WHAT IS THE ‘IMPLANTATION WINDOW’ IN FERTILITY TREATMENT AND HOW TO IMPROVE IT?
SIGN UP AND GET ANSWERS LIVE >

How important is male factor and how to overcome that?

Laura Garcia de Miguel, MD
Fertility Specialist & Medical Director, Clinica Tambre

Category:
Male Factor

male-factor-IVFWEBINARS-Tambre
From this video you will find out:
  • What information does the sperm analysis present?
  • Why is Karyotype analysis helpful?
  • What are other complementary tests?
  • What is CometFertility test and what does it show?
  • What are Chromosperm and FISH tests?
  • What potential reproductive solutions are available?

How important is male factor and how to overcome that?

During this event, Dr Laura García de Miguel, Medical Director at Clínica Tambre explored the importance of male fertility and shared strategies to overcome it.

At the very beginning of each cycle, all initial tests include semen analysis and freezing for future use. This is in case a fresh sample cannot be used or if specific filters are needed. The semen analysis will show the general appearance, pH, volume, consistency, concentration of spermatozoa, mortality, and morphology. You will receive a report the same day with all information.

Semen analysis can vary, abstinence of around 3 days and confirmation with a laboratory that you are not taking any drugs or medications and haven’t had a fever in the past 2 to 3 weeks is recommended.

Interpreting semen analysis results

  • Azoospermia: Complete lack of sperm, often due to stress or obstructions.
  • Asthenozoospermia: Less than 32% mobile sperm or less than 40% general mobile sperm.
  • Oligozoospermia: Volume less than 1.5 milliliters.
  • Necrozoospermia: Less than 58% viable sperm.
  • Teratozoospermia: More than 4% abnormal sperm.

If results are abnormal, ideally, the test should be repeated. It’s crucial to confirm sample collection time, and sexual abstinence, and consider factors like ejaculation frequency, recent fever, drug intake, and occupation.

Karyotype analysis

Another test that is also recommended is a karyotype test before treatment, as chromosomal abnormalities can impact sperm and embryo development. Although not compulsory, it helps assess potential risks. The frequency of abnormality in karyotype is less than 1% in the human population.

Complimentary tests

Complimentary tests may include biochemical analysis of seminal plasma, assessing fructose from seminal vesicles, maltase from the epididymis, and citrate from the prostate.

If abnormalities in sperm are detected, undergoing biochemical testing becomes crucial. This process allows for communication between the patient, neurologist, and other specialists to pinpoint the issue, whether it’s in the seminal vesicle, the prostate, or elsewhere. Notably, not all clinics perform this test in-house; outsourcing is often required due to the need for automatic analysis by trained biologists and specialized units for result interpretation.

Another valuable complementary test is the CometFertility test, which assesses the percentage of fragmented sperm in an ejaculate. Fragmentation refers to breaks or interruptions in the DNA, with normal levels below 60%. Understanding this fragmentation is crucial, as it can impact fertilization success and increase the risk of miscarriages.

In cases of oligoasthenospermia or severe asthenozoospermia, hypospermia, leukospermia, and sperm agglutination confirming infections through sperm and urine culture is essential. Identifying the cause allows for targeted treatment, often involving antibiotics. Freezing sperm after washing is a rule to confirm protection and ensure sperm quality in challenging infection removal cases.

Chromosperm and FISH (Fluorescence In Situ Hybridization) tests provide insights into the genetic status of spermatozoa. Detecting chromosomal disorders is crucial, as it influences the number of abnormal embryos, potentially leading to failures or miscarriages.

Tailoring approaches for unique cases

While each case is unique, certain reproductive solutions can be explored. Intrauterine insemination (IUI) is recommended for specific scenarios, and in vitro fertilization (IVF) becomes a viable option with varying sperm recovery levels. Pre-implantation genetic testing for aneuploidies (PGT-A) offers a method to select chromosomally healthy embryos, particularly useful in cases of abnormal karyotypes or high fragmentation.

