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When IVF Fails

Posted on: by Susannah

Infertility Treatment

INFERTILITY CARE PATHWAYS depend on 1) WHEN infertility diagnosis made (2) age (3) your partner’s age (4) many personal preferences. When IVF fails we reassess these causes. At Susannah Makram Clinics we view infertility as a complete care pathway. That this may be supported by our individual body wellness is where we come in.

When IVF Fails

When IVF fails your decision to go ahead with the same treatment for infertility is usually put into question. This is a natural reaction to have.

In vitro fertilisation (IVF) is the most common ART technique. When IVF fails, the decision to continue with another IVF cycle, at the earliest possible time, is not one to take lightly. Assisted reproductive technology (ART) is any fertility treatment in which the egg and sperm are handled.
IVF involves stimulating and retrieving multiple mature eggs from a woman, fertilising them with a man’s sperm in a dish in a lab, and implanting the embryos in the uterus three to five days after fertilisation.

iStock_000023743474_Small

When IVF Fails

IVF Success Rates

IVF-conceived babies now account for 2% all babies born in the UK.      [tweetthis]IVF-conceived babies now account for 2% all babies born in the UK[/tweetthis]

The success rate of ART is lower after age 35. This is according to new figures on infertility treatment us and outcomes. these figures are released annually by the Human Fertilisation and Embryology Authority (HFEA).

When choosing a fertility clinic carrying out IVF treatment The HFEA presents success rates for every licensed clinic.

Some women need just one or two therapies to restore fertility. It is possible that several different types of treatment may be needed before you are able to conceive.

GENETIC and CHROMOSOMAL issues causing FAILURE OF IMPLANTATION in IVF – The high rate of chromosomal abnormalities in human embryos.

  • As women age, the incidence of chromosomal abnormalities in mature eggs increases significantly. Studies have shown that starting in early 30s, the rate of chromosomal abnormalities in human eggs (and therefore in human embryos) starts to increase significantly.
  • The rate continues to increase with advancing female age. By mid-40s a very high percentage of human embryos are chromosomally abnormal (over 75%).
  • It’s believed that this is mainly due to problems with the spindle apparatus in the egg nucleus. The spindle is involved with properly lining up and segregating the chromosomes as the egg matures at the time of ovulation.
  • Older eggs have an inefficient spindle apparatus that does not line up the chromosome pairs properly. “Mistakes” are made when splitting pairs of chromosomes. This leads to eggs that don’t have the proper balance of 23 chromosomes – and will result in a chromosomally abnormal embryo if fertilised.
  • It has been shown that about 1% to 2% of human sperm are chromosomally abnormal on average – as compared to about 20% to 90% of human eggs (depending on female age).
    lab

    When IVF Fails

PGS – preimplantation genetic screening can be done on embryos prior to transfer to evaluate chromosomal competence.

Other “genetic causes” of implantation failure

  • Implantation failure is probably caused by other genetic mutations sometimes. With a perfectly normal “karyotype” or chromosome complement.
  • There are tens of thousands of genes in the human genome. A lot of places where something can go wrong.
  • With time there will be genes discovered that are crucial for efficient embryo implantation. These will be both on the embryo side and on the uterine side. Perhaps they will involve the immune system as well.

INFERTILITY treatment involves commitment that is significantly financial, physical, psychological and time consuming. Male infertility treatment for general sexual problems or lack of healthy sperm at Susannah Makram Clinics use advanced male fertility diagnostics to outline effective treatment protocols for couple to choose from. Tests identify and support improvement for (normal sperm count and) poor sperm quality.

Your Naturopathic Portfolio to improve sperm quality at Susannah Makram Clinics supports ICSI if used in an IVF cycle as described.
FIND OUT MORE ABOUT FERTILITY TREATMENT ROUTES AND HOW SUPPORTING LIFESTYLE CHANGES CAN HELP COUPLES TODAY.

Female fertility continued 

SpermComet Results Guide

DNA in sperm

Paint a clearer fertility profile picture with the SpermComet test. HOW? Measuring sperm DNA damage in individual sperm using the most sensitive test.       [tweetthis]SpermComet: most sensitive test that can measure sperm DNA damage in individual sperm [/tweetthis]
We’re probably all familiar with with the term SPERM COUNT that deals with the quantity of sperm. However, what most of us know less about is SPERM QUALITY.

