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I am not aware of any evidence that correlates antisperm antibodies (ASA) with DNA damage and it doesn't make sense anyway. The antibodies are found in the fluids that make up the seminal plasma (the liquid portion of the semen). The sperm are exposed to the antibodies only at the time of ejaculation, not before. Hence, they could not have any effect on sperm DNA since the DNA is already packaged inside the sperm head long before ejaulation.

Frequent ejaculation will not reduce the concentration of antibodies in the seminal plasma. Once the body has developed ASA, there is no going back. Your huband will always have ASA. That's something they don't usually warn you about before having the vasectomy reversal.

As I explained, the ASA do not affect the sperm DNA. However, the Sperm Chromatin Structure Assay evaluates DNA damage in sperm. For more information, see www.scsadiagnostics.com.

The solution that your husband ejaculates into for IVF does not "kill" the antibodies. It acts to liquify semen rapidly and dilute the antibodies, thus reducing the opportunity for the sperm to be exposed to the antibodies prior to "washing".

Because you have only a few eggs to work with, it is impractical to split the eggs. In any case, the point is moot. The fact that the majority of the embryos were grade 2 on Day 2 of development is telling. Embryo fragmentation (hence grade 2) occurring before Day 3 is not caused by sperm, its caused by poor egg quality, so you already have your answer. The sperm doesn't have any effect on embryo development until after Day 3.

If your husband's semen paramters have improved to the "normal" range (give or take), IUI with your husband's sperm is possible. They could use the same processing technique (i.e. ejaculating into a cup containing special solution) and then "wash" the sperm for IUI.

Thank you so much for your prompt answer. You've helped me to have a much better understanding of ASA. I was just worried about the quality of my husband's sperm after getting 3 pro-nucleated embryo's, which you mentioned was more likely due to abnormal sperm.

I had a highish FSH reading for my age (9.4). It did drop down to 6.3 the following month, but one of the nurses at our clinic mentioned that my eggs could be poorer quality due to having had a highish FSH reading.

Is there anything that can be done to improve egg quality and lower FSH levels?

Would we benefit from Assisted Hatching next time? My clinic likes to put the embryo's back ASAP (nearly always on day 2), but I'd like to take our embryo's on to blast, to see how they develop in the lab. Would this be a good idea, with so few to play with?

It seems that between my husbands ASA and my raised FSH levels, that betweem us the prognosis doesn't look too promising. Yet I'm not ready to throw in the towel just yet! Just wondering if there is anything either of us can do to strengthen our chances for next time.

Many thanks :)
Nat.

FSH has no relation to egg [i]quality[/i]. The nurse was misinformed. The FSH level reflects the [i]number[/i] of eggs remaining in the ovaries (ovarian reserve) and therefore, the number of eggs expected at retrieval. Increased estrogen will artificially lower the FSH, but manipulating the FSH level will not suddenly make more eggs available. You ovarian reserve is what it is. The quality (i.e. developmental competence) of your eggs is primarily a function of your age.

I believe assisted hatching may benefit you, particularly if you insist on culturing the embryos to the blastocyst stage. However, if your clinic routinely transfers embryos on Day 2, I suspect you will not be successful in convincing them to attempt blastocyst transfer. However, I think this is the next step to take.

Thank you so much for that :)

My clinic is a fairly basic clinic with only average success rates, and a "one size fits all" protocol. We went there because it was the nearest to where we live. They rarely culture embryos to blast and don't do AH at all.

The next time we do IVF we'll be trying a different clinic and one which offers both. In the meantime, while we wait for our next cycle of IVF, we would like to just try IUI.

Does 7 eggs sound like a really low number of eggs at collection? I was on 450iu of Gonal F daily. There were 2 more large follicles, which weren't aspirated in case they were blood vessels (they appeared to be beating on U/S), 2 were empty and 2 more were below 10 mm.
My down regulation was really long too, with about 5 weeks on microgynon, followed by an injection of prostap (2 wks).

Do you think it would be possible for me to produce more eggs if I was on a protocol where I wasn't down regulated for so long?

Is there any scientific evidence to suggest that increasing protein intake, Chinese herbs and acupuncture can make a difference to the overall quality of eggs and sperm?
I tried acupuncture this cycle. My lining was much thicker (grew to 29mm), yet one of our embryo's was a grade 1 on our first treatment, and this time with all the extra effort I only managed to get grade 2 embryo's.

