Recurrent IVF Failure
There can be several possible reasons for a couple to fail multiple cycles of IVF, including functional sperm problems, functional egg problems, a combination of sperm and egg problems, and plain bad luck with earlier cycles.
In the absence of a good explanation for multiple IVF failures, further advanced testing of the couple is an option, to see if there are any reversible factors that may indicate ways to increase the chances of success with subsequent IVF cycles. Since a woman’s eggs are inaccessible to direct testing, interest has focused on the testing of sperm to look for any functional abnormalities that may be contributing to a couple’s infertility problems. Sperm functional contributions are especially suspect when the problem during the IVF cycle seems to be poor embryo progression or quality, since sperm quality usually has the greatest impact on IVF/ICSI outcomes during embryo development. In IVF, the first phase of sperm/egg interaction is fertilization, where the sperm and egg fuse to form an embryo. Normal fertilization rates are generally thought to be in the 70–75 percent range. Fertilization is primarily under the control of the egg’s genetic material, although the sperm does make a few minor contributions. Therefore, problems with egg fertilization, such as poor fertilization rates, are usually thought to be more related to either egg issues or simple bad luck.
Following fertilization, the embryo begins to rapidly divide in a process called embryo development. The male genetic material seems to play a much more important role in embryo development starting at the eight-cell stage. Therefore, if a couple has had several failed cycles of IVF, the timing of when problems appeared can offer clues about whether sperm DNA factors may be playing a role. If poor fertilization (that is, low fertilization rates) is the primary problem, then it is less likely that the sperm DNA is a contributing factor, although this cannot be concluded with 100 percent certainty. If, however, fertilization rates have been good but embryo progression or quality has been the primary problem, this suggests that poor sperm DNA quality may be playing a role.
Abnormalities in sperm DNA fragmentation can sometimes be improved with interventions in the Sperm Boot Camp. Please see the "Advanced Sperm Testing" section for more detailed information on sperm DNA fragmentation.