In unexplained infertility, women should not be the focus of the treatment. An extra level of testing on sperm should be initiated, before poor egg quality is assumed.
One of my clients (28yrs old) completed her first round of IVF, which failed. She produced lots of eggs. Husband sperm parameters were “ok”. The cycle had 15 mature follicles, 12 fertilized and 3 of the best embryos were transferred. No embryos matured to a day five for freezing. The couple was diagnosed with unexplained infertility. What did the doctor feel was potentially the problem? Bad egg quality -early onset of premature ovarian failure.
Some issues with this case bothered me: The client’s BBT charting and physical indicators (cervical mucus and a rise in attraction for her husband) were balanced. Plus, she responded to medications and produced a good number of eggs. Even though the client is healthy and there appears no reason for the couple not to conceive (unexplained infertility) the root of their problem had to be egg quality. I doubted this.
Why does unexplained infertility appear to be the women’s issue? It takes two people to make a baby. If the woman is healthy – it must be egg quality. If the man’s healthy – it must be the women’s issue. This “go to” answer is just frustrating. Western medicine cannot test the DNA quality of an egg or sperm. Then why is unexplained infertility always the women’s issue?
I met with the husband after the failed IVF cycle and he turned out to have more symptoms out of balance then his wife. Which lead me to wonder: are men being ignored in the treatment process because their sperm “looks” good?
Let’s have a look at some of the myths that allow for the “egg quality” statement.
It’s not commonly known, but sperm testing does not rule out DNA fragmentation. 40% of fertility issues are related to sperm and testing provides only rough parameters through visual examination of sperm. Visual testing cannot measure the integrity of the DNA content. It has been “established that the assessment of sperm DNA integrity is independent of sperm parameters, including sperm morphology, concentration, and motility”. Even if sperm “looks” good, it is not an indicator of DNA integrity. When you buy a used car, it’s not enough that it “looks” good. We take it to our mechanic and have all the important parts examined. Usually we want to make sure the engine and transmission are running smoothly. Looks are not enough to assume DNA has not been affected. Men should be receiving testing to review sperm DNA integrity.
Men only have to give a “sample” at the reproductive clinic. Women are accustomed to visiting the doctor. Men are not – especially when it’s about “down below”. Most doctors at reproductive clinics specialize in GYN, not urology. Guys are not getting a thorough overall examination at reproductive clinics. Men should visit an urologist and have all angles reviewed.
Sperm quality is not affected by age. Studies are finding the correlation between age and oxidative damage to sperm DNA . Men over 40 have higher oxidative test levels compared to men under 40. Oxidative radicals damage DNA in cells and by-products can be measured through testing. More oxidative by-products the more DNA damage occurs. Often men feel untouched by the age factor, but the reality is the opposite. Older men need to take care of themselves, just as much as women need to during the conception period.
Sperm have little impact on miscarriages – it’s mostly the women issue with her eggs. The research article (Assessment of sperm factors possibly involved in early recurrent pregnancy loss by Aura Maria Gil-Villa, M.Sc. and ect in Fertility and Sterility September 2010) concluded that sperm DNA will impact embryo quality. In couples with recurrent miscarriage, most men had comprised sperm DNA. When a history of miscarriage occurs, traditional sperm tests are not enough. Other tests, such as lipid peroxidation and measuring antioxidant levels should be utilized to measure DNA integrity. It’s not always the egg that’s a problem.
I believe men are the missing component when unexplained infertility is being addressed. Too many myths exists which encourage the bypass of men in the process and lay full responsibility on the women. It’s time to start including men in the fertility process and treat the “whole couple”.
POST NOTE: The couple mentioned in this article work with me for a year. Natural conception did not occur and they decided to complete another round of IVF. The wife is expecting twins in the fall.