Unexplained infertility and the link with sperm DNA fragmentation
This week on Let’s all Talk Fertility I had a discussion about Unexplained Infertility with James Nicopoullos, the Clinical Director at The Lister Fertility Clinic.
Unexplained infertility is when no cause can be identified in either partner as to why a natural pregnancy hasn’t occurred. So a woman is ovulating regularly, has open fallopian tubes, and things look clear - so no adhesions, fibrous growths or endometriosis - and the man has normal sperm.
Sadly in the UK, unexplained infertility still accounts for around 1 in 4 cases - the highest reason for not getting pregnant.
So when do we get help? Well, the National Institute for Health and Care Excellence (NICE) recommends that women with unexplained infertility, who have not conceived after 2 years of having regular unprotected sex, should be offered IVF treatment.
“If somebody came to see me in this situation, I would reassess everything…to see if anything has been missed” James told us.
The initial tests James recommends doing are:
Repeat scans - perhaps in slightly more detail scan, such as a saline scan within the lining of the womb
Test the fallopian tubes for blockage
Check the sperm - as this is the most common cause of sub-fertility in couples
This third point, James was very passionate about; "I did most of my research in sperm DNA. If you've got high levels of sperm DNA damage, you are less likely to get your partner pregnant naturally. Especially the younger couples where there's no cause of infertility, I would do a sperm DNA test as first line.”
For context, a DNA fragmentation test is an investigation that can measure the actual damage in individual sperm. Research has shown that up to 80% of men with unexplained infertility have problems in their sperm DNA (Queen’s University Belfast). Of course this can be put down to lifestyle factors, but even healthy sperm may have some DNA damage - it’s the amount of damage that matters.
So what to do next? Wait and see if you fall pregnant, or head into fertility treatment?
James’ says there are two factors to consider- age and egg reserve. For egg reserve, you need a scan to prove follicle count plus an AMH blood test. “The more eggs you've got left in your stores, the more follicles are there every month ready to grow” James told us. “Remember, AMH does not impact your chances of getting pregnant naturally. What it tells you is how long you've got to play with. So if at 30 you have a very good egg reserve, your IVF success rate at 30 could be 50%. You've got a little bit more time to play with. Conversely, if you're 30 with a really low AMH and you want three children, the sooner you crack on with IVF, the more chance you have.”
For further information about The Lister Fertility Clinic and to book a chat with James or his team, head HERE
Meanwhile to watch this talk again, head to our on-demand library, where you will find this plus 100+ talks and Q&A’s head HERE
Coming up on the 11th October at 1pm, I shall be talking about premature and low ovarian reserve. To register for this free lunchtime event, head HERE