Will ICSI be effective with 35% DFI?

[Ian2022]

TTC since 3 YearsAge: 38 Years

Partner Age: 32 Years

My parameters:

SA:

Sperm Count: 12 million per ml

Total Count: 42 million

Progressive motility: 22%

Non Progressive motility: 12%

Non-motile: 66%

DFI: 35.38%

Have Grade 1 Varicocele at left testicle.

My partner has hypothyroidism and mild to moderate PCOD.

Initiated IVF+ICSI+Hysteroscopy. Got my DFI report today and suddenly I am in a dilemma whether to go ahead with IVF Cycle because of my DFI Report. I have couple of questions

1. What are my chances of successful pregnancy?

2. Doctor hasn't suggested any Varicocele repair, Any embolization or surgery required?

3. How bad is my DFI? Reading different articles is confusing me, Any Suggestions?

[Coming_up_Roses]

I'm surprised you haven't been advised to sort the varicocele before moving forward with IVF / ICSI, it seems standard practice. SA parameters can often be hugely improved as well with diet and lifestyle changes and a strong supplement (the NHP male fertility is good as is Proceive). It takes something like 70-90 days to make sperm (sorry, can't remember the exact figure!) so if I were in your position I'd get the varicocele sorted asap and then give it some time to work on quality after.

[Ian2022 in reply to Coming_up_Roses]

Thanks for replying.... I've been advised by my doctor that it is grade 1 varicocele and does not need any surgical procedure. He prescribed some antioxidants but didn't suggest any embolization or surgery. Now with the DFI of 35%, I am not sure about the success of ICSI IVF Cycle

[raverg]

My husband has a varicocele as well and yes, it is standard practice to do the varicocele procedure from grade 3 onwards if I remember well, but if conception is difficult, it’s not a bad idea to do it beforehand too. If you only have one IVF round in the bag, it might be a good idea to do it beforehand to maximise chances. But NHS is likely not going to do it (or not if you don’t feel extreme pain and discomfort I think), and the procedure itself will cost around £5k privately with 3-6 months recovery. I also want to stress that you should be seeing a fertility urologist, not a regular urologist, they will be much more helpful.

As someone else said too, SA parameters can be hugely influenced with diet and lifestyle and to be on the safe side, let’s say that it takes about 3 months to see the results. Our IVF consultant and fertility urologist never tested my husband for DFI despite a grade 3 varicocele, because the treatment is the same and not everyone agrees on the best DFI method, plus they could not guarantee that a varicocele procedure will lift parameters or DFI, but in theory they should. The treatment for lower DFI is to take something like Proceive Max, or they also recommend Proxeed Plus and Impryl (good to see a proper fertility urologist, maybe Jonathan Ramsay if you can get in). Cut out processed foods, gym supplements, hair loss treatments, alcohol, smoking, wear loose underwear, avoid hot showers, baths and saunas, as well as exercise or activities that can increase the heat in the testicles (e.g. cycling, heated car seats, sitting for long periods of time). Up your intake of antioxidants like blueberries and lycopene (found in tomato concentrate paste) and do it daily. We haven’t seen Jonathan Ramsay, we saw a different fertility urologist, but I looked into all his advice and he works with Melanie Brown who has lots of posts on nutrition for improving male fertility.

So my husband has a grade 3 varicocele and he was told by his fertility urologist to do the varicocele procedure now or if we go ahead without it, to do alternate day ejaculation for the week before sperm collection, with one day break between the last ejaculation and sperm collection day. Because my AMH had halved in a year and my husband’s recovery could have taken 6 months, our IVF consultant told us that if we can afford it, we should try an IVF cycle before the procedure too, to benefit from my eggs at this age (chances drop with every year, and I’m 36). So we decided to give it a go, and my husband did all the above plus, not sure if it’s for everyone definitely look more into it, he iced every day for 2 months with Snowballs (because he had some pains anyway after the urologist consultation). He did the alternate ejaculation too and he massively lifted his count and progressives and morphology from 1 to 2%. Don’t remember all other results.

We got one high grade blastocyst which stuck and I’m now 10 weeks (fyi varicocele comes with higher miscarriage rate but somehow we avoided that so far 😬) but the other embryos stopped developing after day 3 (clear sperm issue). But everything we did lifted the stats and the DFI (which we’ve never seen) enough to produce one good blasto. And the younger the woman is, the more likely it is for a high grade blasto to be euploid and to work.

Now I’m not saying that you should do what we did as it was insane and I was convinced we were throwing money down the drain, but just wanted to share our experience and what we learned in the process. And obviously your partner should be prepping as well with good diet, supplements (Proceive Max not just regular if you haven’t conceived for a while), exercise and all that. Best of luck!

[Ian2022]

Thank You for your advice, will consult a fertility urologist and see what he says.

[Jwatsonx]

Hi Ian,

I dont have all the numbers on me but my husband had mild varicocele on one side, and moderate on the other, and 2m total sperm count with 40% mobility, he had the surgery in October 2021 as it was recommended to him, after 6 months his count was 13.5m and 60% mobility.

We did ICSI in October 2023, he was 35 at the time. We got 5 mature eggs and three fertilised with ICSI and all three made it to blastocysts.

We did a fresh transfer which was successful but miscarried at 9 weeks, we then had a frozen this February and im currently 24 weeks pregnant.

So even with relatively low numbers, we were still advised ICSI usually results in a 75% fertilisation rate. Hope this helps! Good luck x

[Ian2022]

Congratulations on your pregnancy and thank you for sharing your experience.