Sperm Morphology and IVF Success

July 31, 2007 - Tuesday
5:33 PM to (EST)
Guest Speakers: Ervin E. Jones, PhD, MD for Gad Lavy, MD
New England Fertility Institute

Categories
Acupuncture • IUI • IVF • Male Factor

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Corey_Whelan	Hi everyone, welcome to tonight's chat on Sperm Morphology and IVF Success. I am your moderator, Corey Whelan. Dr. Gad Lavy will be our guest speaker tonight. Dr. Lavy is the founder of the New England Fertility Institute and a very well respected reproductive endocrinologist, with many years of practice behind him. He will be here shortly and we will get started at that time.
dr.jones	Hi Corey:
Corey_Whelan	Hi
dr.jones	I am sitting in for Dr. Lavy.
Corey_Whelan	oh, this is a surprise. Would you like to tell us a little bit about yourself please?
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dr.jones	I am Dr. Lavy's associate. I am board certified in REI.
Corey_Whelan	welcome. Folks, since our speaker is here, I can open up the floor for questions.
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ujfdkmyl	I do not know what sperm morphology is
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Suzi	Hi Dr. Jones. Can you explain to me what I need to know about my dh's sperm?
stephani131	I have been thru 4 iui cycles and 2 ivf cycles with no pregnancy. My husband has low sperm count as well as poor morphology. What can you do to improve morphology, if anything???
dr.jones	ujfdkmyl - Morphology refers to the structure/shape of the sperm cell.
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ujfdkmyl	we did ICSI...does that cover us in the case of sperm quality
pamela	Hello Dr.- My husband and I have been TTC for 3 years. I'm 37, he's 36. I was diagnosed with mild endo and my husband with male factor (3% Krugers). I had 2 losses, one was a miscarriage, my last was an ectopic pregnancy. We've done 5 IUI cycles. IVF is now recommended. What are our chances of conception with IVF? I was told by one RE that ICSI is needed and another RE said it wasn't. That his #'s weren't that bad.
dr.jones	ujfdkmyl - However, if there are specific structural features identified in the sperm, high maginaification may be a tecchnique to assis the embryologist in selecting the best sperm.
dr.jones	stephani131 - There is probaably little that you can do to change the mor
mamainva	Hi Dr. Jones. My husband and I have been diagnosed with male factor infertility. His motility and morphology have been very low on all test performed. The kicker is that we have been able to get pregnant twice, we have a 2.5 year old son and the other pregnancy ended in miscarriage at 20 weeks. My question is what can make motility and morphology change so drastically? We never had problems getting pregnant prior to this, and we've been trying for nearly 1.5 years.
ujfdkmyl	once the egg is fertilized does that mean the sperm was good and it is up to the egg quality?
dr.jones	ujfdkmyl - le. You may consider pgd to help select the chromosomally normal embryos.
stephani131	any suggestions on what things we can do to try to have a successful pregancy - Also we have had two ectopics - one with iui and one naturally. Also not sure if it is an implantion problem. We have an appt with RE in a week or so any suggestions of things we should bring up???
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pamela	Hi doctor
dr.jones	mamainva, it may not be a morphology problem. It may be other factors have your provider given you information regarding morphology? I encourae you to keep trying in view you history.
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Susanna	My dh has had regular SA's where morphology was 30% abnormal. Recently (after 8 years of IF treatments, IUI & IVF, several of each) he had his 1st Krueger Analysis (new RE) and it came back only 5% normal. What are the odds that all the other SA's (10 of them) were all wrong? Could this be a recent development since he just started diavan (for high blood pressure) & vitorin (high cholesterol) the month before the Krueger SA? (Our history is 16 pregnancies, 1 bio son, DES exposure, PCOS, Immunology issues also) Thank you
NINA	DID i need to re-login
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pamela	Hello Dr.- My husband and I have been TTC for 3 years. I'm 37, he's 36. I was diagnosed with mild endo and my husband with male factor (3% kruegers). I had 2 losses , one was a miscarriage due to chromosomal issues, the last loss was an ectopic. We've done a total of 5 IUI cycles. IVF is now recommended. What are our chances of conception with IVF? I was told ICIS was needed but recently went for another consult & was told it wasn't. That his #'s weren't that bad. Also, we're looking into minimal stimulation IVF instead of traditonal IVF. Any thoughts?
dr.jones	Susanah:
Susanna	Oops, I meant 30% normal, not abnormal. :(
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pamela	also (silly ?'), can morphology vary wtih each sample?
dr.jones	sushanah; The fact that the Kruger eval. says 5 percent dooes not imply thathat the others were wrong. 5 percent is common place for strict Kruger morphology.