Many thanks,
Nat :)

You may benefit from an ovarian stimulation protocol that does not involve prolonged down regulation of you pituitary gland. There are a few alternatives to the long prorocol. The short protocols are used for women that become overly suppressed from the long dose micrgynol (Lupron in U.S.). Discuss the alternative stimulation protocols with your doctor.

There is no "scientific" evidence to support the use of herbs to improve fertility. Some herbs can actually be detrimental to fertility. However, accupuncture certainly cannot hurt (no pun intended) and may help. I've heard other anecdotal reports of improved endometrial linings following accupunture treatment. I've never heard of a high protein diet as a way to improve fertility. Doesn't make much sense from a physiology point of view, unless you're trying to loose weight to improve your chances of pregnancy.

Thank you so much for your answer Dr Smith :)

I contacted another clinic this morning which do blastocsyst culture and AH. They told me that my ovaries must have been "dead" because I was down regulated for so long. They still do a LP but it's much much shorter than the regime I followed.

On day 11 of stims I had 7 follicles, by day 14 of stims, I had 13 follicles, so it seems my ovaries really sparked into action in those final days before e/c. In fact I had an U/S done 2 days after embryo transfer, after getting burst chocolate cysts, which showed that I was still making folicles :o Perhaps my ovaries just take a long time to "wake up", but function ok once they are fully "awakened".

My accupuncturist recommended me a herbalist in London. I wouldn't take herbs unless it was on the advice of someone qualified for fear of taking something that, like you say, could be detrimental. It's just that I'm willing to try "anything" to maximise our chances of success!

It appears from what I read online and see on TV documentaries that the US seems to have much better overall success rates than where I am in the UK.
Are clinics in the US more advanced generally, and do you get patients coming to see you from the UK?
Many Thanks :)
Nat

The reason for the apparent higher success in the U.S. is because many U.S. clinics transfer and excessive number of embryos to boost their success rates. The problem with this approach is that an unacceptable proportion of the pregnancies are triplets, quads, etc. High order multiple gestations are dangerous for the babies and for the moms. Very recently there has a push amongst programs in the U.S. to decrease the number of embryos transferred and thereby minimize the dangers of high order multiple gestations.

My clinic is in the New York City metropolitan area and we see patients from all over the world. However, most clinics in the U.S. only serve their local patient populations. I expect we will be seeing more patients from the U.K. in the near future because of new anti-anomynity laws regarding egg and sperm donation in the U.K. Since donor anomymity is no longer an option in the U.K., this will serioulsy decrease the number of available sperm and egg donors there.

Thanks for that Dr Smith :)

My husband and I are currently discussing "our next move" so to speak, and we have talked about the possibilty of going abroad for treatment, and the US is top of my list, because I could have more embryo's transfered there. Though I do appreciate there is a risk involved, it would be nice to be given the choice, which is taken away from us in the UK. Both of my IVF cycles our remaining embryo's weren't suitable for freezing and had to be destroyed. I often think "what if they'd been the ones?"

I have been reading about your clinic and your success rates are double my clinic, so it must make such a difference to the overall outcome.

Many thanks for answering my questions
Nat :)

Just like to make a point here (although you can't see me, I'm stading on the soapbox now). We achieve those pregnancies by routinely transferring only two embryos. I attribute our success to identifying the right two embryos. We culture all embryos to the blastocyst stage prior to transfer and therefore take most of the guess work out of determining which embryos have the best developmental potential. I'm glad you have contacted a clinic that performs blastocyst transfer. I'm convinced you will benefit from this technique. Best of luck.

Oh I so wish I could be treated at your clinic! It seems so much more sophisticated than ours.
I'd like to find a clinic where I felt sure that everything possible was being done to help us achieve a successful outcome, and one in which I had total confidence and trust.
We haven't ruled out anything at the moment and have discussed the possibility of coming to your clinic for treatment, seeing as you do accept patients from all over the world.
I have found several clinics here which do AH and blast (not such high success rates as your clinic though) and at the moment we are going to wait and see what our consultant says at our follow up appointment (re. failed cycle) before we make a decision about where and what (IUI or IVF) to do next :-\
Many thanks for all your help :) It's given me a much greater understanding of what we are dealing with, and good to know that you are there to help me to understand the minefield of IVF!
Thank you so much,
Nat :)