For cases of azoospermia and severe oligoastenoteratoozoospermia, understanding parameters such as volume, pH, and hormones is crucial. Testicular biopsy and sperm aspiration interventions TESA (Testicular Sperm Aspiration) may be recommended to improve chances.

Potential reproductive solutions

Y chromosome microdeletion (YCMDs), a genetic cause of male infertility, presents specific challenges. Sperm banking, ICSI, and even sperm donation are considered. Clínica Tambre has the oldest sperm bank in Madrid and is one of the oldest in Spain offering various sperm donors and the latest technologies, such as Fenomatch, which is an artificial intelligence program that helps to match physical resemblance between the father and the donor.

Conclusion

The male factor in infertility doesn’t need to be a taboo topic. In Spain, a significant percentage (20.6%)  of assisted reproductive cycles address male-related challenges. Each case requires unique consideration and a comprehensive approach, emphasizing the importance of trusting clinics with advanced technologies and a multi-disciplinary team for effective counseling and treatment.

 

 

 

 

- Questions and Answers

What is the normal range of the DNA fragmentation test?

It really depends on the fragmentation test used. In the CometFertility, it is less than 60%, even though the ideal is less than 45 for natural pregnancy.

What is the treatment if DNA Fragmentation is abnormal?

If it’s abnormal, you should aim to improve it with a new cycle of spermatogenesis, which takes 3 months. Trying to change lifestyle factors such as reducing coffee, tea, chocolate, cigarettes, and alcohol could affect this. Also, trying to increase ejaculation and using antioxidants such as zinc, vitamin E, and turmeric can be beneficial. Depending on the result of the fragmentation, the number, the rate, and if it’s a single or double abnormality, each patient will have counseling on what to do. This could involve improving with a new cycle of spermatogenesis or, conversely, doing specific filtration on the day of fertilization to exclude fragmentation, such as the Comet Fertile.

How can we calculate REM (motile spermatozoa count)?

REM is a test done in the laboratory, and experts provide the result based on a combination of volume, concentration, and mobility.

Can a test be done to check if the DNA in the sperm cell itself is normal? What is the chance that it is healthy, and can genetic disorders be detected?

Supposedly, if DNA fragmentation and the FISH are normal, we could proceed, understanding that there is always a risk of transmitting diseases. However, more studies are emerging to counsel couples and patients in such cases.  

How much higher is the risk of infertile sperm, DNA fragmentation in older men? Is it a big risk or still a small risk?

The risk, especially for autism, is increasing, but the exact percentage is not provided. It’s important to note that it might not solely be due to advanced age; laboratory techniques may also contribute. However, in these patients, there is a higher risk of autism.

What is the risk of infertile sperm, DNA fragmentation for older men, specifically 60 years old?

Men of advanced age may have a higher risk of high fragmentation, but it’s not a guaranteed problem. There’s a possibility of transmitting issues like autism, but it’s not certain.
Understanding the Importance of Carrier Genetic Testing
Hysteroscopy before IVF:  can it improve outcomes?
Recurrent Pregnancy Loss challenges: causes and solutions
How to prepare for an embryo transfer to improve your chances: There’s more to consider than just the endometrium
Endometrial factor and recurrent failures in IVF: diagnosis and treatment
How old is too old for my IVF treatment?
Authors
Laura Garcia de Miguel, MD

Laura Garcia de Miguel, MD

Dr Laura García de Miguel has worked in the field of gynaecology and obstetrics since 2008. At present, she is a medical director of Clínica Tambre in Madrid, Spain. Dr García de Miguel has extensive experience in IVF and provides a highly personalized approach to each and every patient and custom-tailored treatments to meet the needs of various patients. Dr García de Miguel specializes in treating patients who have had previous IVF failures or who respond poorly to hormonal or IVF treatment. Dr Laura speaks fluent Spanish, English, and French and treats patients from all over the world.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.
Have questions about what factors will affect your IVF success?
Join our live event to directly ask your questions to three IVF experts.