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stephani131	My husband and I have been trying to conceive for over 6 years now - we have done 4 IUI's and 2 IVF cycles in the last 3 years. My husband has low sperm count as well as poor morphology and the last SA he had WBC's. Any suggestions on what I should discuss with my RE at my follow up appt next week??
mamainva	Thank you Dr. Jones. My RE hasn't talked much about morphology, as his motility is low too so we've been concentrating on that. I'm just confused on how/why things could ahve changed to drastically in the last two years. Or is it that we've just been really lucky in the past? What makes things change so drastically in only two years? Is there something that my husband could do/stop doing to try to better his numbers?
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dr.jones	Pasmela, morphology can vary but probably not enough the change the the picture/diagnosis comppletely.
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pamela	Based on our history, is our chances higher w/IVF than w/IUI? I did conceive twice (after 5 IUI's) over the course of 3 years w/IUI but lost both pregnancies. What are your thoughts on minimal stimulation IVF when male factor is an issue?
vjp	Dr. I was told there is a test given at Yale that will test the strength of your uterus called the Endometrial function Test...are you familiar if so who do I contact to take the test?
dr.jones	Mamainva;, things can change drastically over a two-year period. There needs to be evaluation -urologic and endocrinologic to assess the problem.
dr.jones	vjp, ia am familiar with the test. I believe that it is usful in assessing endometrial functio,
pamela	What is the percentage range for someone my age given our diagnosis (mild endo, male factor due to morphology) for IVF? I've been told so many different #'s and am confused as to what is the actual range. I'm 37, my husband is 36.
Susanna	Dr J - I bet you think & talk faster than you type - would it be easier for you if we got on the phone and I typed your answers for you?
NINA	my husband has only 1% normal morphology. Could this be the reason why we are not pregnant yet? He does have an 11yo son from a previous marriage.
vjp	I've had an etopic, 6 failed IVF and my doctor believes I have a lining issue or an issue holding the embroy due to a weak uterus. Can the EFT help determine if this is the case. If so, do I need to contact someone at Yale or other specialist can perform the test?
dr.jones	Pamela, I would like to know more about you history. It depends on the severity of the male factor. Your ovarian reserve is also very important. If your ovaian reserve remains good and the semen parameters ae reasonable, you should still have a good chaneof pregnancy withgood management.
dr.jones	Vjp, contact Yale or New England fertility and your RE willhelp get the test done.
pamela	My numbers have always been within normal limits. I was diagnosed with mild endo. I've done 5 IUI's over the course of 3 years. My 2nd I lost due to a miscarriage and my last ended in an ectopic. I'm trying to learn more about IVF, minimal iVF in particular, and am confused because I've been told different things by different RE's (my current says we have a 60% chance w/traditional IVF and an RE we consulted w/for mini IVF said our chances were 40%).
Susanna	vjp - Dr. David Keefe in Tampa Fl (Tampa General Hosp) also does that test in case that's closer to you
pamela	Is it too risky to continue to try IUI given my history of an ectopic, mild endo and confirmed scar tissue in my tube?
michal69	can morphology, motility and count drop drastically over a few months. Does stress (i.e. moving to another state, starting a new job) have anything to do with it as well. The last time my FSH was checked it was 19 ( i am 37) but they said they will still go ahead with the IVF (we also have 17 viles of frozen sperm from a few years ago). We just did 3 IVF cycles and the 4th resulted in a miscarriage. Do you think it is wise to go ahead.
vjp	Thanks all...
dr.jones	Pamela, they both may be correct. They are most likely giving yu numbers based on their individual programs. Find a Dr. that you are comfortable with and go with him or her.
stephani131	What are your thoughts on acupuncture and IVF?? We have done 4 IUI and 2 IVF cycles in past 4 years and just looking for a little insight on something that might help.
