 3 but now it looks like only 5 are going to be large enough at day 14 for egg collection. There are 15 in total today but the others are all smaller and might not catch up. So now I am panicking about that instead!

Next scan is Friday and will see if any of the smaller ones are going to come to the party, but just trying to accept 5 eggs for now so that I don't get more depressed on Friday when I learn the smaller ones haven't grown.

I haven't read your link yet. Will have a look now. You started this thread for support for you and now you are getting me through instead! Thank you!

[DogStrummer]

SugarPlummy84's link is a good resource, and in agreement with what we were told when we did ICSI 4 years ago.

The cheapest, most effective, supplement for sperm quality, seems to be Vitamin C. I took 1000mg per day, based on studies like this one:

www.ncbi.nlm.nih.gov/pubmed/17004914

Another study here finds Vits C & E reduce DNA fragmentation in sperm:

www.ncbi.nlm.nih.gov/pubmed/15867002

For the cost of the vitamins, its a no-brainer.

[Sugarplummy84]

I have heard about the merits of these vitamins. It's interesting to read your links- thank you for posting them. What an interesting read x

[Shellster52]

Yes, thanks to both of you for the links. I like the factual, researched based articles, which is what these all are.

DogStrummer, your first link certainly shows vitamin C helps and as you say, for the small cost of vitamins, makes sense to try. Can I ask, did you have a diagnosis that the vitamins assisted with before doing IVF? My husband first test showed 100% abnormal morphology. I then did research and found articles like yours and started hubby on vitamin C as well as other supplements. I was happy to finally have a diagnosis for our infertility and also a remedy. We retested after a few months and the count and motility had improved, but the morphology won't budge from 100% abnromal.

I am about to have IVF egg collection Monday but I have only produced 3 eggs, so it seems highly likley this won't work. Would love to hear your personal experience and if you found a rememdy as I would love to find one for my husband so we can have a back up plan.

[Sugarplummy84]

Shell it's easy to say but please remember that it only takes one ????????

[Shellster52]

Thanks Sugar. I have had my husband ejaculating daily as per the study I mentioned above showing it reduces DNA damage. (This IVF sure takes the romance out of things!) Hopefully as the study suggests, this helps reduce the sperm DNA damage and it's a case of quality over quantity. Will report back after Mondays EC.

[DogStrummer]

My initial SAs showed everything well below par - morphology (3%), count, motility (0%). The motility problem was due to Anti-Sperm-Antibodies, but the other markers all improved a lot with the vitamins. We were fortunate to get a positive result with the first ICSI.

In addition to the vitamins, I did a few other things. Stopped hot baths for 90 days prior, no booze, etc.

I had another test as we were about to do another cycle of ICSI 2 1/2 years after the first. Again, all the markers were a lot better on the vit C. Strangely, the Anti-Sperm-Antibodies had disappeared this time - which I didn't think could happen. Can't credit the vitamins for that, though. We had a natural pregnancy just before starting the ICSI cycle.

So, it's impossible to say for definite that the vit C helped me, because I was doing a few other things too. I think it did though.

I'm a little distrustful of Sperm Analysis. This is because I have given samples, and been told "they were all immotile" more than once. Then, get a completely different result 2 weeks later. Thing is, you don't know how that sample was treated after you hand it over.

Regarding morphology, I have heard of clinics being very, very strict on their criteria. If you have good motility, I would check how they assess the morphology to be honest.

[Shellster52]

Have to give you loads of credit for being so pro-active Strummer
My husband always whinged every time I handed him his tablets. He pulled our bathroom apart just after I got pregnant with number one, and still hasn't put it back together so we have been forced to have baths ever since. So I really wonder if this is the issue, since we got number 1 naturally.

I wonder too how picky they are being with the morphology. They say the acrosome is either small or missing. Acrosome = cap on sperm needed to break down egg shell and penetrate it) If they were just all small, I would think that maybe that's normal for my husbands sperm, but since half of them are totally missing the acrosome, it makes sense that the ones that are developing it aren't doing it properly.

Either way, no conception in nearly 3 years so something is wrong. We had IVF with ICSI today so I am just hoping my future baby is growing in lab as we speak.

[Sugarplummy84]

shell how is it going?? X

[Shellster52]

Thanks for caring and asking Sugar
Don't chat to anyone about this in real life as I don't need the added pressure of having to report back to them with IVF success/failure
Plus those who have not suffered infertility don't really get it and their comments 'forget and it will happen, etc) are not helpful
So the support on Mumsnet means so much.
Last I heard was yesterday - day 2.
Embryo was at 5 cells.
They didn't mention the grading and I didn't think to ask.
Have left a msg for my nurse to get an update and impatiently waiting for a return call.
Normally, the fact that it was 5 cells yesterday would give me hope that it's a strong embryo that's going to go the distance.
But now I know that's not the case and if the sperm is no good, a strong embryo can go downhill after 8 cell stage when sperm starts to play a major role.
Also read that 80% make it to day 3 but only 30-40% to day 5.
So the next two days are really going to drag!

[Sugarplummy84]

I didn't tell anyone about our IVF either so know how you feel about inner turmoil. I'm keeping everything crossed for you. Please let me know how it goes. Keep positive (easier said than done). X