Possibility of hidden issues with sperm
8 Replies
California Zoe - August 7

Hello, Dr. Jacobs. I've been reading a few posts and one that you recently commented on is similar to my situation. I would love to hear your opinion.

We have been TTC for 6 years, starting out when I was 37 (now I'm 43). We pretty much immediately went to IVF back then, starting out with several IUI tries, etc. Well, now six year later and 4 IVFs under our belt, we are still with nothing. The last IVF was with a donor for donor eggs. She was 24, excellent health, etc. We retrieved 35 eggs, 22 fertilized, and 18 made it to blast with the highest possible grades. At the time everyone was high-fiving that we hit the jackpot and that we would get 3-4 children, surely, out of that bunch (which is what we would love).

Well, in the past two years, we have now transferred 12 (in pairs of two) of the 18 without success. Husband has low motility, low morph, so we went with ICSI. Also, he was tested for abnormal chromosone alignment (karyotyping) and also for DNA fragmentation. Both came up in the "normal" ranges.

Like in a recent poster's case, with each transfer, I get pregnant (each and every time) and the HcG numbers are always very, very good (250, 380, 420, 316, 262) and every 48 hours they more than double. But right between 5 and 6 weeks I always miscarry them. This has happened in 5 out of the 6 cycles, with the one-off time being the only time that the numbers didn't double like they should have.

My husband is solidly thinking that it's his sperm, but nothing that seems to be coming up in any test. I'm starting to agree. But our RE keeps insisting that ICSI would have taken care of any such issue, but yet he remains baffled. He's never had such a case as ours.

If we were your patients, would you consider that all of our embryos are not viable even though they looked excellent before and after the freeze, due to an undected sperm issue (or even some rejection issue with me??) Or would you say that in 18 excellent blasts there's probably only one good embryo and to keep plugging away them?

I think our RE wants to sugarcoat things and doesn't want to give us any bad news, but we're problem-solvers and want to do the right thing. What are we missing? What else should we be tested for?


B. Jacobs, M. D. - August 7

According to published data, at the age of 43, your probability of a successful pregnancy is less than 6.5%. Please use an egg donor. without knowing how sperm morphology was evaluated, I do not know if you need ICSI, or not. If you are gettig good fertilization rates, you probably do not need ICSI. You really need younger eggs.
Good luck.


California Zoe - August 8

Oh, yes... that's why with the last IVF we went with donor eggs (she was 24). Those are the ones that we got 35 eggs, ended up with 18 perfect blasts, transferred 2 fresh and froze the rest. That was almost 2 years ago, and we've been transferring two of that batch every few months or so, and each time they have great starting HcG numbers (as I listed in prev. post) and they double perfectly, but around 5-6 weeks I miscarry them.

So, could it be something with the sperm? Surely out of 18 perfect blasts we would have had SOME success in the first 12, wouldn't you think? That's why we think there's something hiddenly wrong with the sperm, or something hiddenly wrong with me, maybe, that I'm rejecting them. Which one would you think is more the case? Me or sperm?


B. Jacobs, M. D. - August 8

If pregnancy occurrs, the only sperm problem likely is if your husband has a chromosome rearrangement called balanced translocation. It is also possible the egg donor is a balanced translocation carrier. If she has produced successful pregnancies in the past, that is unlikely. By now, you deserve an evaluation for recurrent pregnancy loss. Please see the information I have provided on our web page, <www.texasfertility.com>.
Good luck.


Marina - September 12

Dr. Jacobs,
I have a similar question.I have 2 failed IVFs-the first one ended up in 16 week m/c,had left 6 good quality embryos for FET,but all of them did not survived thawing ;2nd IVF-BFN .Both times I produced good amount of eggs(around 16) with good fertilization rate(9 and had a few good quality blasts at the end of each cycle).My RE have no concerns on my side even I turn 38(my FSH is 7,E-40)
But I always suspected a problem with my husbands sperm,even the doctors told us that icsi takes care ot this part.We went to see urologist anyway and found out that his DNA fragmentation assay came back with 82% of pathology.Do you think,
1) with this result we should forget about using husbands sperm and go straight to donor's sperm or there is still hope?
2)you mention in previous post "if pregnancy occurs...it could be ballansed translocation"-is this something else that might be tested or it's bad enough already that we have 82% phatology on dna fragm.assay and don't need to add that test to our portfolio?

Thank you.


B. Jacobs, M. D. - September 12

At the age of 38, you have a greater probability that the eggs you produce will have the wrong number of chromosomes. If the egg, and therefore the embryo has the wrong number of chromosomes, your risk of miscarriage increases. I deo not have data with regards to survival of freezing the embryos and later thawing them.
Good luck.


Marina - September 13

Dr Jacobs,
I understand about all the risks at my age,but my question was about husband's sperm-if 82% of fragmentation plays a big role in getting pregnant and having a m/c later.(they say more than 30% is bad and his score was 82%)
Or, you think,that with ICSI it doesn't mater how bad is his score, and only one thing to blame is my eggs?


B. Jacobs, M. D. - September 13

ICSI merely places the DNA


B. Jacobs, M. D. - September 13

ICSI meerely places the DNA into the egg. If there is a lethal gene defect, the fertilized egg may become an embryo, but will not survive. How much of a role DNA fragmentation, as determined by our current testing methods, plays, I do not think anyone really knows.
Good luck.



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