From the Guidelines
For your third IVF cycle with male factor infertility involving very low sperm count and high DNA fragmentation, I strongly recommend using testicular sperm for fertilization, as it has been shown to have lower DNA fragmentation and improve clinical outcomes, including clinical pregnancy rates, live births, and reduced pregnancy loss rates, as highlighted in the recent guideline updates 1.
Given your specific situation, with two embryos transferred on Day 2, it's essential to consider the quality of the sperm used for fertilization. The use of testicular sperm in nonazoospermic males with elevated DNA Fragmentation Index (DFI) has been recommended as a clinical principle, with studies showing similar fertilization rates but improved clinical outcomes 1.
Some key points to consider for improving sperm quality and overall fertility outcomes include:
- Utilizing testicular sperm retrieval procedures, such as testicular sperm aspiration (TESA) or testicular sperm extraction (TESE), which may offer viable sperm with lower DFI, potentially improving chances of assisted reproduction 1.
- Discussing alternative treatment options, such as lifestyle modifications (including smoking cessation), varicocele repair, and the potential use of microfluidic processing as a sperm processing technique, with your healthcare provider 1.
- Considering the importance of a thorough male evaluation to determine the management of the patient and the couple, as some male factor conditions are treatable with medical or surgical therapy, and others may require donor sperm or adoption, if appropriate 1.
The most critical step is to work closely with your reproductive endocrinologist and urologist to determine the best course of action based on individual patient characteristics and preferences, prioritizing strategies that reduce DNA fragmentation and improve sperm quality, such as the use of testicular sperm, to enhance your chances of a successful IVF cycle 1.
From the Research
Next Steps for 3rd IVF Cycle with Male Factor Infertility
Given the context of male factor infertility with very low sperm count and high DNA fragmentation, the following points are relevant to consider for the next steps in the 3rd IVF cycle:
- Sperm DNA Fragmentation: High sperm DNA fragmentation is associated with poor reproductive outcomes, including lower pregnancy rates and higher miscarriage rates 2.
- Treatment Strategies: Various treatment strategies have been attempted to reduce sperm DNA fragmentation, including antioxidant supplementation, lifestyle changes, and the use of techniques such as intracytoplasmic morphologically selected sperm injection (IMSI) 3, 4, 5.
- Antioxidant Supplementation: Antioxidant supplementation has been shown to reduce sperm DNA fragmentation and improve sperm parameters, including concentration, motility, and morphology 4.
- Lifestyle Intervention: A 3-month lifestyle intervention program combined with antioxidant therapy has been shown to reduce sperm DNA fragmentation in infertile men with elevated sperm DNA fragmentation and a history of failed IVF/ICSI 5.
- IMSI: The use of IMSI has been shown to improve pregnancy rates in couples with male factor infertility and high sperm DNA fragmentation by selecting sperm with optimal morphological characteristics for fertilization 3.
- Embryo Transfer: The transfer of two embryos on Day 2, as in the current IVF cycle, is a common practice, but the success of the cycle will depend on various factors, including embryo quality, uterine receptivity, and the presence of any underlying medical conditions.
Considerations for Future Cycles
If the current cycle is unsuccessful, the following considerations may be relevant for future cycles:
- Repeat Semen Analysis: A repeat semen analysis may be necessary to assess any changes in sperm parameters, including DNA fragmentation.
- Adjustment of Treatment Strategies: The treatment strategy may need to be adjusted based on the results of the repeat semen analysis and any other relevant factors.
- Use of Donor Sperm: In cases where the male partner's sperm parameters are severely impaired, the use of donor sperm may be considered as an alternative option.
- Counseling and Support: Counseling and support should be provided to the couple to address any emotional or psychological concerns related to infertility and assisted reproduction.