High sperm fragmentation - conflicting advice. Can anyone help?

To my dearest fertility friends,

Yet again, I have been trying to make sense of conflicting information from different embryologists about a fertility issue. It seems that - sadly - in our world, there is never a definitive or right answer!

Can anyone help me with information about sperm fragmentation?

1) I have been told that it is impossible to do a fragmentation test just before ICSI is performed and that fragmentation is never checked via a test just before fertilisation. Is this true?

2) I have been told that if you do ICSI, then fragmentation is not an issue because the embryologist just selects the good sperm, but I have also been told that sperm fragmentation can cause arrested embryos on Day 3, so which is correct? Can an embryologist ensure no fragmented sperm is used? So confusing...

3) There are different techniques to reduce the chance of fragmented sperm entering the egg: IMSI, MACS, PICSI and Testi-ICSI - which one would you recommend?

4) I have been told that if TESE or PESA is used, then embryologists can't use any of the above techniques (like MACSs, or PICSI). I don't understand why? Does anyone know?

5) If anyone has a clinic, doctor or embryologist that has good knowledge of fragmentation and can help, please inbox me! I am looking for a new clinic (can be anywhere in the world!)

My partner's sperm has a rate of 42% fragmentation. That's a lot. Many doctors think our embryos arrest during Day 3 because of fragmentation, others blame my egg quality.

If anyone can shed any light on sperm fragmentation, I would be most grateful.

Thank you xxxxx

[Refocus]

Hi Anna,

1) I think so

2) icsi choses the best sperm as far as the eye can see.

3) only heard of PICSI and with this they will individually check the sperm.

I'll pm you an excellent urologist we used. Xxx

[Orla9298 in reply to Refocus]

I’m just trawling old posts, I hope you don’t mind me asking who your urologist is?x

[Hidden in reply to Orla9298]

I will message you now ❤️

[Stsr1234]

Hi Anna i have been asking the same question as well.

No body same to know a lot about dba fragmentation out clinic just said its due to "environmental issues". No embroylogist has even spoken to use about this.

We are getting a second opinion as well. Xxx

[Hidden in reply to Stsr1234]

Our doctor said fragmentation can be caused by excessive pollution (if you ride a motorbike etc), intensive exercise, smoking, bad diet (junk food) etc. I think that is partly what they mean by environmental.

xx

[Stsr1234]

To add further to this. My partner had a DNA fragmentation rate of 40%, yet after going through ICSI we got 6 mature eggs, all 6 fertilised and all 6 made it to day 5 blastocyst. We have gone on to have 2 miscarriages both before a scan.

After the first time we asked did the DNA fragmentation issues play a role in the miscarriage. To which the reply was no, you had 6 day 5 blastocyst embryos, the sperm is not the issue and it could be a bad embryo.

Does anyone have any similar experiences? I now have 4 more day 5 blasts, I don't know if these are good or all will have an issue due to dna fragmentation. Any thoughts will be welcome.

Thanks

[Hidden]

Hello,

I have heard that fragmentation does play a role in the fragmentation of the embryo. I am so sorry you have experienced miscarriages.

I think you should see a urologist first - they might be able to give you more answers. I will PM a recommendation from the other ladies.

Wishing you luck xx

[Lizzielizzielizzie]

My understanding is that the only answer for fragmentation is anti oxidant vitamins so I would suggest just taking these anyway, then points 1 and 2 don’t really apply as you’ll be giving yourself the best chance possible.

[Amy1974]

Dear Ana,

My partner and I have recently found that he has 30% DNA fragmented sperm. This is a border line of male infertility. This explains my three miscarriages (natural conception) and a 'no bonding ' in our last ivf attempt in London.

I am very upset that we found this out upon a routine test in a ferility clinic abroad even thoigh I had a 'thorough ' investigation n a UK hospital, following my third miscarriage. It turned out it wasn't that thorough after all as male factor investigation was never suggested.

Good news is that this can be solved with a magnetic sorting procedure which sorts DNA fragmented sperm from healthy ones prior to ICSI.

In my understanding:

1. This may be true, depending what you mean by 'prior' to IVF? They usually advise 2-3 day abstinence, so doing the test on the same day of fertilisation may be an issue. In our case, it took several hours to get the results (we got results same day though) but we had the fragmentation tests done 6-7 days before the ICSI.

2. The fragmented sperm can be avoided through magnetic sperm soring (MACS) This in our case has been done on the day of ICSI. Because we did a fragmentation test prior we chose magnetic sorting procedures to avoid fragmented sperm selection.

