# DNA Fragmentation - Any advise please



## tigger12 (Jan 23, 2008)

Hi All
I'm hoping that someone out there can help me, basically were thinking of having DNA Fragmentation testing after 3 failed ivf cycles, 1 FET failed and in the main unexplained infertility although have been told poss have diminished ovrian reserve, what my question is the doc that we are under at the lister says you have to think before you have the test if it comes back exceptionally high if your still going to proceed with IVF, I'm just wondering what the advise would be on ivf etc if the results were high,hopefully they won't be but i know that lots of ladies that go overseas partners have the dna frag testing done and i just wonder if the clinics still advise to proceed with partners sperm if they are using ED? Were thinking of trying again with our own eggs but if we are unsuccesful ED was something we were going to consider.
Any help on DNA Frag testing would be helpful
LOL
Tigs
xx


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## Moppit (May 8, 2007)

Dear Tigger

I am currently undergoing treatment for ED in Barcelona having been diagnosed with Premature Ovarian Failure last year aged 31. After 2 failed cycles we had some further tests including DNA Fragmentation. The results came back within what is considered the moderate to high range (between 20 and 30%). Each clinic seems to have a different view over what is considered high and it does depend on the test you do but largely it appears to be under 20% good, 20-30 - moderate 30 and above - High. If you have high it seems to suggest a significantly lower chance of success if moderate it will decrease chances and if good should have a positive effect.

Problem is its a very, very grey area and they don't have a full understanding at hte moment what the effects are, what causes it or how to treat it.

At the clinic we are using in Spain they have recommended that on our next cycle my husband has TESE this is basically a procedure where they extract the sperrm direct from the testicle. Again this is a grey area and I don't believe is widely upheld in the UK, but it is believed that these less mature sperm have less DNA fragmentation. These sperm will then be used with my donors eggs and we will hopefully be successful although no guarentees.

I don't know if any of that is helpful - I would suggest searching on FF under 'DNA Fragmentation' as there are several of us on here whose DH's suffer from this condition and several posts from me and others relating to it which are well worth reading.

Good luck!

Moppitx


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## tigger12 (Jan 23, 2008)

Thanks so much for the information Moppit,  it's so difficult to make a decision about what to do next, were thinking of trying again with our own eggs /sperm but cos of the nature of the infertility unexplained they suggested the DNA Fragmentation testing but the clinic we are at which is the Lister have asked us to consider if we will still proceed with treatment if the results are high, as apparently if they are then it's not worth us having the test done, can i ask if they think that the POF is the reason for your previous failed cycles? was the previous cycles with your own eggs? or if they think it may be due to the dna fragmentation or is it one of those things that they just don't know yet? Are you going into the refund programme in Spain?
Do you know where on FF i would find the thread DNA Fragmentation i wouldn't mind having a browse through that section and do you no anyone with dna frag issues that has had a succesful pregnancy, have they mentioned SD to you at your clinic?
I'm confused at the moment and scared at what the test might show, the clinic I am with the lister have told me to carry on witih my own eggs (I'm 31) my fsh is normal although AMH is normal it's apparently on the low end of the normal range for my age, we went to see a guy called Raj Rai who specialises in failed implantation and he suggests that my ovarian reserve is diminished and this may be the reason for the recurrent ivf failure although he didn't think it was unreasonable for us to try again with our own eggs, i'm so confused at the moment, i've got my hubby on a vitamin regime and having smoothies, he did have some infections going on in the prostate which have been treated with antibiotics so hopefully there won't be any negative effect on his dna frag.
Good luck and please let me know how you get on
LOL
Tigs
which clinic are you with btw


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## Moppit (May 8, 2007)

Dear Tigger

Have the clinic told you what they would consider a 'high result'? Its obviously totally personal but for us we wanted to know all the obstacles so that we could make an informed decision about what to do next otherwise you could be throwing money down the drain and putting yourself through alot of emotional stress.

We are with Institute Marquez, a clinic in Barcelona. We have had 2 attempts at Egg Donation both of which failed and following the 2nd attempt had further tests which revealed the DNA Fragmentation issue. We have since also been for a 2nd opinion to a UK based andrologist and a 2nd test. Although the DNA Fragmenation had decreased slightly (from 25% to 22%) it is still considered in the moderate range and therefore likely to cause issues with infertility. As I said though it is a very grey area and a new area which the fertility specialists in the UK at least know very little about so the andrologist was unable to give us much more advice than we had already heard other than suggesting that he would be surprised if TESA which is what IM propose would make any difference. 