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dr.jones	Michal69, I would continue to try. I believe that your chances remain reasonable.
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pamela	Thanks Dr. Jones. One more ?. What are your thoughts on progesterone? An RE that we're looking into puts all his patients on progesterone even if their numbers are normal. My current RE only prescribes it if the #'s are low which seems to make more sense. But I've been reading a lot about progesterone and how it's often prescribed. Is this safe? Are there any adverse affects from being on it?
dr.jones	You are at increased risk of ectopic. however, you dr. knows that and will be vigililant to deal with it early shoud that occur. You may also want to go to IVF to decrease but not completely eliminate the risk.
stephani131	Have you seen better pregnancy results from Follistim and Antagon or Gonal-F and Lupron??
vjp	Stephani131 great questions
michal69	what happened to dr lavy?
dr.jones	pamela, progesterone is widely used to support early pregnac. I am a believer in prog. supplementation. We also follow serum prog levels and adjust the dose accordingly.
pamela	So it's not unheard of to prescribe progesterone to a patient whose numbers are "normal"?
dr.jones	I cannot say that I have a great difference in pregnancy rates between the meds. Management is more important.
michal69	can morphology, motility and count drop drastically over a few months. Does stress (i.e. moving to another state, starting a new job) have anything to do with it as well.
NINA	That's a good question michal69.
dr.jones	michal69, it is certaikly possible that morphology can drop over a few months. Stressmay affecti. However, the effect is difficult if not impossible to prove and/quantify.
dr.jones	Pamel, that is correct.
stephani131	Is there a reason that my questions are being spkipped over???????
dream_r_1	Hi Dr. Jones, my husband and I have been TTC for 2 years. So far my hormone tests have come back normal (I have had no other tests done). My husband had several SA done and it came back abnormal (low motility). He had a variocele repair in Feb /07 and just had a follow-up repeat SA done at the end of June - his motility is now at 40% which went up (presurgery was 20%). Now his morphology is 30% (the number was higher before surgery). I have gone through 3 unsuccessful IUIs (with sperm wash) with meds and hcg injection. We are now considering IVF. What would our success be in achieving pregnacy with 30% morphology? Do I need to undergo anyother tests to determine if there maybe also be a "female" factor to our infertility?
vjp	Dr.can you address stephani131 questions regarding Acupuncture & IVF?
pamela	Thank you. ::smile
michal69	can morphology, motility and quantity improve over a few months after it has dropped. Are there any supplemets that help this
michal69	thannk you
dr.jones	dream_r, It is very important that you and your partner have a complete work. It is very risky to assume the all is well. If thta is you only problem, your chances should be very good.
dr.jones	I did not mean to skip over the question. The experience with acupuncture in infertilty is accumulating. I have heard of what seem to be positive results. I encourage it. There is no evidence that it does harm.
NINA	Dr. Jones, my husband and I have been trying to conceive for about 2 yrs now. He had a SA in March and it came back as 99% abnormal and 1% normal. He has an 11 yo son from a previous marriage. Do you think that IVF would be the first route to go?
wellyb	good evening my husband had great sperm counts post (greater than 20 mil/ml) for our IUI cycles but we later learned after seeking another opinion that he had very poor morphology (less than 25% normal) . He had surgery to repair multiple bilateral varicoceles and has improved sperm counts (greater than 35 mil/ml, morphology greater than 85% and motility to 95%) at last analysis. We are now attempting IVF for the first and only time. At my age, 41, we know that ICSI will be utilized. We have been told by my husband's urologist that his improvements are among the best they have seen. Would it be unreasonable to attempt a medicated IUI cycle or two before moving on to adoption if the IVF is unsuccessful?
