Sperm DNA fragmentation - is marginally moderate damage a huge issue?

[Holdingontohope36]

My husband has just had the sperm DNA fragmentation test done, following three miscarriages and a chemical pregnancy in the last year. He has fallen just outside of the normal range, which is annoying. Apparently 0-15% is low, 15-25% is moderate and 25% and over is high. His score was 16.9%. Does anyone know if this is significant? And whether it can just simply be righted by doing PGS testing? We did ICSI with our last pregnancy and it resulted in a twin pregnancy loss before 12 weeks. We have obviously done all the other tests too - I have raised natural killer cells and a blood clotting issue (treated with steroids and blood thinners in the last pregnancy), but decided to cover all bases after the most recent loss and do DNA fragmentation too. As we’re keen to do PGS testing next time, is this a massive problem? Any thoughts or experiences welcome! Thank you.

[Ivfgotadream]

Hi there! We were on the same MN thread (I’m the one with twins!)

My clinic said not to worry too much about sperm fragmentation as husband had been on Proceive Max for men for a long time and that contains the anti oxidants they would treat fragmentation with anyway so maybe put him on a good preconception vitamin (not wellman)

PGS is hit or miss (my twins are untested after I got rubbish PGS results last year - no normals) and I don’t think the labs in the U.K. are sophisticated enough to tell you if any chromosome issues are maternal or paternal in origin (I think you can get this in Europe/USA)

Did you do karyotyping on your and your partner I can’t remember?

[Holdingontohope36]

Thanks for your reply and recommendation. My husband has been taking Wellman and has just started on Impryl 10 days ago, on a friend’s recommendation. But the Proconceive sounds good, as I don’t think Impryl has the antioxidants. Just so frustrated that we seem to have a succession of small things wrong (even my NK cells levels weren’t massively high) and yet we keep miscarrying 😔

[LCharlton]

My husband's score is 51% and that definitely contributed to our miscarriage at 8 weeks - to me 16.9% doesn't sound bad at all! But if you're getting enough embryos to do PGS testing then yes, that should exclude the ones that have a problem as far as I know x

[Holdingontohope36 in reply to LCharlton]

Thanks so much for replying. Really sorry to hear about your miscarriage - my first one was at eight weeks too. What did your husband do to rectify the fragmentation and did it work for you (if you don’t mind me asking)?

[LCharlton in reply to Holdingontohope36]

We're still working on it - we went to see the urologist that everyone in London/South goes to see, he sent us to the nutritionist he works with who has put us on the special diet with loads of supplements, so that's one part of it. But also my husband has a hormonal problem that is contributing so he has been put on a course of prescribed medication to try and address that, and the urologist also advised that he needs to try and keep his testicles as cool as possible since structurally he 'is built to overheat' - I'm trying to convince him to ice them but he really doesn't want to! Everything still very much a work in progress to see if we can get the fragmentation down. If it doesn't work, I'm really not feeling good about trying another cycle with his sperm because the chances of miscarriage are just so high - he only has 7% sperm with low levels of damage, and none at all with zero damage. It does sound like your husband's issues are much less serious (even the fact that you got two embryos to put back indicates that you're doing better than we were, we got one early blastocyst out of 12 eggs because fertilisation rate was so low and then the remaining ones arrested between days 3 and 5). Wishing you lots of luck x

[Holdingontohope36 in reply to LCharlton]

I’m so sorry you’re having a real battle with this. As if miscarriages aren’t hard enough, having to change our lifestyles and diets completely is tough. After multiple miscarriages, I’m now gluten and dairy free in the hope that it helps (a doc said it could reduce inflammation in the body, but who knows?). So I feel for your husband. It’s all very stressful and no one ever gives you a guarantee that these things will work. Have you asked your specialist whether you can get around the fragmentation issue with PGS testing and/or ICSI? I’m still confused as to their role in selecting the best quality embryos/sperm. My husband is talking to a doc at our clinic today about his results, though, so if I get any info on this I’ll share. I’m really sorry you had a bad IVF round - is poor fertilisation an indication of fragmented sperm? We had a large number of eggs (15) but only 10 fertilised and we ended up with four blastocysts xx

[LCharlton in reply to Holdingontohope36]

There would be no point doing PGS testing for us as if you can only get one embryo if you're lucky, that's the only one you're going to be able to put back however it tests! We've always known we would need ICSI but I was expecting it to get round the sperm problems and unfortunately it doesn't when they are as major as ours. The embryologists can spot obvious issues with the sperm like malformation or poor motility and avoid those, but you can't necessarily see the DNA damage from the outside. It depends how many good sperm you have in the batch really - only 7% of my husband's have low levels of fragmentation.

Poor fertilisation can be down to a lot of different things but sperm problems are certainly one of them. For us that was the case - out of 12 eggs, 3 fertilised so 25% whereas with ICSI you should get at least around a 60% fertilisation rate. Then all 3 were still going and top quality on day 3, but two stopped growing completely and one slowed down massively between days 3 and 5 and didn't quite make blastocyst - generally what happens up to day 3 is more reflective of egg quality and between day 3 and 5 is more reflective of sperm quality.

It sounds like with your numbers - 4 blastocysts out of 15 eggs - your quality is probably a lot better. Really hoping that what happened before was just bad luck and the next round works out better for you xx

[ChloeDE]

Hi

Our clinic used MACS to help combat DNA fragmentation. It's a magnetic procedure to help select the best sperm. It might be worth looking into.

[Holdingontohope36 in reply to ChloeDE]

This is really interesting, thanks! Not sure whether my clinic offer this but will definitely investigate

[JanB78]

Your level is totally fine and near normal

My Dh level stays around 31 and now 36!

Any help ?

[Holdingontohope36 in reply to JanB78]

That’s really helpful, thank you so much for replying! Wishing you lots of luck on your TTC journey x

[josephnsn]

My partner did the test and had 33%. He took wellman conception plus vitamin C with zinc I had a succesful pregnancy after after 2 cycles of ICSI and one frozen transfer. 3yrs later I am pregnant I am 12wks pregnant. This time he took proxceed plus for about 4mths plus 500mg slow release Vitamin C. I have no fertility issues apart from age, I was 42 when I had my 1st succesful pregnancy

[Holdingontohope36 in reply to josephnsn]

Thanks so much for posting such a positive story! We are actually with Shehata now - due to have a consultation next week, so I’m glad to hear he helped your friends. Good luck with your pregnancy!

[josephnsn]

I have read articles that PGS is not that accurate and you could be discarding good embryos. Also if you can afford it you could try the miscarriage clinic in London. Dr. Shehata has a good reputation. He helped 2 of my older friends have successful pregnancies after multiple miscarriages