Sperm’s ability to fertilize an egg is dependant on healthy DNA. But some sperm are fragmented.

Healthy DNA is arranged in a double-helix spiral bound by cross-bonds resembling a ladder. DNA damage means the bridges become unstable or broken causing instability in the DNA ladder.

That instability is referred to as fragmentation or damage of the DNA. If there is a high amount, you’ll likely see a reduction in male fertility, poor embryo development and lower rates of implantation.

Scientific literature shows that the extent of DNA fragmentation has little relevance to the basic semen quality parameters (concentration, motility, morphology, etc.) For example, a “good” sperm sample with high concentration, motility and morphology doesn’t guarantee you’ll get pregnant if there’s poor DNA Fragmentation Index (DFI).

Why is DNA Fragmentation important in the assessment of male fertility?

The test (flow-cytometry or TUNEL assays) is used to count the number of sperm cells per sample that contain suboptimal, damaged or fragmented DNA.

What are the values and what do they mean?

DNA Fragmentation Index (DFI) is used to quantify DNA damage in the sperm. DFI is inversely related to sperm’s ability to fertilize an egg and produce a viable embryo. DFI of less than 15% in sample is considered optimal. DFI between 16-29% is considered to be good or fair fertility potential. Sperm with DFI over 30% is considered to have poor fertility potential. Although exceptions do exist, these percent ranges have been established based on numerous scientific publications over many years of research.

What does testing mean for our ability to conceive?

• More accurate assessment of semen sample quality
• May explain previous failed attempts to conceive
• Determine suitability for IUI versus IVF/ISCI
• Assessment of efficacy of medical intervention or treatment of infectious diseases to improve
• Ultimately improve fertility potential of the male partner

What are the causes of DNA damage?

We don’t yet know all of the factors that lead to DNA damage. Most common ones we do know are chemical/toxin exposure, heat exposure, varicocele, age, infection, smoking, alcohol, radiation or testicular cancer.

The post What is DNA Fragmentation? appeared first on Fertility.ca.

I was reading about the success rates of FSP (fallopian sperm perfusion) for unexplained infertility and how FSP may be more effective than IUI. It is suggested that couples with unexplained infertility may benefit from FSP over IUI, resulting in higher pregnancy rates.

I was just wondering what your thoughts were on FSP vs IUI and if you offer FSP treatments?”

We use a modified FSP technique much of the time.

FSP was developed in the 1990s, before ultrasound could be used widely. It addressed the concern: is it better to have the sperm highly concentrated and thus quite possibly left in the fundus of the uterus (“IUI”) or dilute the fluid 8x, put a balloon or other device to make sure nothing comes back, and thus ensure through higher pressure and volume that sperm must go up the tubes (“FSP”).

It took randomized controlled trials to see if there was a difference. The result: both techniques appear to deliver the same pregnancy rates. You can read more about this in The Cochrane review, here.

At our clinic we do a combination of IUI or a FSP variant with every insemination: we focus on ultrasound guidance and, when necessary, using a balloon catheter to keep the sperm up and inside. We’ve been doing this for about four years or so. When we started we saw a 50% boost in pregnancy rates from previous techniques. Now we find success rates are the same whether we use ultrasound or not (but M-F we use ultrasound).

In our opinion, pregnancy rates are maximized when your team is focusing on what you individually need. Its less about IUI FSP or ultrasound, more about your clinician taking care when completing the procedure.

Hope that helps!

The post What’s more effective: IUI or FSP? appeared first on Fertility.ca.

Not everybody needs IVF. Many patients may benefit from intrauterine inseminations.

IUI, where sperm is washed and placed high within the womb, can address a variety of concerns including:

• concerns around cervical mucus or scarring after a LEEP procedure
• erection concerns
• difficulty timing intercourse (perhaps due to work, or irregularity of ovulation)
• unexplained infertility
• donor sperm
• financial: And understanding that IVF may be “better”, but it is also much more expensive and invasive, and a hoped for success through a trial of inseminations

As you can see, there’s a wide variety of reasons why people may choose IUI, so success rates vary greatly from less than 5% to over 20% per cycle. You would really need to speak with your clinical team to understand what the odds of inseminations may be like for you.

It can be difficult to make sense of these wide-ranging numbers. Specific questions of what approach will maximize pregnancy rate can be actually quite tricky to answer. Here are two:

1. Should we always trigger ovulation?

One of the advantages of inseminations is we should be able to get the timing exactly right.

