Experience with Male Factor

[Anonymous]

We've been doing IVF for several cycles. DH has significant male factor - low on # and motility, morphology has ranged from 0-4%, and elevated % fragmentation (but not really bad). I am over 40, but have good #s and get 10-13 eggs per retrieval. Even still, we're aware that the number of "good" eggs is probably low.

I'm getting mixed messages about how much of a role the male factor plays. One urologist/clinic says so long as we do ICSI (which we always do), it's not a factor. Several other REs have brought up donor sperm (not being pushy, but fulfilling their ethical obligations to inform us of options) and cite the fact that we have lost all but a very small # of embryos between days 3 and 5. Apparently, that can be caused by male factor? Fertilization rates have been normal, as have the # that get to day 3. Pretty much everything has pooped out prior to reaching blast. We are going to another urologist for a second opinion to see if we can do anything else to help (he doesn't have structural issues or any genetic condition, or even low testosterone, so I'm not that hopeful).

I'm comfortable in my understanding of the egg issue, and I even feel reasonably comfortable that we're doing what we can to address the male factor issue, but I don't feel like I have a particularly good understanding about how much or little of a role male factor plays in IVF outcomes and would love to hear from others with relevant experience.

Thanks!

[Anonymous]

My sister is going through the exact same thing. She is 40, good egg quality, but her husband's sperm is just really not great and getting worse. Their last cycle, they got 12 eggs, 6 fertilized, and none made it to blast. Their RE said that it was not an egg quality issue...she believes it was 100% a sperm issue. She has ordered my brother in law to go on a number of different supplements, lose weight, quit smoking (ugh I know), start acupuncture, etc. They've now done 4 rounds, transferred one PGS that failed, and have one PGS on ice. They are going to go for a fifth retrieval in three months after my BIL has been on this new regimen, which their RE is hopeful will produce better results.

FWIW - their RE is convinced that the reason they got no blasts this cycle is 100% male factor and not an egg issue.

[Anonymous]

I think if you’re able to fertilize you’re good? Getting to blast I think is more a function of egg quality? Egg quality can depend on protocol though is my view. I have AFC of 30, good AMH and with one protocol zero made it to blast (day 3 only) and the next one we had about 5 make it to blast. Partly it’s about number of mature eggs you get but also partly their quality.

[Anonymous]

We are dealing with the same situation OP. Male factor, low numbers, low motility, low morphology. Had 18 eggs retrieved, 13 mature, 11 fertilized and only 3 made it to blast (one on Day 6 and two on Day 7). We did FET (no PGS testing) with the Day 6 blast and got a chemical pregnancy. Then did another FET with both Day 7s and am currently at 9 weeks with one that took, but am holding off getting excited until we get clear genetic test results.

To your question about the role that male factor plays in post-fertilization development: After our chemical, we went in to talk to our RE about next steps and his assessment was that since we lost most of our embryos between Day 3 and 5, and the ones that made it were slow to grow, it was a sperm issue. As he phrased it for us, for Days 1-3, the development is being driven by the energy of the egg. After Day 3, the embryo has to have enough energy and momentum from the sperm to keep developing. If there's a significant sperm problem, you are going to see a sharp drop-off between Day 3 and Day 5. He thought that this lower energy/slower momentum was also probably the reason we didn't have any embryos develop to blast before Day 6.

As our RE told us, there's not a ton you can do to improve sperm if you are already doing all of the right things. He did put my husband on a supplement (conceptionXR), but said that now that we knew this was the situation and that my eggs were good, it was just going to be a process of picking the right sperm, which I assume they try to do anyway, but maybe there are special things they look for in cases like this? Anyway, he seemed pretty confident that having seen this result, they could course correct enough for another round of IVF if we need it without needing to start talking about donor sperm. Holding out hope that this little one is a-okay and we don't have to go there, though!

If you've done this a couple of times using ICSI, do you know if they are doing PICSI? That's the best way to get the strongest swimmers.

Have you always been with the same clinic? Have you gotten any that made it to blast/transfer? I know that some clinics prefer not to freeze or transfer past Day 5, but we wouldn't have had anything at that point, so maybe yours need some extra time to develop too? I'm with Shady Grove if that helps!

Good luck, OP! Hoping for good outcomes for you and yours!

[Anonymous]

I realize that you're getting a lot of information here, and that some of it conflicts. I am simply passing along with what our male factor RE told us. He was very well respected, but there is so much they/we don't know that I just add this for your consideration.

Oddly enough, we were advised AGAINST ICSI. Our male RE believed that ICSI was only needed if you had a protein barrier problem (the sperm did not have the enzyme/protein to break down the egg wall). This is a very easy test to have done. The male RE's view was that, barring that problem, you reduced the likelihood of "bad sperm" getting into an egg by letting them fight it out, even in the tiny arena of the petri dish. This is for two reasons. One, in his view, the more normal sperm will swim better and penetrate faster. Two, the egg actually communicates with the sperm and can be said to "choose" the sperm. ICSI bypasses that natural process, and, in his view, may have an impact on the resulting embryo quality.

