It is so important to understand your body and your fertility treatment, so please, if you have any questions that you need the answers to, or if you feel lost and you need some help and guidance to get back on track, please do ask won’t you? We will go straight to our experts, just like we did for this lovely reader, who was concerned about her husband’s 0% morphology ‘score’. We turned to Dr. Elena Santiago from Clinica Tambre for some advice . . .
Q: “We have had three chemical miscarriages after IVF (2 frozen, 1 fresh). We have MFI. My husband has 0% morphology (count and mobility are fine). He has had a DNA fragmentation test, which came back fine.
How much difference would waiting 3 months to start over and his having an excellent diet/lifestyle make?
He doesn’t smoke, drinks very little and has a reasonably good diet, but doesn’t exercise much. We will be waiting for three months until we start treatment and then we will be having an ERA”.
A: “In your case it is debatable whether waiting 3 months following a healthier lifestyle is really going to improve your husband’s sperm quality. We know that DHA can improve sperm quality in SOME patients but not in all of them. Sometimes all the parameters are improved but for some, you see an improvement in motility but not morphology. I have even seen patients where the treatment didn´t improve all any of the parameters.
However, DHA needs to be taken for at least 3 months and re-testing of the sperm quality should be done afterwards, as the sperm cycle takes 3 months to create a completely new sperm cohort.
My advice would still be to wait for these 3 months anyway, and get your husband to take an antioxidant treatment.
There are many vitamin complexes with DHA (Docosahexaenoic acid) that could improve sperm quality. DHA is an omega-3 fatty acid that is essential, as it constructs the arch that turns a round, immature sperm cell into a strong swimmer with a smooth oval shaped head an extra-long tail.
In fact, low DHA status is the most common cause of low-quality sperm and frequently found in men with subfertility or infertility problems. Getting adequate DHA through vitamins supports both the vitality (percentage of live, healthy sperm in semen) and the motility of sperm, which impacts fertility.
We can’t know the reason for the chemical miscarriages, but I would recommend doing further tests regarding your blood coagulation and instead of only having an ERA, have a more complete biopsy of the endometrium that includes ERA and uterine microbiome, which studies whether there is or not a chronic endometritis (this can be done in the same lab that does the ERA test and it’s called EndomeTRIO.
For your next IVF treatment I would always recommend PGS in the blastocyst stage to decrease the miscarriage rate and increase the chances of success.
Understanding the terminology!
What is a chemical pregnancy?
This is when a pregnancy has been diagnosed with a positive blood or urine test but a miscarriage has occurred before being able to see the pregnancy with a scan. A chemical pregnancy can have no symptoms; in fact some women have an early miscarriage without even realising they were pregnant. For women who do have symptoms, these may include menstrual-like stomach cramping and vaginal bleeding within days of getting a positive pregnancy result.
What is MFI?
MFI stands for Male Factor Infertility.
What is the difference between mobility and morphology?
- Mobility is the ability of sperm to move properly.
- Morphology refers to the structure, shape and size of the spermatozoa (the sperm cell). This is important, especially the shape of the head, because it affects the sperm’s ability to burst through the outer surface of an egg and fertilize it.
What does a score of 0% mean?
Sperm morphology tests look at semen samples under a microscope and work out the percentage of sperm with a ‘normal form’ in the total sample. A normal or healthy sperm morphologyrange isbetween 4 and 14 per cent. A score below 4 per cent may mean it takes longer than normal to achieve pregnancy. A result of 0per cent usually means in vitro fertilization may be necessary for conception.
What does the DNA fragmentation test involve and what does it test for?
The DNA strand inside the sperm cell can be fragmented due to oxidative causes such as temperature, toxins, diet, etc.
It’s known that a high DNA fragmentation can lead to the following:
- decrease fertilisation rates
- embryo development can decrease in quality
- less embryos could be achieved
- pregnancy rates can be decreased, and miscarriage rates increased.
It is useful to test the sperm before treatment starts, as if there is a high DNA fragmentation, many IVF labs have the possibility to select the correct sperm without fragmentation before ICSI. There are different techniques that can be used to achieve this, but normally they will only be used in those patients who need it.
What is ERA?
The ERA test is a specific endometrial test to see the window of implantation. An endometrial biopsy has to be done at the theoretical time of the embryo transfer. In this way, genetic sequencing will inform if the patient is really “receptive” at the time of the biopsy. They have proven that 10% of the patients can have a displaced window of implantation and therefore will need a different timing for the transfer.
What is PGS?
PGS stands for pre implantation genetic screening and is a test that checks the chromosomes of embryos that have been created through IVF or ICSi, for abnormalities. A single cell or a small number of cells is removed from the embryo and is then tested to see whether there are any chromosomal abnormalities. The embryos without chromosomal abnormalities are put back in to the womb.
If you have any questions, please do drop us a line (firstname.lastname@example.org) and we will get in touch with our experts for the answer. Remember, no question is a silly question.