Wednesday, March 23, 2016

Infertility tests which raise more questions than they answer

Both doctors and patients are fascinated by new and fancy diagnostic tests . When things don't go as predicted during the IVF cycle, the natural response is to run more tests , so that we can get more information , which will allow us to pinpoint the problem and make a more accurate diagnoses.

For example, when your patient has poor quality embryos and you suspect this is because of a sperm problem, the first question the patient is going to ask is, " How do prove that this is because of a sperm defect?"

One of the tests available to test for sperm function is the sperm DNA fragmentation test, and it's very tempting to order this. After all, the sperm is just a DNA carrier -
a packaged missile which delivers the man's DNA into the egg to create a new embryo. If there is a lot of sperm DNA fragmentation , then isn't it obvious that you will get poor quality embryos with lots of fragmentation ? After all, if  the sperm quality is impaired , and if the sperm provides 50% of the DNA to the embryo, and if this DNA is fragmented, then it's logical to conclude that this is a cause and effect relationship - that poor quality embryos in a man with defective sperm are because of the poor quality of the sperm.

I wish life were that simple , but biology is far more complicated, and does not always follow what seems to be logic and common sense.  While it is true that men with high sperm DNA fragmentation are more likely to have fertility issues, it's also equally true that for the individual patient there is no cut-off value for sperm DNA fragmentation which demarcates fertile men from infertile men.  This means that there are
lots of fertile men who have high DNA sperm fragmentation levels; and that there will be men whose sperm DNA fragmentation is completely normal , who will still end up with creating abnormal fragmented embryos in the lab, even when they do ICSI with high quality donor eggs.

This is why we need to be selective when ordering these tests. Ordering them is easy, but interpreting the test for the individual patient is very difficult ! How do you make intelligent use of the information once you get the test result - that's what makes medicine so challenging and complex !

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  1. Anonymous7:17 PM

    Dear Doctor,

    I am currently on 2ww. 21st of march had FET. Was supposed to be blastocyst, but doc told me it is in Morula stage after the transfer. I am little co concerned about the embryos. I do not know the grades not the quality. Am keeping positive mindset still it is worrying me little. Could you please have a look at it and give your inputs.

    1. If the embryo is only a morula on Day 5, this is bad news, because it suggests it is growing slowly and may arrest.

      Can you send me more details about your IVF cycle ?

      You can see what embryos should look like at

      What were the meds which were used for
      superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? What was the endometrial thickness ?
      How many embryos were transferred ?
      What was the embryo quality ?
      Can you please send me the printed treatment summary from your IVF clinic ?

    2. Anonymous5:51 PM

      Dear doctor,

      Am so grateful for your reply. I was given Gonal F for my Superovulation. Though I haven't been given clear summary of embryo report. I was told 16 eggs were retrieved , 14 were fertilized and 10 top quality. All were freezer on day3.Estradial level was at 1476.
      My endometrial thickness on day 16 was 9.6mm and they stared susten 100 & 50 on alternate days.embryos were transferred on my cycle day 21. Which Id can I send my embryos pictures which were transferred?

      Am so glad to have found you to have a clarification.

    3. You can email me at [email protected]

      We look forward to helping you to have a baby !

  2. Does a day 5 early blastocyst also have a poor prognosis?


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