Sperm morphology issue - ICSI recommended - should do sperm dna fragmentation test even though clinic says no need? AMH 3.9

[WanderingWonder]

Hi All, hope you’re enjoying your long weekend!

I’m 34 - AMH 3.9 - husband borderline morphology issue.

Clinic has recommend 3 rounds with moderate stims and ICSI.

We have asked about dna frag testing and they have said this is not needed as we will going down the ICSI route. The clinic says that even if there is dna fragmentation the ICSI will overcome it, but the info on this forum seems to say otherwise.

I’m very anxious that with such a low egg count I don’t want to waste any eggs on poor quality sperm. We have both been taking CoEnzyme Q10 and another a complete fertility supplement. Husband has lost 14kgs and is eating very carefully and exercising - I’ve made improvements too.

Do you think we should insist on the sperm dna frag tests? What will they advise if there are issues?

I’m very anxious about wasting time either way as my egg count is so low.

Should I just harvest any eggs I have left and freeze them without trying to fertilise? Or will the changes with have made over the past 5 months be sufficient to try and make some embryos?

Any advice much appreciated!

Thank you 🩷

[Keepondreaming]

hey - we are in a very similar situation!! They said to us the advice would not change even if the dna fragmentation result was poor, however we chose to do it anyway for piece of mind. It is expensive though and delays treatment as the results if I remember rightly took about 4-6weeks and we had to wait for those before we could progress. They advised a multi vitamin and ICSI which we were already doing and didn’t say much else about it to be honest!

Wishing you lots of luck xx

[Eloquentia]

My husband has low morphology too, we did ICSI and had very good fertilisation rate (75%). From what our clinic explained, it is not certain whether and how low morphology impacts fertility but they do ICSI out of precaution. Low morphology is different from DNA fragmentation, I don't think there is a connection between the two. With ICSI they select the best looking sperm after examining it under a microscope. To determine whether there is DNA fragmentation, you need genetic testing of the sperm. I hope this helps! Very best of luck with your cycle.

[Tamaa]

Hi. We did icsi for low morphology. I think the question to answer is that in case you get to know DNA fragmentation results aren't good, what will you do to potentially increase the chances of a successful cycle? Also it's worth exploring if your clinic offers add one for selecting the best sperm .. ZyMot,MACS

[zbexbj]

We did ICSI for low morphology (currently in the TWW which is killing me!). Our clinic did recommend that we do a DNA fragmentation test because, if result came back high, they would do PICSI which is basically like an additional sperm selection technique which is supposed to help overcome DNA fragmentation issues. I’ve also heard of clinics using zymot, although I’m not sure how that works. Could be worth asking your clinic about that. And if they don’t offer it, can they explain why not?

In our case, results came back normal, but I did find it reassuring to have the information and know that we were going with the right treatment for our situation. If you’re worried about numbers then it might give you peace of mind to get additional checks, especially if it means they change your treatment protocol.

One other thing is whether your partner has seen a urologist at all? Mine ended up going privately after a recommendation on this forum and they diagnosed him with a varicocele which may be causing the low morphology. We ended up going ahead with ICSI anyway but it is possible to have varicoceles embolised which, in most cases, improves sperm parameters. In my experience, our clinic is almost entirely focussed on me and has barely paid any attention to my partner’s results even though our only known issue is MFI. So we’ve found it reassuring to see specialists.

Sorry, bit rambly and hopefully not overwhelming. It’s very likely everything will come back fine but I very much wanted to do all the tests and get all the info before doing treatment so just wanted to share what I learned! Btw we did end up with a 75% fertilisation rate through ICSI so it seemed to do a good job of overcoming the low morphology 😊

[WMolly88]

Hi WanderingWonder,I queried the DNA fragmentation test with my Dr and he said that if we went ahead and done the test and it didn't come back great, they would only tell my husband to do the things he is already doing and take supplements he is already taking. So we didn't think it was worth the extra cost.

Good luck to you 🤞