Urologist for DNA fragmentation test in DC

[Anonymous]

GW Fertility poo pooed DNA fragmentation, but after 3 failed cycles with them, we want to get fragmentation checked at least. Looking for recommendations for a urologist in DC that will test for DNA fragmentation. MFI is 1% morph and post-wash count ranges from 1-5 million usually, though we did ICSI for IVF.

[Anonymous]

Shady Grove does this.

[Anonymous]

Anonymous wrote:GW Fertility poo pooed DNA fragmentation, but after 3 failed cycles with them, we want to get fragmentation checked at least. Looking for recommendations for a urologist in DC that will test for DNA fragmentation. MFI is 1% morph and post-wash count ranges from 1-5 million usually, though we did ICSI for IVF.

We went around and around and around with GW about this. We ended up doing the DNA frag test on our own after 5 failed rounds of IVF (4 at GW) and the results came back showing high frag and GW still will not listen to our concerns about it being male factor. It’s incredibly frustrating. Bottom line, you’ll probably need to move to a different clinic for help with this.

[Anonymous]

Anonymous wrote:

Anonymous wrote:GW Fertility poo pooed DNA fragmentation, but after 3 failed cycles with them, we want to get fragmentation checked at least. Looking for recommendations for a urologist in DC that will test for DNA fragmentation. MFI is 1% morph and post-wash count ranges from 1-5 million usually, though we did ICSI for IVF.

We went around and around and around with GW about this. We ended up doing the DNA frag test on our own after 5 failed rounds of IVF (4 at GW) and the results came back showing high frag and GW still will not listen to our concerns about it being male factor. It’s incredibly frustrating. Bottom line, you’ll probably need to move to a different clinic for help with this.

Wow this is so frustrating! Can I ask what your results looked like? Low fertilization rates? Or normal fertilization rates and failed transfers? Something else? We have only one failed round at gw but they aren’t recommending further testing for my husband which I don’t understand. I think our fertilization rate with ICSI was low (60%), but they say it’s fine.

[Anonymous]

Anonymous wrote:

Anonymous wrote:GW Fertility poo pooed DNA fragmentation, but after 3 failed cycles with them, we want to get fragmentation checked at least. Looking for recommendations for a urologist in DC that will test for DNA fragmentation. MFI is 1% morph and post-wash count ranges from 1-5 million usually, though we did ICSI for IVF.

We went around and around and around with GW about this. We ended up doing the DNA frag test on our own after 5 failed rounds of IVF (4 at GW) and the results came back showing high frag and GW still will not listen to our concerns about it being male factor. It’s incredibly frustrating. Bottom line, you’ll probably need to move to a different clinic for help with this.

OP here. Thanks for this, I'd also love more detail if you don't mind sharing. We always had good fertilization (though I'm a poor responder, so only a few eggs to work with) through day 3, then everything went to hell. I really liked GW, but now I'm thinking it was a mistake not to get a second opinion on the MFI issues earlier. They say there's not much to do about MFI, so no point in investigating, but my husband is willing to do a TESE. I'm worried that SGF will push donor eggs because we have TERRIBLE results, but not sure what other local options there are.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:GW Fertility poo pooed DNA fragmentation, but after 3 failed cycles with them, we want to get fragmentation checked at least. Looking for recommendations for a urologist in DC that will test for DNA fragmentation. MFI is 1% morph and post-wash count ranges from 1-5 million usually, though we did ICSI for IVF.

We went around and around and around with GW about this. We ended up doing the DNA frag test on our own after 5 failed rounds of IVF (4 at GW) and the results came back showing high frag and GW still will not listen to our concerns about it being male factor. It’s incredibly frustrating. Bottom line, you’ll probably need to move to a different clinic for help with this.

Wow this is so frustrating! Can I ask what your results looked like? Low fertilization rates? Or normal fertilization rates and failed transfers? Something else? We have only one failed round at gw but they aren’t recommending further testing for my husband which I don’t understand. I think our fertilization rate with ICSI was low (60%), but they say it’s fine.

OP again. GW's standards for "normal" are much lower than other clinics because they intentionally take harder cases. That is great and they were really good with trying different protocols and thinking creatively, but do NOT take their word when they say it's "fine". They "look for" 3-4 million post-wash for IUIs and most other clinics won't do an IUI with less than 10m. That's a big difference that has an impact on success rates. If you only have the resources to do a set number of cycles, then you want to maximize success rates with each cycle, even if that means skipping a cycle until certain parameters have improved. That's just my opinion, but something I wish I would have considered more seriously when we were at the beginning of treatment like you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:GW Fertility poo pooed DNA fragmentation, but after 3 failed cycles with them, we want to get fragmentation checked at least. Looking for recommendations for a urologist in DC that will test for DNA fragmentation. MFI is 1% morph and post-wash count ranges from 1-5 million usually, though we did ICSI for IVF.

We went around and around and around with GW about this. We ended up doing the DNA frag test on our own after 5 failed rounds of IVF (4 at GW) and the results came back showing high frag and GW still will not listen to our concerns about it being male factor. It’s incredibly frustrating. Bottom line, you’ll probably need to move to a different clinic for help with this.

