Sperm DNA fragmentation -

[Lola33]

Evening All,

I hope you’re well.

I was wondering if anyone has advice to improve sperm DNA fragmentation? My husbands results have come back ‘moderate’ but at the top end, closer to 'severe’ on the scale. The clinic said they are high for his age (34) and the results are more what they’d expect to see from someone around 45.

We do tend to have good fertilisation and are able to get 5 day blastocysts so it’s puzzling. But we have struggled with a MMC, implantation failure and CP. Do you think the sperm DNA fragmentation could be the main reasons for these or is it still worth continuing to explore potential issues with me? (EMMA/ALICE/NK etc).

Our clinic have told us there’s not much that can be done for sperm DNA fragmentation and it’ll just continue to get worse with age, but this seems inconsistent with other things I’ve read. We were due an EC in January and the clinic just want us to try MACS ICSI which we haven’t done before. But I’m reluctant to make more embryos if there’s something we can do to improve the sperm, even if it means waiting a few more months!

I'd love to hear your thoughts on this please. And if anyone has any suggestions for a good urologist (London/Cambridge way), please could you send me a PM. I did send a message to Dr Ramsay but he’s off sick until at least March.

Thanks so much in advance xx

[conceptionimpossible]

I can’t recommend a urologist but my husband had high DNA fragmentation and our clinic recommended he try Proxeed Plus and this worked well during our ICSI cycle last year. I think sperm can take three months to improve, with lifestyle changes and supplements.

[ChloeDE]

My partner didn't do DNA fragmentation testing but has poor quality sperm so we used MACS as a precaution. I don't know if it helped but we got 2x blastocysts from our first donor and 3x blastocysts from our second. We have twins from the second round. We had never gotten any blastocysts using my eggs and without MACS

[Eswyn]

Hi Lola, Emma K Belle has a podcast ‘All IVF ever wanted’ and in it her and her husband talk about how they reduced his DNA fragmentation from high to just 4% through diet and lifestyle changes over three months. It may be worth listening to see if there are any helpful tips. One thing she mentions is reducing abstinence before the sperm sample is produced to just 1 day, so the sperm hasn’t been too idle. My clinic also suggests this for moderate to high DNA frag.

If the DNA frag is being caused by varicocele your husband could have an embolization procedure. This would delay treatment by a couple of months, but again improve things. I imagine Jonathan Ramsay would have suggested this already if applicable.

Interestingly, we’ve been told that if DNA frag is on the high end of the normal range or lower end of moderate, IVF would be better than ICSI as natural selection would mean only the best sperm fertilise the egg. The embryologist can’t see fragmentation by looking alone, so there’s a chance they might pick a high frag one while doing ICSI.

I’d personally continue with all the tests so you have an informed view, as it may be a combination of factors, not just the DNA frag.

Wishing you the best of luck!

[soccerkt6]

Hi lovely

It's absolutely not true that nothing can be done for DNA frag and it is so incredibly frustrating to me that professionals in the field continue to believe and tell patients this! There are several different factors that can contribute to high DNA frag so you might need to do a bit more experimentation and testing to figure out what the cause of your husband's issue is. For my husband, diet changes and supplements did help a bit, but when he re-tested after about 5 months his numbers were improved but still fairly bad. For us, fixing his varicocele (which we didn't know existed until Dr Ramsay found it) was the key. His DNA frag numbers improved massively after he had it embolised and his results went into the "fertile" range. And I know there are other ladies on here have seen improvement after their partners were tested and subsequently treated for silent infections in the urinary tract.

It's a bit of a shame that Dr Ramsay is out for a few months (I hope he's okay!), so I'd email his PA and ask if she could recommend any other urologists who do similar work. There is an embryologist who specialises in male fertility called Claire Mooney and she works closely with Dr Ramsay, so you could book a consult with her and I'm sure she'd be able to start you off in the right direction and order some things like the infection testing and an ultrasound to check for varicoceles.

Until you can get a consult with someone, I would suggest having your husband start Impryl and Proxeed Plus (one Impryl in the morning and one Proxeed in the evening seems to work well for people), and make some dietary/lifestyle changes. All the standards recces apply - limit alcohol and caffeine, eat lots of vegetables and protein, limit/eliminate sugar and processed foods, no cycling or smoking or hot baths/ saunas, etc.

As for you, I think it's best if you can test for as much as possible up front but obviously, money is a factor for most of us (!). Do you have a sense of anything being "off" with you? If you have a history of autoimmune disease personally or in your family then testing NK cells might be a good first step but, barring any obvious clues, most people just go with their gut when deciding what to test first. It is, unfortunately, a bit of an unscientific process! 😔

Good luck!

PS - I second the suggestion about reducing abstinence time in cases of high DNA frag. Dr Ramsay told my husband to aim for 18-36 hours abstinence when providing his sample for IVF.

[VariR]

Hi we saw Mr Tet Yap, a consultant andrological surgeon in London for high DNA fragmentation. He was very good.