For couples trying for a baby, when it comes to sperm quality, conventional semen analysis tells us little. One in Four couples in the Uk have difficulty starting a family. The Sperm DNA test may help guide couples. Don’t wast time. Find out if it’s worthwhile taking this test – the most sensitive of its kind – contact us 0207-060-3181

If you’ve already been trying for a baby, or even just starting to think about it, measuring sperm DNA damage in individual sperm paints a clearer fertility profile picture:  [tweetthis]Trying for a baby, or starting to think about it? See your fertility profile clearly[/tweetthis]

<25% Damage = Sperm DNA damage is not the major cause of infertility Damage

>25% Damage = Sperm DNA damage is a cause of infertility

-> Refer to fertility clinic

25-49% Damage = Sperm DNA damage is a cause of infertility

-> Lifestyle Changes + Antioxidants
-> IVF may be the best option

>50% Sperm DNA Damage

-> Lifestyle Changes + Antioxidants
-> ICSI may be the best option

>50% Sperm DNA Damage & Failed ICSI

-> Lifestyle Changes + Antioxidants
-> Testicular Biopsy may be the best option
-> Alternatively ICSI with donor sperm may be considered

ICSI – Intra-cytoplasmic Sperm Injection – is the most successful form of treatment for men who are infertile and is used in nearly half of all IVF treatments (HFEA 2010). ICSI only requires one sperm, which is injected directly into the egg. The fertilised egg (embryo) is then transferred to your uterus (womb) (HFEA 2009a)

 One in six couples has difficulty having a baby: in 40 per cent of these cases, the difficulty is associated with the man.

Susannah2

When it comes to sperm, not talking about it means many couples trying for a baby may be missing out on information that could improve their chances… information that could help reduce the loss of valuable time and financial costs and – not least – the emotional heartache that can be hardest of all.

When IVF fails it’s a frustrating situation for couples and their fertility doctors. Sperm DNA Fragmentation Testing results can help be a guide for couples.

Gut Microbiome and Fertility

Gut Microbiome and Fertility

Recap then gut microbiome and fertility. The human microbiome consists of the microbes living on and within our human bodies. Most of these bugs inhabit our large intestine. There, a few pounds’ worth of bacteria, yeasts, archaea and even viruses. These help digest food, calibrate our metabolic and immune function and hold off would-be invaders.

There’s growing evidence that the pathogenic effects of bacterial vaginosis may not be confined to the lower genital tract.

Fertility Nutrition

Most studied is how gut microbiota affects an individual’s risk of obesity and other metabolic conditions. In both men and women weight management plays a pivotal role in reproductive heath, pre conceptual care, without and throughout use assisted reproductive technologies.      [tweetthis]In men & women weight management is crucial to reproductive heath, pre-conceptual care[/tweetthis]

Much more attention should be paid to the impact of obesity on fertility in both women and men. This appears to be particularly important for women before assisted reproductive technologies are used. Treatment of obesity may improve androgen imbalance and erectile dysfunction, the major causes of infertility in obese men.

Gut Microbiome and Fertility

Gut Microbiome and Fertility

Female Fertility – The Vaginal Microbiome

A special subset is the vaginal microbiome. The vaginal microbiome inhabits the vagina and successful reproduction, as it turns out, owes an immense debt to this microbial community.

A healthy vaginal microbiome produces lactic acid and hydrogen peroxide. These maintain a level of acidity that keeps troublemaking microbes at bay. When the vaginal community becomes unbalanced, on the other hand, acidity decreases. The wrong microbes may then invade or, if they’re already present, bloom. How does this happen?

The Role Of The Vaginal Microbiome In Fertility – Reproductive Health & Beyond

This disturbance can cause bacterial vaginosis—not really an infection, but an out-of-whack ecosystem. It sounds like a trifling problem, and half of women with vaginosis may display no obvious symptoms. But this minor-seeming imbalance can have major consequences.

Vaginosis increases the risk of contracting secondary infections, from herpes to HIV. But even on its own, the microbial shift may prompt low-grade inflammation that can derail reproduction. It can prevent fertilisation in would-be mothers, prompt spontaneous abortion in pregnant women, and increase the risk of preterm birth later in pregnancy.

