The Natural Fertility clinic

complementary therapy specialists

This week we were visited by Verity Paz and Katie Flello from the natural fertility clinic. At the Natural Fertility Clinic (NFC), they offer a wide range of complimentary therapies. They aim to enhance fertility and offer maternity treatments including: reflexology, acupuncture and specialist massage. Verity and Katie also offer in-depth assessments on the best use of natural and complementary therapies, lifestyle changes and can provide further investigations to optimise the chances of conception.

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New Clinic Opening

Coming soon…

We are delighted to announce that in the next few weeks we will be offering male fertility diagnostic services at our new clinic location in Tunbridge Wells, Kent. The clinic will run Monday to Friday offering convenient appointments from 09.00 to 16.00.

Your results will be available on the same day and discussed with you following urological review.

THE PLACE OF SPERM DNA FRAGMENTATION TESTING IN CURRENT DAY FERTILITY MANAGEMENT

Abstract

In this debate article, I am going to set out the case that sperm DNA fragmentation testing is essential in current day fertility management because:

  • Our current semen analysis testing is unfit for purpose
  • We need to take a fresh look at the ‘evidence’ against sperm DNA testing
  • Sperm DNA damage testing has strong associations with every fertility check point
  • Sperm DNA damage testing has strong associations with miscarriage
  • Sperm DNA testing can explain ‘unexplained’ infertility
  • There are reasons why sperm with poor DNA are successful in ICSI
  • There are no non-invasive sperm function tests that provide the same information.
  • We need to take a fresh look at the ‘evidence’ against sperm DNA testing

We have no reason to wait. There are benefits for clinics and couples alike.

Continue reading “THE PLACE OF SPERM DNA FRAGMENTATION TESTING IN CURRENT DAY FERTILITY MANAGEMENT”

For 40 per cent of couples who can’t conceive, the problem lies with the man. So why is male infertility rarely spoken about?

Female fertility is a hot topic. Women are constantly reminded of their biological clocks and warned about the risks to fertility of diet, alcohol and stress, but there is a gradual dawning that men, too, should plan their families sooner rather than later.

Continue reading “For 40 per cent of couples who can’t conceive, the problem lies with the man. So why is male infertility rarely spoken about?”

Use of surgical sperm retrieval in azoospermic men: A meta-analysis

Objective

To compare the outcomeof intracytoplasmic sperm injection (ICSI) cycles [1] using epididymal and testicular sperm in patients with obstructive azoospermia (OA); [2] using surgically retrieved sperm in patients with OA and nonobstructive azoospermia (NOA); and [3] using fresh and frozen-thawed sperm.

Design

Meta-analysis of published data.

Setting

Assisted conception unit.

Patient(s)

Ten reports (734 cycles: 677 transfers) were identified as suitable to assess source of sperm; 9 reports (1,103 cycles: 998 transfers) to assess etiology; and 17 reports (1,476 cycles: 1,377 transfers) to assess the effect of cryopreservation.

Intervention(s)

Surgical sperm retrieval/ICSI.

Main outcome measure(s)

Fertilization rate (FR), implantation rate (IR), clinical pregnancy rate (CPR), and ongoing pregnancy rate (OPR) per embryo transfer.

Result(s)

Meta-analysis demonstrated no significant difference in any outcome measure between the use of epididymal or testicular sperm in men with OA. Meta-analysis showed a significantly improved FR (relative risk [RR] 1.18; 95% confidence interval [CI]: 1.13–1.23) and CPR (RR 1.36; 95% CI: 1.10–1.69) in men with OA as compared to NOA with a nonsignificant increase in OPR. There was no difference in either IR or miscarriage rate between the two groups. Comparing fresh with frozen-thawed epididymal sperm there was no difference in FR or IR, a significantly higher CPR (RR 1.20; 95% CI: 1.0–1.42), and no difference in OPR. No difference in fertilization or pregnancy outcome was noted when the testicular cycles were analyzed separately, but IR was significantly impaired using frozen-thawed sperm (RR 1.75; 95% CI: 1.10–2.80).

