To test or not to test.

Let's swing the focus back towards the Sperm!

FACT:

A semen analysis cannot tell you if the DNA inside the sperm is good enough for that sperm to be considered to be fertile. A semen analysis looks at the sperm from the outside, and uses that information to infer the quality of the sperm DNA inside.

FACT:

Around 15% of men whose semen analysis looks ok are thought to have high enough sperm DNA fragmentation to render that sperm infertile.

Some men with normal looking sperm have high sperm DNA fragmentation, and high sperm DNA fragmentation may be involved in cases where there has been prolonged infertility, especially if . . .

• you have been trying to conceive for some time and had either no positive pregnancy test

• you have been able to conceive, but are going through recurrent losses

• you have had an unsuccessful IVF cycle (especially if most embryos were lost after day 3 or if the issue was implantation failure or early loss)

If you have been trying to conceive for a while, I would strongly recommend a sperm DNA fragmentation test BEFORE considering IVF as high sperm DNA fragmentation can easily derail an IVF cycle by causing implantation failure or early loss. If high fragmentation is found, in the majority of cases it can be improved. Many IVF clinics will discourage you from running a sperm DNA fragmentation test, and insist that IVF/ICSI is a suitable workaround for highly fragmented sperm - that opinion is counter to the opinions we hear from male fertility experts. If there is something you can do to improve the integrity of sperm DNA, it is worth doing as that has the potential to have a huge impact on the safety of the pregnancy and health of the child.

Some of the causes of high sperm DNA fragmentation:

- age (yes, sperm DNA integrity decreases with age)

- smoking (cigarettes, vaping, shisha, cannabis)

- structural issues such as varicocele and cysts in the testes

- infection, inflammation, autoimmune issues

- poor diet and lifestyle - heat (saunas, hot baths, wearing tight lycra in the gym and keeping it on for hours afterwards) - radiation (mobile phone in the front pocket, laptop on the lap)

- trauma

- mumps (if it impacted the testes or inguinal lymph nodes)

- The Virus

- stress

- poor sleep habits

However, in most cases I don't advise people to run the sperm DNA test.

Why not, I hear you ask.

Because it's an expensive test, and in most cases you can see that sperm DNA fragmentation is likely to be high because of the impact of diet and lifestyle choices - so there seems little point in spending £500 confirming that the sperm DNA is fragmented. It is often better to put the time and effort into improving sperm health through acupuncture, diet, supplements and lifestyle changes - and only worry about testing once everything has been on point for 2-3 months.

There are however a few exceptions:

• I will recommend a sperm DNA fragmentation test if he is indulging in diet and lifestyle choices that we know damage sperm DNA but cannot see why he needs to change his ways. Some men need to see the data before they will change their habits.

• I will recommend a sperm DNA fragmentation test if someone is moving into IVF for no known reason. Knowing that raised sperm DNA fragmentation is part of the picture might prompt them to consult with a urologist before they launch into IVF, or might mean they put more attention into working with a clinic that uses advanced sperm selection techniques in an attempt to identify sperm with less DNA fragmentation.

• I will recommend a sperm DNA fragmentation test if I see a woman having recurrent early loss or IVF failure and is convinced that it is all to do with poor egg quality. Often poor sperm DNA quality is involved and it feels important to show them that it is not necessarily an egg issue.

And when I do recommend that someone have a sperm DNA fragmentation test, I recommend they go to a male fertility clinic such as Fertility Solutions, Andrology Solutions or Cambridge Urology instead of running the test through an IVF clinic in order to get the best post-test advice.

Have you asked about sperm DNA fragmentation and been told to test it or told not to test it??

I'm a Fertility Support Trained Acupuncturist. Yes, we do the acupuncture magic stuff - but we also know a lot about the science of fertility and how to investigate it properly.

Stay tuned for the rest of my 12 Days, 12 Posts - and if you think someone needs to be following this series, please share.