Many factors affect the vaginal ecosystem—smoking, stress, diet, the number of sexual partners, and obesity. One of the most direct ways to upset the vaginal microbiome may be douching.

The Role Of The Vaginal Microbiome In Fertility – Bacterial Vaginosis & Miscarriage

The consequences of bacterial vaginosis can be devastating. In a study of 1,950 urban women in Philadelphia, for example, vaginosis in the first trimester more than doubled the risk of spontaneous pregnancy loss in the second. In Belgium, vaginosis more than quintupled the risk of early preterm birth.

Vaginosis-related microbes have been implicated in roughly one-quarter of all preterm births. For the most vulnerable group of children, those born extremely preterm, or before 25 weeks, the number perhaps doubles.
Studies in Kuopio Finland by this Finnish group have since replicated the finding among 15-to-17-year-olds, implying that the consequences of prenatal inflammation persist into adolescence and probably adulthood.

Does the vaginal microbiome play a role in IVF?

personalised nutrition

personalised nutrition

                                                     

Influence of bacterial vaginosis on in-vitro fertilisation and embryo implantation during assisted reproduction treatment.

Although an altered vaginal microbiota has been demonstrated to affect parturition, its role in assisted reproductive technologies is uncertain.
Clinical findings suggest that routine screening for bacterial vaginosis in the hope of improving the success of IVF treatment is not justified. The prevention of complications in pregnancy associated with bacterial vaginosis might be a more relevant indication for screening at the time of IVF treatment, in particular patients with tubal disease, if treatment were shown to be effective for that particular purpose. However, antibiotic treatment before IVF has been shown to be positively disadvantageous for IVF by encouraging other organisms.

Sperm DNA testing UK

Posted on: by Susannah 1 Comment

Sperm DNA

Testing Sperm DNA damage  can help couples optimise diet and lifestyle for fertility. DNA fragmentation testing, The Tunel assay and sperm chromatin dispersion Halo test will be compared. Read on. At Susannah Makram Clinics we offer the best type of sperm DNA fragmentation testing  – a type of male fertility testing. At consultation we address the pros and cons of test so you can decide. Ask us how. 0207 060 3181

Couples – who benefits from a sperm DNA test?

Sperm DNA testing UK consultation . We provide essential information regrading lifestyle and our environment based on your health and fertility story so far. We outline what use of the test means for you and your partner. We can suggest which clinics guide couples to their bespoke treatment, for their particular needs. These include couples with:

  • Unexplained infertility
  • Men with normal semen by semen analysis (normal sperm count and sperm motility) prior to IVF
  • Couples who have had unsuccessful IVF 
  • Couple with no success using ICSI
  • Couples who have had miscarriages

Sperm DNA damage – Which Test?

The Comet assay – The SpermComet Test – Lewis Fertility testing at Susannah Makram Clinics

Extensive clinical trials and statistics that prove this test is the best indicator for, not only choosing the right treatment, but also to test when Sperm DNA Damage reversal IN THE FOUR PHASES is successful thus.

 

Sperm DNA testing Uk

All testing in and outside of the UK to measure sperm DNA damage are different. The Spermcomet test is described by Prof Lewis and was featured in Daily Mail recently. The current range of sperm DNA tests measure different aspects of DNA damage. The tests all have different sensitivities. The tests also provide information that may or may not provide couples with treatment advice.

The four tests most often used today are: 1) the Comet assay, 2) SCSA, 3) the terminal transferase dUTP nick end labeling (TUNEL) assay, and the 4) Sperm Chromatin Dispersion (SCD or Halo) test.

We want only the best for couple visiting our clinic for consultation. If we recommend the test we use data collected to actively reverse sperm DNA damage. this care pathway is unique for every couple at Susannah Makram Clinics. 

 

The Comet assay – The SpermComet Test

The comet assay is a second generation sperm DNA test. Unlike the other three tests, it quantifies the actual amount of DNA damage per sperm. Super DNSA testing UK – result guide can de found here.

One major advantage of this assay is that it uses only 5000 sperm. Therefore, it is suitable for the assessment of small samples left over from clinical use, or for samples where only a few sperm are available.

The Comet assay can measure both single and double strand breaks. With an additional step, the SpermComet can measure even altered bases.

