DNA fragmentation and ICSI

[Xmishell37]

Hello, I'm experiencing severe PMS today which means I'm overthinking everything and negative thoughts are just going round and round after a confirmed negative test on Friday (my 3rd and last FET of this cycle). We recently discovered my partner's DNA fragmentation is sitting at 30% and I have a few questions...Has anyone had a successful natural pregnancy with DNA fragmentation being high? (30% or more)

Is ICSI an alternative likely to be offered rather than 'normal' IVF due to this level of fragmentation (I'm an NHS patient but paid for the test privately and still to share the results with them)

Is ICSI higher risk than IVF when it comes to birth defects/abnormalities etc?

Thanks xx

[Endofitall]

I am so sorry this transfer resulted in a negative test.

There are risks linked to ICSI. This is the HFEA information, see under the “how safe is ICSI” tab

hfea.gov.uk/treatments/expl...

However I don’t believe ICSI is necessarily the answer here. As it won’t fix the dna fragmentation. Who did the sperm dna fragmentation test for you? Have they discussed the result with you? Finding high dna fragmentation is just the first step and then the next steps need to be considered to investigate why this is the case.

I hope you can get to the bottom of this and plan next steps. Sending hugs.

[Endofitall in reply to Endofitall]

Also completely empathise with the severe PMS that adds a whole layer of horror to TTC and infertility.

[Xmishell37 in reply to Endofitall]

Thank you ❤️ it was a private clinic and they will discuss the result with my partner this week, they're more of a natural fertility clinic rather than medical and do acupuncture etc, but I'll pass on the results to my NHS doctor and see what they say as my next IVF round will start in May! (Only giving my partner 7-8 weeks to work on lifestyle progress) xx

[LittleL3]

After a first round of IVF with low fertilisation we asked our clinic if worth doing DNA sperm fragmentation test. As it is quite pricey and they said the 'fix' would be ICSI anyway (which they were already recommending) we decided not to bother. So ICSI is what our clinic seems to recommend for high DNA frag. My understanding is that ICSI comes with a slightly increased risk of congenital abnormalities, which our consultant described as 'things that can be surgically fixed', such as cleft palette. Best of luck to you x

[Xmishell37 in reply to LittleL3]

Thank you ❤️ didn't read anything about icsi until now and I've got a telephone call with a doctor and the end of this month so will see what they recommend ❤️ xx

[Wishinandahopin]

ICSI is generally needed with high dna fragmentation at a minimum.

We had severe male factor (which warranted it anyway) but when we asked the andrologist about DNA fragmentation they said that given his other results he probably did have high fragmentation and it would require ICSI anyway which we were already having.

We opted for something called Zymot which can help filter the sperm to find the least fragmented ones. And this really worked for us as we got decent embryos.

There are very few risks of ICSI compared to others but it is a slight increase. The chance of birth defects for the general population without assisted reproduction is 5.8%, following IVF it is 7.2% and following ICSI it is 9.9% (so not a massive increase to the ivf group) the vast majority of these would be very minor birth defects which would include things like Clinodactyl (a slightly bent pinky finger) or a single palm crease.

There have also been studies to show that the reason for the ICSI increase is probably more likely due to the quality of the dna in the sperm used rather than anything the actual process does.

In america most clinics do ICSI as default nowadays I believe.

It’s all totally a lot to weigh up for sure! But just putting your mind as at much rest as possible.

Wishing you so much luck 🤞🏼🤞🏼🤞🏼

[Xmishell37 in reply to Wishinandahopin]

Thanks so much this is really helpful and the kind of numbers I was looking for ❤️ I should probably do more reading on the subject since I hadn't considered it an option until now xx

[Wishinandahopin in reply to Xmishell37]

The other thing that is meant to help DNA frag is ejaculation every 1-2 days and def not leaving too long between ejaculations. Xx

[Xmishell37 in reply to Wishinandahopin]

Thanks this is defo useful to know as egg retrieval gets closer 🙏🏻🤞🏻❤️ xx

[DianeArnold Partner Nurse Fertility Network UK]

Hi Xmishelle. Just wanted to wish you well with this. I have been doing fertility work for many years, and have never ceased to be amazed at how many ICSI babies I’ve been involved with and all fine. It’s often used when motility is low. It’s the tail that’s faulty, being a weak swimmer. Your embryologist will select the best ones to give you the best results. I believe that it is not the process of ICSI that causes defects, it would most likely be a gene defect or inherited problem. Good for and try not to worry. Diane

[Xmishell37 in reply to DianeArnold]

Thank you that's really helpful ❤️ I have a call with a doctor in a few weeks to share the results so will see what they recommend then xx