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.

Couple TTC, Husband With Diabetes & 42 Yr Old Wife on Fertomid (Clomid): What Can Be Done?

Question:

Hello. My husband and I have been trying to conceive for over one year. I am 42 yrs old and have one ovary. I have regular menstrual cycles but when the ovulation test was done there was no ovulation. I have started to take Fertomid for the first time. The first treatment was a month ago. Also my husband is diabetic, type 2. Can this affect his fertility? He is age 36.

I appreciate any advice you can give. B. from Ohio

Answer:

Dear B. from Ohio,

Yes, diabetes can affect male fertility. Diabetes affects the blood vessels in our body and causes the vessels to shrink, thereby limiting blood flow. This is the reason that diabetics end up getting leg ulcers and require amputation. In the genital region, it can reduce blood flow to the testicles and reduce sperm production. To check your husband's fertility, all he would need at this point would be a semen analysis. It is a simple test and will answer the question of whether or not his diabetes is affecting his fertility.

Your one ovary is not an issue, the bigger issue, which you mentioned in passing, is your age factor. Your chances of natural pregnancy at 42 years old is only 1% per year. That is probably the major factor in your failure to conceive. Fertomid is NOT an appropriate treatment for you (Fertomid is the generic form of Clomid).

You need to go to the advanced treatment level called IVF (in vitro fertilization) if you truly want to have the opportunity to get pregnant. Anything less than that is a waste of precious time, such that even at 43, IVF could still be an option without donor eggs. I would strongly recommend that you go see a Fertility specialist that provides IVF as soon as possible. Your age combined with your husband's possible male factor problem would indicate that this might be the best option for you both at this time. I see way too many patients like you, after the age of 40, that have wasted years doing simple treatments with their Ob/Gyn docs. Then, when they come to see me, it is too late and I have limited resources to offer them. Most leave very disappointed. Don't let this happen to you!

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.