Dr Potter: scsa test and poor embryo quality

[lisvna]

Dear dr Potter,

I'm 34 husband is 38 and we have 1 son conceived naturally within a few months.

We wanted to add a girl into our life so we did ivf/pgd. The eggs after collection looks always great and the sperm morphology is also good (they are fast and looks healty). After fertilization with ICSI (for PGD) the embryos developed poor and there was severe fragmentation.

I have no health issues (as far as i know) but my husband has familial hypercholesterolemia and he uses Inegy 10/20 (10 mg ezetimibe and 20 mg simvastatin).

I have 3 questions:

1) can this medication cause semen DNA fragmentation?

2) Can fragmented sperm cause poor embryo quality?

3) Is an SCSA test for my husbands semen usefull?

I hope you can help us out with these questions because in the Netherlands (Europe) they have no answers for us!

[lisvna]

Anyone else?

[Dr. Potter]

Dear dr Potter,

I'm 34 husband is 38 and we have 1 son conceived naturally within a few months.

We wanted to add a girl into our life so we did ivf/pgd. The eggs after collection looks always great and the sperm morphology is also good (they are fast and looks healty). After fertilization with ICSI (for PGD) the embryos developed poor and there was severe fragmentation.

I have no health issues (as far as i know) but my husband has familial hypercholesterolemia and he uses Inegy 10/20 (10 mg ezetimibe and 20 mg simvastatin).

I have 3 questions:

1) can this medication cause semen DNA fragmentation?

2) Can fragmented sperm cause poor embryo quality?

3) Is an SCSA test for my husbands semen usefull?

I hope you can help us out with these questions because in the Netherlands (Europe) they have no answers for us!

It is possible that sperm DNA fragmentation could cause such an outcome. It unlikely though. Getting the scsa is a good idea as is having your husband take Cyvita 3 tablets twice daily. I would also suggest that you have testing for insulin resistance. Also would recommend a change in protocol. What is your ovarian reserve? What protocol where you on??

[lisvna]

Dear dr Potter thank you for you answer! I'm very glad you want to help us!

These are my tests results.

LH: 4.5 U/l (reference values 2.4-6.6)
FSH: 4.6U/l (" 3.4-21.6)
Prolactin: 461 mU/l (" 25-635)
TSH: 1.4 mU/l (" 0.35- 4.94)
AMH: 1.0 ug/l ("0.9-2.3)

First cycle: single shot downregulation with decapeptyl depot 3.75mg and stimulation with Menopur 300 IU. Supplements: DHEA, pregnacare, fish oil.

Second cycle: a few months on BCP Yasmin. Downregulation daily shots of Decapeptyl 0.1 mg. stimulation with menopur first 5 days 375 IU and last 3 days 300 IU. Supplements: pregnacare and fish oil (NO DHEA anymore).

The second cycle I did get hatching blasts (the first time we didn't) but again severe fragmented (we have pictures if you are interested) we put back 4 embryos (2xx and 2xy) and I'm now pregnant with just one and it is unfortunately a boy (we wanted a girl that's the reason for PGD but eventually the highest priority was a sibling for our son).

We want to try again PGD because we still really want a girl and we want to know how we can increase our chances on good embryos.

We're can we buy this supplements for my husband and how long do he has to take it before trying again?

Is there anything wrong with me?

[Dr. Potter]

You may have insulin resistance. If you get gestational diabetes that would confirm it. The first cycle, I don't like depot. The second cycle was better but they still used too much LH. that they were willing to transfer 4 embryos says a lot about their lab. You can do better.

[lisvna]

Dear dr Potter,
Im almost 22 weeks pregnant now and it is still a boy hihihihi so we defenetly want to try again for a girl.
I have no gestational diabetes is it stil possible I have insulin resistance? Can I test it during this pregnancy or do I have to wait?
I have read about HGH (human growth hormone if im correct). If I would add it to my next cycle can it help to improve egg quality?
I hope you can help me out with these questions, thanks!

[Dr. Potter]

Dear dr Potter,
Im almost 22 weeks pregnant now and it is still a boy hihihihi so we defenetly want to try again for a girl.
I have no gestational diabetes is it stil possible I have insulin resistance? Can I test it during this pregnancy or do I have to wait?
I have read about HGH (human growth hormone if im correct). If I would add it to my next cycle can it help to improve egg quality?
I hope you can help me out with these questions, thanks!

they will test you again for gestational diabetes around 28 weeks. hGh may help, I would need to see the lab records to decide.

[lisvna]

Dear dr Potter,
Thank you for your respond. I'm almost 27 weeks pregnant now so I will ask my doctor again about the insulin. I will update....TIA!

[Dr. Potter]

Dear dr Potter,
Thank you for your respond. I'm almost 27 weeks pregnant now so I will ask my doctor again about the insulin. I will update....TIA!

good luck with your pregnancy!

[lisvna]

Thank you very much!