This is useful because we do not yet know which types of DNA damage are most deleterious to male fertility.       [tweetthis]We do not yet know which types of #DNA damage are most deleterious to #malefertility. [/tweetthis]

The Comet is sensitive, repeatable and capable of detecting damage in every sperm. This is high sensitivity is evident of fertile donors. Since 2010, clinical thresholds for the diagnosis of male infertility and the prediction of successful IVF have been established.

At Susannah Makram Clinics we use The Comet Assay in our laboratory testing

 

The Sperm chromatin structure assay

The SCSA is a fluorescence cell sorter test which measures the susceptibility of sperm DNA to denaturation after exposure to heat or acid conditions.

The clinical threshold for this test is a DNA fragmentation index (DFI) of 30%- that means 30% of the sperm have damage (with quantification into moderate or high damage) and 70% have no detectable damage.

Couples with >30% damage are more likely to have success with ICSI than IVF

The TUNEL assay

The TUNEL assay detects ‘nicks’ (free ends of DNA) by incorporating fluorescent stained nucleotides. This allows the detection of single and double stranded damage.

The TUNEL has major potential but robust clinical thresholds have yet to be established.

The sperm chromatin dispersion (Halo) test

The Halo test is a ‘cheap and convenient’ kit form of sperm DNA testing. It is a simple and inexpensive assay, available in fertility labs for in house use.

Unlike all the other tests, the HALO measures the absence of damage, rather than the damaged DNA in sperm.

One limitation of the assay is that its low-density nucleoids are relatively faint, with less contrasting images.

To date, correlations have been observed between DNA and other sperm parameters. Few correlations between sperm DNA damage and ART outcomes have been established with the Halo test, even in large studies.

Sperm DNA Fragmentation Testing

Posted on: by Susannah

When IVF Fails
MORE THAN 60,000 IVF CYCLES take place in Britain each year. Just 24% of these treatments lead to live births. At Susannah Makram Clinics we’re here to use information highlighted below. This helps map out a care pathway centred around optimising your health.    [tweetthis]There are >60,000 #IVF cycles in Britain p.a. Only 24% of these lead to live #births[/tweetthis]

When IVF Fails

IVF Implantation Failure. Why does in vitro fertilisation sometimes fail?

When IVF fails it’s a frustrating situation for couples and their fertility doctors. Sperm DNA Fragmentation Testing results can help be a guide for couples.

Why do we do sperm DNA fragmentation testing at Susannah Makram Clinics London?
Email from client: “We have followed your instructions and the Aneuploidy test went down from 60% to 14% which is a very good result. I feel fine and have lost weight…” — Mr. R (Dubai)

Before booking your appointment with Nutrition Expert Susannah for referral we’ll help assess the need for Sperm Fragmentation Testing. This way you know what to expect when you book your appointment with Susannah. Will this data be helpful in your case, on your fertility journey? The extent of this is covered in your initial consultation when a full history taken.
We use this test at Susannah Makram Clinics London – with use of previous reports and investigations and your medical case history. When it comes to helping you make nutrition and lifestyle changes we answer: How will these benefit you and your partner?
The SpermComet Test for Sperm DNA Fragmentation Testing helps couples decide whether IVF is best first or again. Sperm DNA fragmentation reports guide couples to help them map out their fertility treatment route. At Susannah Makram Clinics we’re here to use this information to map out a care pathway centred around optimising your health.
There is an equation we can use to illustrate the implantation process:

  • Embryo quality + receptivity of uterine lining = chance for implantation and pregnancy
  • We know that many human embryos will arrest (die) before day 5
  • Unfortunately, embryonic arrest also occurs after day 5
  • Some of the embryos that are transferred that ” look good” will die after they are placed in the uterus
  • This is the explanation for IVF failure in the large majority of cases
  • It is usually a weakness in the embryo that leads to failed implantation
  • On the average, only about 25% of transferred embryos continue to develop and become kids
  • This percentage of implanting embryos is greatly dependent on female age – see below
    • About 45% implant under age 35
    • About 15% implant at age 40-42

When IVF fails, couples often ask why the embryos did not stick. When IVF fails we ask why the uterus isn’t accepting the embryos. Rarely is the answer straightforward, unfortunately.