Conclusion(s)

Meta-analysis of published data confirms that etiology of azoospermia and cryopreservation of surgically retrieved sperm impacts on ICSI outcome, and allows us to make several recommendations for clinical practice. Origin of sperm, in men with similar etiology, does not affect outcome.

https://doi.org/10.1016/j.fertnstert.2004.02.116

NOVEL MEASURES OF SPERM DNA DAMAGE INCREASE ITS USEFULNESS TO DIAGNOSE MALE INFERTILITY AND PREDICT LIVE BIRTHS FOLLOWING BOTH IVF AND ICSI

BACKGROUND

• Lister has been using the SpermComet test since 2011
• Initial clinical thresholds seen as a limitation of the test:

– 0-25%– 25-50%– >50%

No significant DNA damage Consider IVF
ICSI recommended

• Majority of clinic results fall in the 25-50% range

• Tighter thresholds would be more clinically useful in guiding treatment selection.

OBJECTIVES

• Determine and compare novel Comet Plot parameters to identify which has the highest ability to predict a live birth following IVF and also ICSI.

• Analyze the relationship between treatment pathway, live birth and sperm DNA damage for clinic patients who have had the SpermComet test.

• Define clinic specific thresholds to better guide the selection of treatment pathway.

CONCLUSIONS

All COMET markers highly predictive of male subfertility confirming role for testing in unexplained infertility

IVF Livebirth rate declined sharply once sperm DNA damage exceeded all ROC threshold levels identified with
HCS > 6% the most predictive (38% vs 13%)

ICSI Livebirth rate moderately declined once sperm DNA damage exceeded all ROC threshold levels identified with HCS > 10% the most predictive (43% vs 28%)

SUMMARY

• We have identified clinic-specific thresholds for ACS and novel SpermComet parameters

• Role for testing in Unexplained Subfertility

• Role for prediction of ART outcome / improved treatment pathway

– HCS parameter is most predictive of IVF and ICSI Livebirth

– Recommend IVF over ICSI even with normal semen parameters with COMET scores above identified thresholds

– ICSI livebirth also impacted by COMET scores suggesting role for urological intervention to reduce damage before treatment

– ?Role for testicular retrieval with very high levels / recurrent cycle failures

https://examenlab.com/wp-content/uploads/2018/11/Nicopoullous-BFS.pdf

Use of surgical sperm retrieval in azoospermic men: A meta-analysis

Objective

To compare the outcomeof intracytoplasmic sperm injection (ICSI) cycles [1] using epididymal and testicular sperm in patients with obstructive azoospermia (OA); [2] using surgically retrieved sperm in patients with OA and nonobstructive azoospermia (NOA); and [3] using fresh and frozen-thawed sperm.

Design

Meta-analysis of published data.

Setting

Assisted conception unit.

Patient(s)

Ten reports (734 cycles: 677 transfers) were identified as suitable to assess source of sperm; 9 reports (1,103 cycles: 998 transfers) to assess etiology; and 17 reports (1,476 cycles: 1,377 transfers) to assess the effect of cryopreservation.

Intervention(s)

Surgical sperm retrieval/ICSI.

Main outcome measure(s)

Fertilization rate (FR), implantation rate (IR), clinical pregnancy rate (CPR), and ongoing pregnancy rate (OPR) per embryo transfer.

Result(s)

Meta-analysis demonstrated no significant difference in any outcome measure between the use of epididymal or testicular sperm in men with OA. Meta-analysis showed a significantly improved FR (relative risk [RR] 1.18; 95% confidence interval [CI]: 1.13–1.23) and CPR (RR 1.36; 95% CI: 1.10–1.69) in men with OA as compared to NOA with a nonsignificant increase in OPR. There was no difference in either IR or miscarriage rate between the two groups. Comparing fresh with frozen-thawed epididymal sperm there was no difference in FR or IR, a significantly higher CPR (RR 1.20; 95% CI: 1.0–1.42), and no difference in OPR. No difference in fertilization or pregnancy outcome was noted when the testicular cycles were analyzed separately, but IR was significantly impaired using frozen-thawed sperm (RR 1.75; 95% CI: 1.10–2.80).

Conclusion(s)

Meta-analysis of published data confirms that etiology of azoospermia and cryopreservation of surgically retrieved sperm impacts on ICSI outcome, and allows us to make several recommendations for clinical practice. Origin of sperm, in men with similar etiology, does not affect outcome.

https://doi.org/10.1016/j.fertnstert.2004.02.116