I was diagnosed with POF after failing to restart my periods after coming off the pill. The key indicator for this is High FSH so it sounds like if your FSH levels are normal you do not have this illness (which is good news!). I don't know much about limited ovarian reserve though I"m afraid. With POF you don't ovulate at all so there is no chance of getting pregnant without using donor eggs hence our decision to move straight to ED. Unfortunately as if life isnt unfair enough we have now discovered that my DH also has DNA Fragmentation.

We are on the refund programme and intend to do 3 more cycles using TESA and donated eggs. If we fail after that we will either consider double donation sperm and eggs or move on to adoption.

it is a very difficult journey but there are so many amazingly brave women on here that you can't help but feel that you are not alone.

There is a very strong chance that your DH does not have DNA Fragmentation so try not to panic, it is rare particularly in younger men. From what I know it is much more common in older men (above 40) although it does seem to be increasing although this could just be because they are testing for it more. My DH is only 32 so a bit of a shock for us. You should definately continue with the high dose vitamins particularly antioxidants (Zinc/Vitamin E/Selenium) and get your DH to avoid hot baths and tight fitting underwear although again I don't think any of these things are proven unfortunately. 

According to IM it could just be bad luck that we have failed so far or it could be down to the DNA Fragmentation its very difficult to know so all we can do is carry on and pray that it works next time.

Has the clinic suggested other tests as well as DNA Fragmentation, we also did the FISH test which tests for chromosomal abnormalities and a karotype blood test. It may be worth asking about these.

I don't think there is an actual thread on the subject of DNA Fragmentation but if you go to the search tab on the FF tool bar you can type in DNA Fragmentation and it will come up with all the posts that contain the term. There are quite a few including several from me which repeat alot of what I've said here. There are also various papers on teh internet which you can read but be warned they can be confusing and all seem to have different opinions.

There are definately people who have got pregnant despite having DNA fragmentation but I think it does depend on the levels.

Good luck with everything and feel free to email me - unfortunately I seem to have become a bit of an expert on this area - I wish I wasnt!

Moppit x


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## anna the third (Jan 15, 2008)

Ladies, what would indicate a possible issue with fragmentation? we have 100% fertilisation rates - can we assume from this that there is no frag issue or are the two unconnected? thanks


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## Moppit (May 8, 2007)

Dear Anna

I'm not an expert but I believe that DNA Fragmentation presents itself more as an implantation issue than a fertilisation issue. I believe that the effects are only felt in the embryo after 4 days hence the fact that many people with this issue end up either failing to concieve at all, having a chemical pregnancy or an early miscarriage. Having said this our fertilisation has never been brilliant (around 50%) which is slightly below average and IM did think this could be linked as the other tests we have had (FISH etc) all came back normal. 

DNA Fragmentation is a very, very grey area though so I'm not sure they really know and there isnt enough research to show whetehr it effects fertilisation or not.

Moppitx


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## anna the third (Jan 15, 2008)

moppit, thanks very much. xxx


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## tigger12 (Jan 23, 2008)

Hi Moppit
Sorry to hear of your awful journey so far as you say as if life isn't unfair enough and then something else throws its self into the mix, i hope that you are succesful with your next attempt? have you decided when you will be trying again?
I'm going to go back and speak to my consultant and get his opinion on the dna frag testing i do see what you mean about rulling things out before putting yourself through more stress and emotional heartache but i guess the doc is saying if it's high and your still going to have ivf anyway is it worth testing at this stage, i wonder if PGD makes any difference when there are fragmentation issues, we have had quite abit of testing done and have had the karotyping which was normal as well as the natural killer cell immune testing along with all the failed implantation testing, the only thing thats flagged up is the killer cells we've had steriod treatment for this but not been succesful next time clinic are suggesting trying something called IVIG with our treatment, it's a difficult decision about what to do next and for us we've had 8 months of clomid, 1 iui, 3 ivfs & a frozen embroy transfer you do start asking yourself it all that can be just a case of bad luck, it's such a head wrcker and the worst experience i have had to deal with in my entire life, as you say hopefully dh doesn't have dna fragmentation issues, ED is something that we would try if we still don't have any success with my eggs as we can't keep going indefinetly i don't have the emotional or financial resources to do so, i know that you mention double donation, is that after the 3 attempts in the refund program or can you use donor sperm in the refund program as well if you try with dh sperm a couple of times could you then say try SD on your last attempt, we've also thought about adoption but thats not an easy journey either! 
I agree that there are lots of amazing ladies on here and lots of success stories to keep us positive.
Anyway good luck with your treatment and do keep in touch and let me know how you get on
LOL
Tigs
xxx


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