But for the timing to be “exactly right” we want to be able to place the sperm before the egg is released. We say a released egg is viable for twenty-four hours but we know from watching eggs in the lab that they are really optimized in their first six hours upon release.

Sperm, while functional for up to five days, is almost always very functional for the first twenty-four hours. That means we want to place the sperm into the womb before the egg is released, ideally the day before, so that they will be available when the egg is available.

The challenge with placing it the day before, however, is that while we are organizing for the insemination, we don’t actually know if the egg is going to be released on time.

To ensure the egg is ready on time, we often encourage using a “trigger shot”. This is an HCG hormone. It is actually a pregnancy hormone – and after a trigger shot, if you did a home test, it would suggest that you were pregnant. We use HCG because it is almost exactly the same structure as LH, the natural hormone that releases eggs. By taking the HCG shot, you can ensure yourself and us that the timing of the insemination will be ideal.

Different clinics will have different approaches. And it’s important to make note, it hasn’t been proven that HCG shots improve pregnancy rates.

2. Should you do one or two intrauterine inseminations?

The worry is that the timing of the insemination may not have been perfect. For that reason, it may be helpful to do inseminations two days in a row. If one insemination is too early (or the other is too late), at least one of them will be ideally timed. So is it worth doing IUIs two days in a row?

You can discuss this with your clinic. Pregnancy rates that peak at 30% are frustrating: It means that 70% of patients at least won’t succeed with their insemination cycle.

At my clinic, we do the double IUIs as our standard of care, not because we know that it increases pregnancy rates – we can’t know that – but because we are certain that it helps to minimize the stress of all involved. Everybody needs to be able to look back on the IUI and know that it was done in the best possible way.

Having said that, when it comes to donor sperm, which is so much more expensive, we generally encourage a single insemination. Clearly, every clinic is going to have a different opinion on this approach.

As long as you find a clinic and solution that minimizes your stress and maximizes your comfort level, then you have the best approach that fits you.

The post Should I have one or two intrauterine inseminations? appeared first on Fertility.ca.

The lowest-normal peak luteal progesterone level – measured about 7 days after ovulation – is 15 ng/ml, but many women are in the 30-50 range.

So 6.5 is low. You might wish to repeat this test, through a monitored cycle, before continuing with inseminations.

This may be a timing issue, meaning maybe it wasn’t 7 days. Sometimes lab errors do happen (the assay doesn’t work). But if repeat levels are low as well, you and your doctor may wish to consider progesterone supplements in the luteal phase.

Through our clinic, we do daily hormones (estrogen, LH, progesterone) and ultrasound in the days leading up to insemination.

It is not unusual for a fertile couple to take up to 6 months to become pregnant. but you wouldn’t want to have to go through that many treatment cycles if you could help it.

You ask what other things you can do.

I’m sure you’ve looked to your overall health already. Make sure that you are taking folate; some suggest up to 5mg daily.

Ovarian stimulation medications such as Puregon or Gonal F will really boost your chances. You may also substantially increase your rate for multiple pregnancies, especially twins. But your pregnancy rate per cycle can also double (or more). Unfortunately, these products can double the cost per cycle for you and I know you have financial concerns.

I hope you’re able to quickly find a balance of care and cost that works best for you.

The post 7 days after ovulation, I got a progesterone level of 6.5. What other tests can I do? appeared first on Fertility.ca.

IVF with Intracytoplasmic sperm injection (ICSI) should provide a success rate that is at least 3-4x better. Recent improvements in lab techniques have been shown to lower DNA fragmentation rates to ensure higher fertilization rates in eggs.

But you’re doing the right thing: getting yourself organized before taking this next, important step.

Thyroid control should happen quickly. But the effects of varicocele repair can take 3-9 months….and still not make a difference.

If you really aren’t certain what to do, get a second opinion if you can.

You’re about to embark on a new approach (surgery? IVF? both?). Before doing so, you want to be certain that you’re getting the best advice possible.

The post My husband has thyroid problems and a varicocele. We’ve tried IUI 6 times. What now? appeared first on Fertility.ca.

Many corners of the internet encourage people to continue lying on their back, perhaps with a pillow under their bum after intercourse. The speculation is that this allows more sperm access to the womb and increases the chances of pregnancy.

Does it work? I don’t know.

But, if it does, you would only need to lay in this position for about ten minutes. After that, all the “best” sperm will be gone. The vagina, after all, is a very acidic place and sperm do not last very long. After ten minutes, the remaining ejaculate will naturally come out when you stand up. But all the good sperm is gone.

Intrauterine insemination is different: The sperm have already been placed up into the womb. No amount of further lying on your back will change that.