So what did we do with that information? Hedged our bets of course! We did half ICSI/half regular. We got 6 to blast. 3 failed. The Fourth is DS. We have two left in the freezer. DS was not an ICSI baby. Two of the three failed embryos were ICSI. This is NOT a statistical sample obviously! Just letting you know For us, we wouldn't do ICSI again, given that we didn't have fertilization problems in the test or with my eggs. So let the best man win

[Anonymous]

Anonymous wrote:I realize that you're getting a lot of information here, and that some of it conflicts. I am simply passing along with what our male factor RE told us. He was very well respected, but there is so much they/we don't know that I just add this for your consideration.

Oddly enough, we were advised AGAINST ICSI. Our male RE believed that ICSI was only needed if you had a protein barrier problem (the sperm did not have the enzyme/protein to break down the egg wall). This is a very easy test to have done. The male RE's view was that, barring that problem, you reduced the likelihood of "bad sperm" getting into an egg by letting them fight it out, even in the tiny arena of the petri dish. This is for two reasons. One, in his view, the more normal sperm will swim better and penetrate faster. Two, the egg actually communicates with the sperm and can be said to "choose" the sperm. ICSI bypasses that natural process, and, in his view, may have an impact on the resulting embryo quality.

So what did we do with that information? Hedged our bets of course! We did half ICSI/half regular. We got 6 to blast. 3 failed. The Fourth is DS. We have two left in the freezer. DS was not an ICSI baby. Two of the three failed embryos were ICSI. This is NOT a statistical sample obviously! Just letting you know For us, we wouldn't do ICSI again, given that we didn't have fertilization problems in the test or with my eggs. So let the best man win

Clarification: three failed after transfer. All woke up just fine from the freezer. One may have failed because of poor timing by the doctor (we changed doctors).

[Anonymous]

We have severe mfi. After several failed cycles, my shady grove re suggested doing half with my husband’s sperm and half with a donor. We opted not to do that and decided to cycle out of state with ccrm.

For my ccrm cycled, I had 20 eggs retrieved, 9 mature, 5 fertilized. It took them 45 minutes to find 5 good sperm. By day 6, I finally had 2 make it to blast. They were grade 4BB and were PGS normal. We froze them and transferred several months later.

We have healthy boy/girl twins from that cycle, and another from a previous cycle.

[Anonymous]

Anonymous wrote:We have severe mfi. After several failed cycles, my shady grove re suggested doing half with my husband’s sperm and half with a donor. We opted not to do that and decided to cycle out of state with ccrm.

For my ccrm cycled, I had 20 eggs retrieved, 9 mature, 5 fertilized. It took them 45 minutes to find 5 good sperm. By day 6, I finally had 2 make it to blast. They were grade 4BB and were PGS normal. We froze them and transferred several months later.

We have healthy boy/girl twins from that cycle, and another from a previous cycle.

OP here. SG keeps telling my husband all is fine, but they may know that he's pretty uncomfortable with donor sperm. Did you find CCRM to be all that different from SG? I've heard their lab is very good, not that you can see that specifically. E.g., did you do a different protocol? I've consulted with Cornell, and thought about CCRM, but it's the Colorado clinic that has the great stats and going out there seemed daunting - of course, now it seems like it could be worth a try!

Also, thanks to other posters, too! It's really helpful to hear about others' experiences.

[Anonymous]

Anonymous wrote:

Anonymous wrote:We have severe mfi. After several failed cycles, my shady grove re suggested doing half with my husband’s sperm and half with a donor. We opted not to do that and decided to cycle out of state with ccrm.

For my ccrm cycled, I had 20 eggs retrieved, 9 mature, 5 fertilized. It took them 45 minutes to find 5 good sperm. By day 6, I finally had 2 make it to blast. They were grade 4BB and were PGS normal. We froze them and transferred several months later.

We have healthy boy/girl twins from that cycle, and another from a previous cycle.

OP here. SG keeps telling my husband all is fine, but they may know that he's pretty uncomfortable with donor sperm. Did you find CCRM to be all that different from SG? I've heard their lab is very good, not that you can see that specifically. E.g., did you do a different protocol? I've consulted with Cornell, and thought about CCRM, but it's the Colorado clinic that has the great stats and going out there seemed daunting - of course, now it seems like it could be worth a try!

Also, thanks to other posters, too! It's really helpful to hear about others' experiences.

Hi there - there were certainly some differences between CCRM and SG.

Dr. Schoolcraft gave me much higher odds of success than SG. Now, this is also based on the fact that we had had one healthy child together before (also IVF conceived through SG), so there's that. But he was way more confident in our case. He had my husband meet with a Urologist in CO, and he really didn't recommend anything different for my husband. Just produce a fresh sample and do the cycle. I was a little surprised/concerned - I mean, my husband produces 0-100 total with each cycle, so we had really low numbers to work with.

For my part, the differences were the little things. Dr. Schoolcraft did all of my procedures (HSG, transfer, etc). I think that helped. They also have you lay for an hour after the transfer, and take a valium to relax you. Then you have 2 days of bedrest. And of course, there's the lab. But honestly, Dr. Schoolcraft is, in my opinion, top notch. In our hearts, we knew that if it didn't work with him, that we had tried everything that we could and it would've been time to either move on or explore other options.

Good luck with whatever you choose to do. I'm sorry you're in the situation, but don't give up hope. Second opinions are ALWAYS worth it. Schedule a call with them and see what they recommend. The call is free. He absolutely changed our lives for the good, and we are so grateful for that. Shady Grove is also excellent, but when they lost confidence in our situation, we decided to go a different route.