U.K. Patient Concerned About ICSI And Husband's Diabetes: Will There Be Abnormal Embryos?

Question:
Dear Dr. Ramirez,

My husband had a semen analysis result and he had Moderate Oligospermia and Severe Asthenospermia (only 4% normal progressive). It has been suggested that we would require ICSI IVF, however my husband also has Type 1 diabetes. I have read that his sperm cells might have DNA damage and to use such sperm in ICSI could result in an unhealthy child prone to cancer. None of the professionals I have spoken to in this early stage have made any reference to the implications of my husband being diabetic and it is causing me concern.

I was hoping that you could clarify how sperm are tested for DNA damage and if it could be used in conjunction with ICSI. Also, does non-ICSI IVF avoid the risks of DNA damaged sperm cells? Would they be filtered out by natural processes? Thanks, L. from the U.K.

Answer:

Hello L. from the U.K.,

Sperm can only undergo DNA testing apart from IVF/ICSI because the sperm tested are essentially destroyed. There is not method to test the sperm prior to ICSI at the time of IVF. There is also no way to test the resultant embryos from DNA damage, but testing for genetics is possible.

There have been some studies, mainly out of Europe and using small homogeneous numbers (homogeneous meaning that everyone tested was of the same racial type such as Sweden), that showed the possibility of fetal abnormalities with ICSI. However, that has been unproven and IVF with ICSI has been around for almost 20 years. In the U.S., where the population is more diverse, studies have not shown any type of abnormalities, so the tests that were done previously in Europe might have some type of population/genetic weakness.

The fact that your husband has diabetes might explain why his semen analysis was abnormal (due to reduced blood flow in the testicles). This should not affect the embryos formed with ICSI, however. In general, the embryologist performing ICSI chooses the healthiest swimming and formed sperm for injection. There should be plenty to choose from. The embryos that might be abnormal generally do not progress, and therefore are not implanted.

Hope this helps to set your mind at ease!

Good Luck,

Edward J. Ramirez, M.D., FACOG

Executive Medical Director

The Fertility and Gynecology Center

Monterey Bay IVF Program

www.montereybayivf.com

Monterey, California, U.S.A.

Comment: Thank you for your response. It has really put my mind at ease. It is very difficult to find a small amount of information that could have a massive impact on your children and it not seeming to be acknowledged. Regards, L.