At Susannah Makram Clinics we feel passionately about this. We care greatly that information is provided to patients at all times. Especially in this difficult time, so time is not wasted and that right treatment is offered. We care to avoid heartache.

Unexplained infertility

Unexplained infertility is a frustrating conclusion for couples. It’s a very unsatisfactory diagnosis for couples and clinic alike. In our latest study we have shown that 80% of couples diagnosed with idiopathic infertility have sperm DNA damage (>25% damage per sperm).

This suggests that sperm DNA damage is the cause of infertility in a substantial number of men if we compare these levels of damage we reported in sperm of donor men with proven fertility

When IVF Fails

When IVF Fails

Sperm DNA Fragmentation Testing

WE KNOW:

The percentage of implanting embryos is greatly dependent on female age. Typically female age is the main factor responsible for unexplained infertility. This is especially the case after repeated failure of  IVF cycles. Find out more about this in detail here.

Which couples benefit from a sperm DNA test?

Sperm DNA testing will provide essential information on which clinics can guide couples to bespoke treatment for their particular needs. These include couples with:

  • Unexplained infertility
  • Men with normal semen by semen analysis prior to embarking on IVF
  • Couples who have had unsuccessful IVF
  • Couples who have had miscarriages

Sperm DNA Fragmentation Testing

We are testing Sperm DNA damage so we may guide couples with low damage to intrauterine insemination (IUI) or in vitro fertilization (IVF). We are pro patient choice.

Sperm DNA Fragmentation Testing

Sperm DNA Fragmentation Testing

 

Guiding couples with high DNA damage to ICSI and only couples who would not benefit from testing are advisable but ultimately it is the couples’ choice. With oligo-astheno-terato-zoospermia there is no treatment other than ICSI for couples. It helps to understand what this means. That is why we take the time to explain all options available to couples following any fertility results.

At Susannah Makram Clinics we use the SpermComet Test for Sperm DNA fragmentation testing. Find out why here

15 Fertility Rate Facts To Know Now

Fertility Rate – 15  Facts  – What You Need to Know Now If You Ever Want Kids

It’s likely you’re unsure of your current fertility rate. Modern times are affecting our fertility rates. Our fertility rates are subject to changing trends and patterns. We know lifestyle choices during pregnancy affect the health of your baby. What about food, exercise and other lifestyle choices we’re making today? Do they affect our fertility rate, our potential future?

These are choices we are making today.

“15 Fertility Rate Facts To Know Now”

‘One in six couples has problems starting a family’       [tweetthis hidden_hashtags=”#fertility #pregnancy”]’One in six couples has problems starting a family’ [/tweetthis]

In a word, yes. Lifestyle factors can affect a woman’s chances of getting pregnant. This is by natural and assisted conception. It’s not just women, male partners affect chances of pregnancy too. Your fertility rate or your current fertility profile should enable you to face facts.

Why Fertility Rates Are On The Decline

Let’s get clued up now. Here’s why:

  1. One in six couples has difficulty having a baby – in 40 per cent of these cases the difficulty is associated with the man.         [tweetthis]In 40% of #infertility cases, the cause, for 1 in 6 couples, is associated with the man[/tweetthis]

Equal responsibility is about sharing knowledge and open communication. 

  1. Timing is just about everything when it comes to fertility –

In a normal cycle of 28 days, the woman ovulates normally on day 14 (14 days after the start of menstruation). The most fertile day would be on day 14 and the most fertile week is that which goes from day 11 to 17.

  1. The medical definition of infertility is the failure to conceive following twelve months of regular unprotected intercourse After this time your GP will refer you for:

A blood test to measure ovulation is required. The most common cause of ovulation problems is polycystic ovaries.

Chlamydia can cause pelvic inflammatory disease and fertility problems. So this might be tested for also (vaginal swab or urine test). Male sperm count and motility are measured at this stage from a sperm sample.

  1. Secondary infertility accounts for 60 percent of infertility cases – that is, when a couple has trouble conceiving after they’ve already had a baby or more — is more common than primary infertility, when first-timers have trouble.
  1. Women are at their most fertile between the ages of 20-24

There are both advantages and disadvantages to giving birth at different ages. Overall, being healthy parents puts you in good stead.