pamela	I have one last question (sorry), the RE that we're considering for IVF feels that ICSI is not needed and that we "might as well save the money", he said it's best for the sperm and I quote "to choose for themselves" as opposed to being chosen by an embryologist. He said he's done studies that showed that ICSI wasn't necessary when morphology is an issue. My current RE feels it's necessary due to my husband's morphology count. He's done 2 semen analysis w/them and his numbers have come back consistant. Will our chances be better w/ICSI in your opinion?
dr.jones	nina, I recommend IVF with ICSI pending semen parameters at the time of the retrieval.
stephani131	Thank you for answering that questios - what about studies between different protocols of meds - any thoughts on Follistim and Antagon vs. Gonal-F and Lupron?????
NINA	Thank you Dr. Jones
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dr.jones	Stephnie, It has been very difficult to find large, randomized, placebo controlled studies to settle that question. We all have our per protocols.. I personally do not believe that there is a significant difference. What is important is how well you MD handles your stimulation.
vjp	Dr. does the HLA/DQ test really matter with IVF. My husband was a 1.2/1.2 & I'm a 1.1/1.2, we are a slight match...should we be concerned?
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dr.jones	Pm, I believe that you chances will be better with ICSI.
dream_r_1	Thank u...Dr. Jones, how much improvement can you expect in motility, morphology after a varico. repair? How many IVF cycles should be attempted before calling it quits (that you will not likely conceive by that method?
Corey_Whelan	guys, we are just about at the ten minute mark, fyi
pamela	Thank you again Dr. Jones. ::smile
NINA	Dr. Jones, are there any other "non invasive" things we can do before IVF to increase healthy morphology?
Dee_Dee	Any thoughts about having an extra sex chromosome resulting from ICSI? i.e. xxy or xyy. Sorry I arrived late.
dr.jones	vjp, This is tricky to answer based on the literture. I belive the there is litle if any significance.
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michal69	How many IVF cycles should be attempted before calling it quits - good question
dr.jones	Dee_dee, Not sure, that should not be case based on what we know of the biology of fertilization.
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dr.jones	Michal69, I like to make decisions as we go. It would depend on how each cycle performs, stimulation, fertilization, embryo quality etc.
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michal69	if the last cycle resulted in a miscarriage are my chances better/worse or the same for another IVF cycle thank you
dr.jones	Nina, I do not know of anything to do to increase morphology. It is important to have a good evaluaton to see if causes or potential causes can be identified.
michal69	what could cause morphology issues
dream_r_1	Do you believe in Fertility Blend for Men? It claims to help with sperm morph, motility and #
dr.jones	Michal, It would depend on the cause of the miscarriage if it cuold be identified. If it occured due to a random chromosomal error, your chances should not decrease.
NINA	Thank you Dr. Jones. My husband and I are going to be evaluated soon.
dr.jones	Dream, I am not familiar with it. I will be by by morning. Sorry.
michal69	what are your thoughts on lycopene for sperm motility
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Dee_Dee	Does ICSI override the difficulities/problems with slow moving sperm?
vjp	Dr. any thoughts on IVig?
dr.jones	Dee_Dee, yes.
dr.jones	vjp, the data remains muddy. I remain cautious.
vjp	Thank you Dr. ::smile
Dee_Dee	At what age does male sperm have the possibility of having problems? My husband is 41 yrs.
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michal69	what could cause morphology issues
Corey_Whelan	Dr. Jones, thank you for sitting in for Dr. Lavy tonight, we appreciate all of your insights. And thanks to all of you for attending tonight's session as well.
dream_r_1	this was great...when can we do it again?
michal69	thank you
stephani131	thank you
dream_r_1	thanks Alot!
michal69	thank you Dr Jones
pamela	Thank you again Dr. Jones.
Corey_Whelan	we have a weekly chat on tuesday nights. Please feel free to join us next week. Good night all.
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dr.jones	Dee_dee, There no known specific age that we know of. Certaily age is important and sperm fuction /parameters deminish wit age. 41 is not particulalry old.
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Dee_Dee	thanks for your insight!
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dr.jones	Thank you all.
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Sperm Morphology and IVF Success

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