3. MACS (magnetic activated cell sorting) and IMZI prior to ICSI. (This is what we have been advised). Through MACS they sort DNA fragmented sperm from non fragmented. IMZI is a method of using higher quality magnifying which allows them to look closely at the nucleus of a sperm to select the most normal looking sperm from previously selected bunch ( through MACS)

4. Not sure.

5. We did ours in North Macedonia, even thought our ICSI was not successful due to my poor egg quality we will try again at the same clinic.

I wish you the best of luck.

[Aqua17]

Hi reading this is very similar situation to ourselves. We have had 2 failed ivf cyxles 1st missed miscarriage at 10wks. Both attempts embroyos failed to divide correctly and reach blastocyst at day 5 so none ever frozen. Comet test showed sperm fragmentation so advised try icsi- egg collection is in 2 days!! Hes been taking antioxident tablets 4 months. Did you ever get success? Hope so . Any advice ia welcomed xx

[Hidden in reply to Aqua17]

You should ask for IMSI not IMSI and it’s better to take the sperm directly from the testes using TESE. Ask the doctor about it, because the embryologist can’t see fragmented sperm unless they use IMSI xxx

[Aqua17 in reply to Hidden]

Thank you Anna, I've emailed my Dr to query why were not doing this. Hope this not going to be another waste cycle. X

[Hidden in reply to Aqua17]

I really hope not too...really push this, make sure they are doing something different. You don’t want to do all those injections when the sperm is the issue...

That’s what happened to me 😫

[Hidden in reply to Aqua17]

Also worth noting that many clinics don’t do IMSI or Micro-TESE so you might have to change clinics x

[Missl73]

Hi Anna

My husband had a DNA fragmentation result of 57% which is extremely high. With lifestyle changes and supplements we’ve brought this down considerably. Our first cycle we had ICSI and only got one blast that ended in MMC (egg issue what are the chances!). Our second cycle we switched to IMSI all fertilised and all made it to day 5 - I’m currently almost 10 weeks pregnant from one of the embryos from that cycle. For us IMSI was much better and was what our doctor who specialises in MF infertility advised. With high fragmentation a shorter abstinence protocol is often advised - rather than 2-3 days before giving sperm my husband never abstained longer than 18 hours (on our doctors advice). TESE is also shown to help but is a much more expensive and invasive choice so I would try IMSI first as with an operation, although very unlikely, it’s possible damage could be done that could impact the sperm production in the future.

In answer to your questions:

1) Yes correct you cannot have the same sperm sample tested for fragmentation and then used for your treatment

2) no they can’t be certain. Fragmented sperm is often associated with certain characteristics e.g abnormal shape, slow moving, but there are no guarantees using ICSI means the sperm has no DNA fragmentation. With IMSI as the microscope is even more powerful, the chances of picking a good one are even higher and each sperm is actually given a quality grading which doesn’t happen with ICSI.

3) I would recommend trying IMSI first and if this is unsuccessful consider progressing to TESE.

4) I don’t know.

5) I’ll PM you ours is amazing and widely recognised as the best in the country.

Brand new research being done in this field has found there are two types of DNA damage, single helix breaks and double helix breaks. Single helix breaks are much easily repaired and a high quality egg can overcome much of the damage. Double helix breaks are indicative of an issue at production and are less easily overcome. My husband had the new test (as a test subject in a study of this) and we found that almost all of this damage was single helix breaks. I’m young and have very good egg quality which may explain why we are getting day 5 blasts and BFPs despite the DNA damaged sperm.

xxx

[Hidden in reply to Missl73]

Thanks so much!! Can you PM me the clinic?

Also, what is the test you did to discover what type of helix breaks you had? Was it a COMET test? Xx

[Missl73 in reply to Hidden]

I’ve sent you a PM. Yes the test that tests the helix breaks is called a neutral sperm comet. I think it’s not commercially available yet but my DH got it through the urologist I’ve sent you the details for in the PM. If you have any questions feel feel free to message me any time, we’ve been on a two year journey with this so there is very little I haven’t read or discussed with our doctor! Xx

[Hidden in reply to Missl73]

Thanks so much ❤️

[Ladypii in reply to Missl73]

Hi Missl73, please could you share what supplements your husband took? Thank you

[Missl73 in reply to Ladypii]

Of course he took Fertilsan M which is one tablet 3 x per day and Ubiquinol 300mg per day xx

[Ladypii in reply to Missl73]

Thank you! X