Watch the video recording of the live #IVFWEBINAR with Dr. Laura García de Miguel, a Medical Director at Clínica Tambre in Madrid, Spain who discussed the male factor and its impact on successful IVF treatment.
It really depends on each problem. As I said before if the problem is fragmentation, single strain then antioxidants are recommended, and if the problem is with a double fragmentation, the recommendation is curcumin. If you want to do the mix of antioxidants and curcumin, it’s fine, so whatever antioxidants such as coenzyme Q10 and magnesium, zinc will improve it. There are usually multivitamins that you can buy directly in the pharmacy that is vitamins specific for a male factor.
My recommendation is that if he has children, it’s not necessary to do the karyotype, it is recommended, only if after or before the children were born there were miscarriages. Regarding the poor morphology and poor DNA fragmentation, if there is a very low morphology, it could be abnormal DNA fragmentation, but I have lots of patients having abnormal morphology and then when we do the DNA fragmentation everything is absolutely fine. It’s not necessarily linked.
If we have different failures, it’s always necessary to remember that the embryos because of the male factor or because of the eggs could be abnormal. We have to do the PGS and also I would recommend starting doing implantation failure check. If you have had different blastocyst transfers with good morphology, not only do the genetic screening but also do the implantation failure study such as the window of implantation, hysteroscopy, coagulation disorders, immunological problems etc.
We do the TESE because our urologist considers it has the best outcome with that, so we don’t have the micro TESE surgery.
Lifestyle is something very important, we do have patients such as for instance drivers that are sitting for a long time, and that could be a problem for the sperm function. We all live in a world that it’s really crazy, having phones and many radiations close to us, so we know this is not positive for the sperm but by contrast, we cannot only consider this is the problem for the male factor. We need to improve our lifestyle, so no smoking, having a very good diet with a lot of fruit and vegetables, fish and also consider taking vitamins and these types of species like Curcuma but yes we cannot only focus on the radiation problems
Yes, I think we really focus a lot on the eggs and the women and the age but sometimes we don’t spend enough time to study the male facto, so I completely agree with you.
It’s not only the low testosterone that really is the cause of the sperm count, but we also need to do all the tests that I recommended before mainly FSH, LH regarding the parameters in the spermogram and see if finally, it is because hormones are low, so FSH, LG and testosterone, then treatment would be gonadotropins to improve the count of the sperm. In case there is a very severe Oligo-, Asthenic-, Teratospermia or azoospermia by contrast if there are more than one million millilitres then it’s not necessary to do that and we just go directly with ICSI procedure.
With normal volume and PH we need to do all the tests I’ve mentioned before, so karyotype, why microdeletions, the cystic fibrosis and very important to talk with urologists to understand what is the problem and if we can go to the testicle because it is an obstructive problem, and we can retrieve spermatozoa from the testis or not.
Yes, it could be one of the problems if there is an infection, some of the infections, for instance, ureaplasma could really cause repetitive miscarriage. There is a problem that your embryos are already frozen and with the frozen embryo, it’s not really recommended to do the genetic screening because it’s an invasive procedure and with frozen embryos, it does not really work very well. You also need to do the repeated miscarriages tests to understand where the problem is and if everything is clear and you don’t have problems in the uterus, in your coagulation, with your immunity, then you need to talk with your clinic. It’s important to check if it is more convenient to do the transfer directly or if by contrast, they would recommend another round with more embryos do the genetic screening on all of the embryos.
The latest studies show that it’s around 3 days. I would say 2-3 days is the best, between 2 and 4 days, 1 day is a very short time, so usually, concentration could be decreased, so at least 2 days of abstinence and no more than 4 days.
Yes, we consider fragmentation could be decreased when there is a shorter time of abstinence for instance in the Fertile Chip sometimes we ask for 2 samples the same day, so yes with short abstinence it could be reduced.
There is no evidence that sperm count could be improved with exercises, so of course, fragmentation and all the quality inside could be improved if we change our lifestyle, but not the sperm count.
Yes, absolutely we can work with that sample, but it’s really necessary to go directly to the ICSI procedure. I wouldn’t recommend other treatments in your case, and also it looks that you should have changed in your sperm parameters, so perhaps it could be important to exclude infection and do sperm and urine culture.
We do understand that the specific work of the sperm in the embryo starts from day-3. But it does not mean that if there is a blastocyst even of good morphology reaching day-5, that everything is okay with the sperm. It could be also abnormalities inside the sperm, such as abnormal fragmentation or chromosome disorders that could interfere in the genetic charge of that embryo.
So, 50% of embryos are not evolutive from day-3 but depending on each case if all the embryos have good development till day-3, and then, by contrast, there isn’t any embryo achieving day-5, yes we need to study more in-depth the sperm to exclude problems with fragmentation for instance.
Mainly for necrozoospermia what we need to exclude is infections. If the cause is an infection, it will be improved after antioxidants. By contrast, if it is not the cause, then there’s nothing to do only antioxidants, but of course, although it’s not a good parameter, it’s not a positive parameter if concentration and mobility are good and we do ICSI procedure, the results are going to be good.