Why isn’t my IVF working?
Sadly, many of our patients come to us asking exactly this - why isn’t my IVF working? And, whilst there isn’t always a straightforward answer, sometimes there is and it is commonly linked to male factor infertility which hasn’t been investigated, diagnosed or treated prior to the couple starting IVF treatment.There are many reasons why IVF treatment fails and it is well documented that the live birth rate per IVF cycle remains disappointingly low despite the 40 years since IVF treatment began. Whilst these birth rates are well documents, one of the reasons behind poor IVF rates is not so well reported - male factor infertility. 50% of all cases of infertility are related to male factor. Why does this cause IVF to fail?
The reason IVF won’t work if there is a male factor infertility issue is because IVF/ICSI treatment itself doesn’t improve sperm quality, it simply puts the sperm and the egg together. If the male factor is diagnosed and the cause of a man’s infertility ascertained this can be treated to improve the chances of natural conception and the IVF process becoming more successful.
So what is our advice?
If you are considering IVF treatment we strongly recommend you to have the male partner fully investigated. It might sound strange but even if a man has had a normal semen analysis result it is often worth getting some more tests done because a “normal” semen analysis does not mean that the man is fertile. A normal semen analysis just shows the number of sperm in the ejaculate not how good that sperm is. So a normal semen analysis shows that there are a normal number of sperm but it cannot give you any information about the genetics of those sperm.
It is surprising but entirely possible for sperm to look normal following a semen analysis test but have genetically abnormalities. For this reason we recommend a more in depth examination of sperm at the genetic level - this is called a DNA fragmentation test.
Who do we recommend a DNA fragmentation test to?
At Fertility Solutions we recommend DNA fragmentation testing to those couples that:
- Have been trying to conceive for more than a year
- Have undergone an unsuccessful IVF cycle
- Have suffered an early miscarriage.
We consider the reproductive history of the male partner, their previous semen analyses and whether they have had a previous IVF cycle fail.
We would then suggest that you undertake a DNA fragmentation test and when the results come back, we review them with a specialist team. The team approach includes a gynaecological, urological and embryology approach to actually give the patient as much information as possible to determine if a male factor could be contributing to IVF failure or not. When IVF fails and it is caused by the male factor, the patient should see a urologist who will work to first diagnosis, and then to improve sperm quality and therefore improving the IVF cycle outcome.
We understand both the emotional and financial cost of IVF cycles and the repeated disappointment if the IVF does fail. We know that by assessing the couple as a whole early in their fertility journey it can help with earlier diagnosis of any male or female factor problem before the treatment starts. Often this saves time, money, some of the emotional stress and led to a more positive outcome for the couple.
There are many potential diagnoses for men including infection, varicocele or obstruction which can be treated and improved, thus improving and creating the opportunity for the couple to get pregnant without the need for IVF.