 

Female Infertility

15 Fertility Rate Facts To Know Now

  1. Female fertility begins to decline at age 30.

If you are over 40, you may want to start your quest for a second pregnancy with a fertility expert on hand. Similarly, if your partner is over 40, you may want to get a specialist on board from the beginning.

  1. Sperm DNA damage has been identified as a major contributor to male infertility        [tweetthis]Sperm DNA damage has been identified as a major contributor to male #infertility[/tweetthis]

The quality and quantity of the sperm diminishes from the age of 25. Damage to sperm DNA (sperm DNA fragmentation) affects every fertility checkpoint and can increase the risk of miscarriage.

The SpermComet assay is a second generation sperm DNA test. It is the ONLY test that can measure the extent of damage in individual sperm.

  1. Men Do Have a Biological Clock

Males can produce viable sperm — and father babies — well into their AARP years. However, older men are more likely to have fertility issues. Also, due to dipping testosterone levels, there is a decrease in quantity and quality of sperm. Sperm strength, motility and other factors.

Male Fertility Testing

Male Fertility Testing

 

  1. More than half of all pregnancies conceived through IVF in women over age forty are produced through donor eggs. Egg freezing or (new techniques like) vitrification is not a taboo subject any more.

 

  1. Female infertility is typically caused by one or more of these factors:

Damage to fallopian tubes (tubal infertility)
Endometriosis
Uterine or cervical causes
Ovulation disorders

 

  1. Success in assisted conception is dependent on the quality of the sperm and eggs

Egg quality falls with age. Hence, one of the strongest predictors of whether an IVF cycle will be successful is the age of the woman. A major cause of this is the development of chromosomal abnormalities in the egg as it matures, which can in turn be passed on to the embryo.

Genetic screening is available to help choose the best embryo(s) to replace and thus increase the pregnancy rate.

 

  1. Cough medicine can help you get pregnant, laptops and briefs can impair sperm production. Saliva is a sperm Killer & position doesn’t really matter. Common Chemicals Are Fertility Inhibitors

Expectorants loosen up mucus in your chest but they are also able to loosen up cervical mucus – if antihistamine-free. Looser cervical mucus is easier for sperm to hitch a ride in!

Not all bodily fluids get along. In fact saliva is a sperm killer. The truth is most lubricants and massage oils are fertility unfriendly. So it is best to go without when you are baby making.

Some studies have shown that the now-infamous Bisphenol A (BPA) can decrease fertility in women. Perfluoronated chemicals (PFCs), used in Teflon, have also been shown to affect the menstrual cycle.

15 Fertility Rate Facts To Know Now Continued…

  1. Both Prescription & Recreational Drugs affect fertility as does smoking cigarettes

Some antidepressants (like SSRI’s) can raise a woman’s serum prolactin level. This can interfere with normal ovulation. Even certain antiemetic (anti-nausea) medications can alter prolactin levels.

Using any drugs, even cannabis, can affect the menstrual cycle. Heavier drugs like opiates have been shown to suppress the reproductive cycle. They affect the centers of the brain that control release of the female hormones.

Smoking cigarettes – even secondhand smoke – has been shown to reduce fertility time and time again.

 

When IVF Fails

When IVF Fails

 

  1. An Unhealthy body weight may prevent you from having children

Being overweight, obese or underweight can have negative consequences for one’s ability to conceive. This is because obesity can interfere with normal hormone function and fertility. The only treatment available to successfully reverse sperm DNA damage is largely dependent on two things. These are nutrition and nutritional supplementation.

  1. Fertility is a sensitive subject for a reason and there are support groups. Fertility and therapeutic counselling is also available for couples trying to conceive naturally. These are also there for individuals and couples using assisted fertility methods.

15 Fertility Rate Facts To Know Now

Susannah understands that when a couple hears a diagnosis of  ‘unexplained infertility’ it’s incredibly frustrating. When natural conception or assisted reproductive fertility treatment haven’t been successful, it’s difficult to hear. The most common assisted fertility treatment is IVF.  We put together 15 fertility rate facts to know now because you want to understand what the next steps are. You want to move forward from this, when ready. You should be able to discuss these steps and come to a decision together.

Nutrition impacts 80% of your modern lifestyle. This impacts every single factor affecting fertility. This goes for both men and women. If you  take ownership of your health you can make sure that the right changes impact you and your partner for the best.

 

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