Male Factor IF Studies

I have been collecting studies and journal articles about male infertility issues for awhile. Our male factor problems with honey's sperm are DNA damage (23-25%DFI = fair) and really low morphology (2% normal forms with Kruger Strict). I decided to put what I have collected into two categories...those that concern and create more anxiety for me and those that give me some hope. Our RE thinks our miscarriages (3) are related to the sperm issues. What I notice is that the bad news seems more related to DNA damage than poor morphology. And the good news is related to morphology. My thinking: since our morphology is worse than our DNA issue, we still have a "shot" at having a sticky, healthy baby. How many times will we have to try? I don't know. I'm looking for any glimmer of hope out there.

Summary of Male Factor Studies-Articles

Concerning/Challenging Studies:

1. Sperm DNA damage is associated with an increased risk of pregnancy loss after IVF and ICSI: systematic review and meta-analysis
http://humrep.oxfordjournals.org/content/23/12/2663.abstract

Summary: Doing a meta-analysis of 11 studies, they conclude that DNA damage greatly increases the risk of pregnancy loss.

2. Sperm DNA fragmentation: paternal effect on early post-implantation embryo development in ART
http://humrep.oxfordjournals.org/content/21/11/2876.full

Summary: Risk of pregnancy loss is increased with DNA Fragmentation. However, poor morphology and other semen parameters did not increase/predict pregnancy loss. Therefore, DNA damage is more predictive of pregnancy loss.

3. Male Factor Infertility Blog
http://www.malefactorinfertility.info/2009/12/sperm-morphology-most-important.html

With IVF/ICSI, poor sperm morphology has been associated with normal fertilization rates but higher rates of spontaneous abortion.

4. Permanent Link to Sperm DNA Damage Linked To Increased Risk of Pregnancy Loss after IVF and ICSI
http://www.ivfnewsdirect.com/?p=106

Recent research provides evidence that sperm DNA damage may be associated with an increased risk of spontaneous abortion.

5. SCSA Predicts Male Fertility: Zouves Fertility Center
http://www.goivf.com/news/newsletter.php4?vol=4

Comparing the poor category (over 30% DFI) relative to the excellent category (under 15%DFI), the blastocyst rate is about half, the pregnancy rate is reduced by 2/3 and the spontaneous abortion rate is doubled.


Hopeful/Promising Studies:

1. A Retrospective Comparison of Pregnancy Outcome Following Conventional Oocyte Insemination vs Intracytoplasmic Sperm Injection for Isolated Abnormalities in Sperm Morphology Using Strict Criteria
http://www.andrologyjournal.org/cgi/content/full/28/4/607

Summary: Sperm with poor morphology but other parameters normal had a lower rate of fertilization w/regular insemination than that with IVF and ICSI, but pregnancy and delivery was more successful w/regular inseminations: 50%.

2. Inferility Blog
http://infertilityblog.blogspot.com/2010/07/sperm-morphology-new-guidelines.html

Quotes: “Any morphology over 3% is considered normal. If your doctor tells you otherwise, ask him if he has seen the new WHO guidelines." "To take it one step farther, can there really be a difference between 4% and 2%? I doubt that there is a difference between having 96% abnormally shaped sperm and 98% abnormally shaped sperm. So as I have said before, at our practice here at NYU, morphology is not considered with much respect, except in some rare cases where the sperm is unusually abnormal.”

3. Evaluation of Sperm Morphology Using Kruger's Strict Criteria
http://informahealthcare.com/doi/abs/10.3109/01485019208987674

Summary: There were no statistically significant differences found in pregnancy rates in partners of men with normal morphology of ≤4% vs. those with 14% or greater. The retrospective analysis showed a 50% pregnancy rate in the group with ≤4% morphology scores vs. 67% in >14% group. The 56% success rate in the men with normal morphology ≤4% reduces the significance of the diagnosis of sperm morphology using the new strict criteria.

4. SCSA Predicts Male Fertility: Zouves Fertility Center

http://www.thenewjerseymaleinfertilitycenter.com/sperm_detection_cases.php#morphology

Case 1: Man w/normal WHO morph but only 2% Kruger. “Many couples in my own infertility practice have a severe abnormality when the sperm morphology is assessed by Strict Morphology, a normal morphology by WHO criteria, and achieve pregnancies with IUI alone.”

Case 2: “Since the initial research on the Strict Morphology criteria (1980s) there has been a great deal of controversy about their true reliability. If this (abnormal morph with Strict Kruger) is the only abnormality that is seen in the semen analysis, I generally suggest re-assessment of the semen using the World Health Organization (WHO) criteria. If the morphology is normal using WHO criteria, I consider the man to have a potential mild to moderate male factor which I usually treat with intrauterine inseminations (with good results)."