My Sperm: A Brief History

A guest post from Mr Moon . . .
Around 2 years ago, and after TTC for a year I was tested to rule out any potential male factors before we could be referred for fertility treatment. The news that came back from the initial test organised by our GP was pretty devastating. I was diagnosed with low count, motility and morphology and what followed was a period of anger, confusion, guilt and helplessness, all of which carry through to today to some degree. This amazing article by Paul Ford which puts all of this into words far better than I can ...

No camp Saunas allowed

Following the initial test the usual things were prescribed, cut the alcohol, saunas, hot baths, and eat a good diet - and come back again in 3 months for a retest. 3 months came and went and the results were very slightly improved, but nothing near normal.

By this time we were on our way to ICSI #1 at Bourn Hall where my the results were slightly improved but still not near the minimum required for standard IVF, let alone a good chance of TTC naturally. 'Normal' seems to change depend on who you talk to, but the current World Health Organisation range is 15m per ml though this seems to be regularly revised downwards, with the minimum being 50m back in 1999. Here is a good Q&A on the WHO numbers and why they should be taken with a pinch-of-salt.

For ICSI #1 we had a good number of eggs and fertilised embryos, it was all looking good. But at Day 3 our embryos started to degrade and none reached the blastocyst stage by Day 5 when we were booked for Embryo Transfer. On Day 5 we transferred a single embryo which was at the compacted morula stage. It was our only option as all other embryos had not developed.

Onward to ICSI #2, this time at Herts & Essex. They performed another test on my swimmers, more improvement, so something was working but the outcome for ICSI #2 though was very similar. At our Day 3 transfer everything looked very good and we put 2 embryos into Mrs Moon. Another devastating failure followed although this time we had a pattern (I am a glass-half-full person), again none of the other embryos reached Day 5, again no blastocysts. We of course don't know if the transferred embryos survived to Day 5 and failed thereafter - all we can go on is the embryos which were left to grow in the lab. 

Despite the agony of another failed cycle we have realised that there is no point in looking for anyone to blame or to be angry at, all we can do is carry on and salvage some hope, so it was time for more research.

At Day 3 an important event occurs in the embryos development, the Sperm DNA is activated within the embryo and the male genome merges with the female DNA (as you may guess I'm not a biologist), so degradation at or after Day 3 may point to some low level issues within the sperm, specifically DNA Fragmentation, Aneuploidy or Chromosomal faults.
It was also clear that there were many vitamins and supplements which various studies have shown to help improve sperm quality and quantity. Up to now I was only talking Wellman conception so after collating the results from Dr Google we settled on the following concoction:

Our House.

MORNING
Vitamin C
Vitamin B complex
L-arginine
Vitamin E
Pyncnogenol
Omega 3

EVENING
Wellman Conception
Zinc
Selenium
Omega 3
Co-Enzyme Q10
Maca
Vitamin C
Vitamin E
Folic Acid
Pyncnogenol
L-Carnitine
Alpha Lipoic acid
This lot will take 3 months to show any results, so there is nothing more to see here at the moment ...

At our WTF2 appointment we discussed the Day 3 issue with our consultant, he agreed that there was a pattern and talked about a new technique, beyond ICSI, that can filter out damaged sperm. Essentially the embryologists use a super high powered microscope that can actually see into the head of the sperm, this is coupled with a different medium which attracts the good sperm for interrogation. This process is called IMSI and PICSI.

We also talked about tests for DNA Fragmentation, though our consultant dismissed these as no matter what the result the treatment recommended would be ICSI (Herts & Essex do not provide IMSI). As Mr and Mrs Moon like to have all of the info we went for the tests anyway.  Firstly, in true Mrs Moon style we have a spreadsheet tracking all of the standard tests I've had performed, here are the results:

And here are the advanced tests. 

DNA Fragmentation = 25.4% (Moderate)
5 Chromosome Aneuploidy = 1.00 (Normal)
Chromosome Karyotyping = Normal
Anti-Sperm Antibodies = Normal
ROS Oxidation = 0.15 (Very Good!)
Sexual Health Screen = All Negative

For once there was some good news here - my ROS value was very low at 0.15 - yay for me! 

Finally there was the dreaded Physical Checkup with a Urologist…drop your trousers and cough, well it's a more lengthy grope and prod to be honest. The doc is looking for evidence of varicocele, undescended testicles or any other abnormalities in 'the area'. He's also looking for evidence of hormone imbalance (lack of testosterone), for example moobs, lack of bodily hair.

So in summary: 
- My sperm DNA fragmentation is a little high (still within normal range).
- At the last sperm test my count, motility and morphology are still below par.
- Everything else genetically is OK and I don't have any weird STDs.
- My balls have descended and my moobs are caused by not enough visits to the gym rather than a lack of testosterone.

For those of you that have made it this far and looking for some magic answer....there isn't one. I've now seen three consultants at two IVF clinics, a Harley Street Andrologist, a Harley Street Urologist, had my crown jewels poked and prodded by a posh middle aged man, and had every type of bodily fluid extracted and tested. The result being that we are a few thousand pounds poorer and none the wiser. The same 'treatment plan' remains:

a) Reduce Heat...fairly easy.
b) Reduce Oxidation by taking supplements and eating/drinking healthily.
c) Reduce General Stress...Not easy when living through infertility.

In about 4 weeks we'll find out if any of this has made a difference. The best case scenario is that ICSI #3 will work and we won't care about any of this. If we have another failure I can only hope that all of this has made a difference and we can hope for a miracle naturally or with a procedure that is less stressful and invasive for the brave Mrs Moon.
The toughest part of dealing with this is that Mrs Moon that has to go through all of the pain and stress on her body when the problem lies within me. After nearly half a year of avoiding most social situations (they nearly always involve alcohol), making up stories to avoid seeing people during treatment, and generally leading a sheltered life it's very easy to think of giving up...but doing that is just self defeating...we have to go on, stay strong and be there for each other...

Mr Moon.