Should you have a quiet day that day? You can! But only because you would like to have a quiet day.

After all, hopefully the sperm will be meeting the egg that same afternoon. But it takes a full five to seven days for the fertilized egg to float down and implant.

In other words, you are not going to achieve implantation that day, so there is no particular reason from a fertility perspective that you could not have as active a day as you had in the days leading up to that procedure.

Intrauterine inseminations do not have the highest success rates in a fertility clinic. IVF generally does.

IUI is much more straightforward and there are huge advantages. It’s a less expensive procedure. It’s less invasive, and it interrupts your life less. If having a quiet day the day of the insemination appeals to you, please take it! But it’s not a requirement for pregnancy.

The appropriate choice is to take on whatever level of activity emotionally fits the best choice for you.

The post Are there any activities I should do the day of my IUI? appeared first on Fertility.ca.

Initial Sample

We like to see sperm in the “normal” range. This is because normal sperm, as you know, are able to enter eggs on their own. Fertilization is a very likely outcome.

The capacity to enter eggs is based on the “acrosome reaction”. While we’re not able to measure this capacity directly, we can use indirect measurements like concentration, motility, and morphology.

A normal range sperm sample will have a concentration over 20 million/mL, motility over 40% or 50%, and morphology over 5%. If your sperm are below these numbers in any one of those parameters, it reduces the chances that any individual sperm will be able to enter an egg.

Washed Sample

The process of washing involves putting the sperm in a Centrifuge. The sperm will form a pellet at the bottom of the tube. We discard the seminal fluid and place a layer of special culture medium on top of the sperm. This allows us to separate the functional sperm – which “swim up” into the medium – and leave the less motile sperm behind. This may be repeated a few times until we end up with a smaller number of high-quality sperm with a motility of at least 80%.

We routinely see motility rates in the 90% or 95% range. One reason your sample may be less is if the technician had to “dive deep” to find any sperm at all.

If you’ve selected frozen-thawed sperm, you may see significantly reduced motility rates. We find 60% – 70% motility is common with donor sperm. While it’s not uncommon to see numbers as low as 30% or 40%, we ask the sperm banks to provide a new sample when we see numbers in that range.

Reduced motility usually means the sperm have a reduced capacity for entering eggs.

Why don’t we add samples together?

Adding three or four donor sperm packets together doesn’t actually provide any extra value. The sperm have the same concentration, motility and morphology levels. This is a case where more does not equal better.

After all, when a couple have intercourse, only 60 thousand sperm enter the uterus. With IUI, there’s a much higher number than that. So your odds on volume are already increased.

The key isn’t really about the number, but the quality of the sperm. The more normal the sperm appears, the more likely it is that they’re able to enter eggs on their own.

The post I’m having IUI, how do I interpret the sperm numbers? appeared first on Fertility.ca.

Intrauterine insemination is kind of like having sexual intercourse timed to when you ovulate. The difference is  that it helps bypass any obstacles sperm may encounter at the cervix.

Some examples of when it’s helpful to move sperm past the cervix:

1. A woman may have reduced cervical mucus related to previous cervical procedures.
2. Erectile dysfunction or other lifestyle challenges may make it difficult for a couple to time intercourse.
3. A woman may be relying on frozen-thawed sperm, such as in the case of anonymous donor sperm.

A woman may choose the option of medications such as Clomiphene, Letrozole, or low-dose gonadotropins (like Puregon and Gonal-F) to stimulate her ovaries and increase the number of eggs released; up to four eggs at once.

We’re reluctant to go higher than these numbers, because it puts the woman at real risk for high-order multiple pregnancy. For some patients, anything over two could be seriously risky for their health.

We’re also happy to work with women who prefer to have IUI with a natural cycle (meaning only one egg is produced by her body).

In a future post, we’ll talk about IUI and how to interpret the sperm numbers.

The post When is IUI the right choice? appeared first on Fertility.ca.

1. Ask to have the test repeated, along with a DNA fragmentation assay.
2. Consider taking antioxidant vitamins.
3. Speak to a urologist – they’re the final word in sperm.

In the end, 25% normal morphology may be amenable to intrauterine insemination cycles (IUI). IUI usually has about a 10% overall success rate (ranges are 7-22.5% depending on the clinic and other factors) and IVF about 32% (depending on age) per cycle. Yes, IVF has the better success rate, but many couples will try IUI first because it is less intense and less expensive.

The post “My sperm morphology results say 75% are abnormal. Help!” appeared first on Fertility.ca.