Wow this is so frustrating! Can I ask what your results looked like? Low fertilization rates? Or normal fertilization rates and failed transfers? Something else? We have only one failed round at gw but they aren’t recommending further testing for my husband which I don’t understand. I think our fertilization rate with ICSI was low (60%), but they say it’s fine.

OP again. GW's standards for "normal" are much lower than other clinics because they intentionally take harder cases. That is great and they were really good with trying different protocols and thinking creatively, but do NOT take their word when they say it's "fine". They "look for" 3-4 million post-wash for IUIs and most other clinics won't do an IUI with less than 10m. That's a big difference that has an impact on success rates. If you only have the resources to do a set number of cycles, then you want to maximize success rates with each cycle, even if that means skipping a cycle until certain parameters have improved. That's just my opinion, but something I wish I would have considered more seriously when we were at the beginning of treatment like you.

Thanks! Wow that’s insane, I’m trying to remember what our post wash IUI numbers were, but I can’t for the life of me. Do you agree that 60% with ICSI is indicative of potential MF issues? We shouldn’t be a hard case (unexplained, 32 with normal AMH and no indication of MFI), but we had a bust of a first round (only 5 mature eggs, (one 3 day transfer that led to an early miscarriage, nothing else made it to blast). I think our bad first round was at least partially due to them putting my on a super low dose of meds because they were really concerned about OHSS. We are already estrogen priming for number 2, so it might be too late to switch, but we agreed we would get a second opinion elsewhere if this round also went poorly.

Curious to hear what others say about who is good to identify potential MFI issues!

[Anonymous]

In my experience, res will tell you to keep trying with icsi because they can get some good sperm. Unfortunately, I've listened and failed multiple cycles. Someone just referred us to Robert Dean at GW. He specializes in Andrology and may be worth consulting with.

[Anonymous]

PP, 60% fertilization with ICSI does seem low to me, especially at GW which has a good lab. It's absolutely not too late to skip a cycle if you're only priming. I've done that more than once. But after one cycle, it's hard to tell if it was a fluke or a pattern, especially if you only had a handful of mature eggs retrieved. I would absolutely recommend a second opinion after this round, if not for anything else, because it starts getting really mentally exhausting and you don't want to keep pouring mental and emotional effort in when there's something fixable you can do to improve your odds.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:GW Fertility poo pooed DNA fragmentation, but after 3 failed cycles with them, we want to get fragmentation checked at least. Looking for recommendations for a urologist in DC that will test for DNA fragmentation. MFI is 1% morph and post-wash count ranges from 1-5 million usually, though we did ICSI for IVF.

We went around and around and around with GW about this. We ended up doing the DNA frag test on our own after 5 failed rounds of IVF (4 at GW) and the results came back showing high frag and GW still will not listen to our concerns about it being male factor. It’s incredibly frustrating. Bottom line, you’ll probably need to move to a different clinic for help with this.

Wow this is so frustrating! Can I ask what your results looked like? Low fertilization rates? Or normal fertilization rates and failed transfers? Something else? We have only one failed round at gw but they aren’t recommending further testing for my husband which I don’t understand. I think our fertilization rate with ICSI was low (60%), but they say it’s fine.

Lots of eggs, good fert rate, but most of the embryos arrested around Day 3. We managed to get 6 blasts over the 4 cycles, but all were PGS abnormal.

[Anonymous]

I was told that arresting at day 3 is a sperm issue and was advised tese may help. I haven't done another cycle since then. 60% fertilization rate is low, but sometimes I've sometimes had that.

[Anonymous]

Anonymous wrote:I was told that arresting at day 3 is a sperm issue and was advised tese may help. I haven't done another cycle since then. 60% fertilization rate is low, but sometimes I've sometimes had that.

Where did you go when you got this advice?

[Anonymous]

Dr. Dean. Also, I think my situation is different than yours. All my embryos over multiple cycles at different centers arrested after day 3, which is very different than six blasts over four cycles. Also, to be fair, none of the centers I've been to, have been able to Diagnose anything other than mf, but I have a lot of failures. The advice is to just keep doing icsi. I don't know if tese will make a difference, but it's something new instead of same old failures.

[Anonymous]

Anonymous wrote:Dr. Dean. Also, I think my situation is different than yours. All my embryos over multiple cycles at different centers arrested after day 3, which is very different than six blasts over four cycles. Also, to be fair, none of the centers I've been to, have been able to Diagnose anything other than mf, but I have a lot of failures. The advice is to just keep doing icsi. I don't know if tese will make a difference, but it's something new instead of same old failures.

That was actually me (OP) asking where you went. We had all 4 arrest after day 3 on cycle one, converted to IUI for cycle 2, then did a day 3 transfer on cycle 3 and the remaining one arrested on day 4. We've also done a number of failed IUIs with multiple follicles (and I've never had empty follicles) and have had early miscarriages.

Would Dr. Dean do the TESE then you do the cycle with GW? Or would you go to a different clinic that does the TESE and cycle?

[Anonymous]

I think he works with everyone except sgf (who has their own ppl). I was at gw a few years ago. They always thought sperm or both sperm and egg was the issue but never recommended tese or anything except keep trying with icsi. It could have been the state of technology/knowledge then or it could be that they don't think it will make a difference. Also, I haven't tried it yet, so I don't know if it will work.