Dear Dr Faesen
I hope you can help me. I know it is difficult for you to give me an exact plan of action as I am not a patient of yours, but I would love it if you could give me some sort of guidance as to what to do next.
Me and my partner have been trying to get pregnant for 5 years but with no success as we have been told he has a high level of sperm antibodies. I have polycystic ovaries but I ovulate regularly so they don’t seem too concerned. We had ICSI in 2018, but sadly our embryos didn’t make it to transfer.
I was wondering if you could suggest what I should do next and answer some of my questions.
To start, this is my diagnosis:
15 eggs were collected of which 9 were considered suitable for treatment.
The initial semen parameter was as follows: density of 66.00 million/ml, progressive motility 60.0%, and normal morphology 3.00% of the total.
9 eggs were inseminated on the day of egg collection.
A total of one egg was observed to have fertilised normally. On day three, the embryo was classified as a 6 cells grade -4.
Unfortunately after 6 days of culture, the embryo was not considered suitable for cryopreservation or embryo transfer. Therefore they were unable to proceed.
There is very little scientific evidence about the actual effect of sperm antibodies and subsequent treatment, however, I would advise you to try again, with prednisone suppression in the 4 months before the IVF. This drug decreases inflammation in an attempt to try and reduce sperm antibodies and suppresses the immune system.
An adequate daily dose of anti-oxidants could also help. Take a look at this article that talks you through the different supplements.
So let me answer your questions:
What determines whether or not an egg is considered suitable for treatment?
Once the egg retrieval is completed, the embryologist evaluates its suitability to be used in the treatment process. This is quite medical heavy here, but these are the things they look out for: The maturity of the oocyte, integrity of the oocyte, colour of the oocyte, zona pellucida scoring, peri-vitelline space, cytoplasm scoring, vacuolisation, presence of a polar body ( a polar body is a small haploid cell that is formed concomitantly as an egg cell during oogenesis, but generally does not have the ability to be fertilised.) and Cumulus-oocyte complex scoring (Grade A: oocytes that are completely surrounded by cumulus cells. Grade B: oocytes partially surrounded by cumulus cells. Grade C: oocytes not surrounded by cumulus cells. Grade D: degenerated oocytes and cumulus cells)
What does ‘sperm antibodies’ mean?
Anti-sperm antibodies are antibodies produced against sperm antigens. This may occur due to a number of reasons such as the breakdown of the blood‑testis barrier, trauma and surgery (like a vasectomy), orchitis, varicocele, infections, prostatitis, or testicular cancer.
Once these antibodies are present, the process, unfortunately, cannot be typically reversed. It can interfere with sperm motility and transport through the female reproductive tract, inhibiting fertilisation of the egg.
ICSI excludes the effects of sperm antibodies altogether because the sperm cells get isolated from the fluid with antibodies during the sperm washing process allowing the selection of individual sperm for ICSI.
Do you think this is the reason my embryo was not suitable for transfer?
There are a number of factors that are at play in embryo development when done in a lab.
How does my partner’s sperm analysis compare to an excellent sperm analysis?
His count and motility are fair, however, his morphology sits on the lowest end of the normal range of 4% – 14%.
What does this mean? “6 cells grade -4.”
On day 3, ideally, you would like to observe 8 cells with a grade of 1.
Why would the embryo not be suitable for transfer?
It may not have survived to Day 5 or 6. On day 3 of development, the embryo showed slow growth and possibly did not develop further. If graded at 4 it may have had multiple poor qualities that would have impeded further growth and development.
I do hope this helps. If you have any further enquiries please do not hesitate to get in touch with the team here at Hart Fertility.