male varicoceles

Varicoceles are a collection of varicose veins around the testes much more commonly on the left and are present in between 4 and 22% of all men. However if men with primary infertility are examined then between 21 and 41% have varicoceles and men with secondary infertility have an even higher incidence. Varicoceles may run in families and may  worsen with time.
The association between varicocele and male infertility has been hotly debated for the last 50 years. Recently the world of science has  changed its view and is now saying that repair of a varicocele which is of moderate to large size is a useful exercise in men with fertility issues.The choice of repair either surgical or radiological is also up for debate.
Varicoceles are thought to impact on sperm health by increasing the temperature of the testes. The increased pressure in the veins may cause reflux of toxic adrenal and renal metabolites into the testes along with  chronic vasoconstriction of arterioles. This  leads to  under perfusion, stasis and hypoxia, and subsequent dysfunction of the spermatic epithelium . There is also evidence that DNA damage to the sperm is higher in men with varicoceles and that this reduces after ligation.
So what does this all mean? Men should be examined for the presence of varicoceles particularly when their semen analysis is abnormal or their DNA fragmentation level is raised.

Selecting Great Sperm

We are excited to be getting a technology called IMSI up and running in the next few weeks. IMSI stands for Intracytoplasmic Morphologicall Selected Sperm Injection. In an normal ICSI cycle the embryologist selects the sperm for injection at a magnification of 400x however IMSI is where sophisticated optics allows a magnification of 7000 to 8000x therefore enabling a much better look inside the sperm to select sperm without vacuoles within the nucleus. A recent meta analysis suggested that both implantation and pregnancy rates may be improved over conventional ICSI by 2 to 3 times with reduced miscarriage rates.
As yet it is not clear who may benefit from this technique possibly men with 2 previous failed ICSI cycles, poor embryo quality or poor sperm morphology or high levels of DNA fragmentation. The technique is time consumptive for the lab staff and will add about another $750 of cost.
We expect to offer IMSI by mid July and will announce its introduction on our website. It will be available initially through our Auckland Clinic only.

What to eat during an IVF cycle

I had always assumed that women knew what was a healthy diet and that they followed the general principles when going through an IVF cycle because they knew this would increase their chances of conceiving and also that their child would have improved lifelong health outcomes. However recent work has shown that women often eat poorly during their IVF treatment with many not having enough folic acid, iodine, carbohydrate or protein in their diet, with many still consuming caffeine and alcohol along with too much fat, salt and convenience foodc.
So this is a blog about what women should be eating when doing IVF treatment. Firstly, adequate folic acid supplementation which means 0.8mg daily and if a woman has a BMI above 30 then she should be taking 5 mg folic acid. The folic acid story is really confusing as many of the pregnancy supplements don't have the correct dose. The next absolute is to remove caffeine and alcohol from the diet, caffeine can be difficult as is present in a number of beverages not just coffee, such as tea, green tea, chocolate. coke and energy drinks. The NZ Ministry of Health Guidelines suggest women who are pregnant should be eating 6 serves of fruit and vegetables, two servings of lean protein, six servings of bread and cereals (preferably wholegrain), three servings of dairy (low fat yoghurt, trim milk), drink plenty of fluids, choose and prepare foods low in fat, salt and sugar. Here are the  Ministry of Health Guidelines . So eat well!

Birth Defects and IVF

There has just been an article published in the New England Journal of Medicine concerning this issue which is why I thought the subject deserved a blog. This paper showed an association between babies born from assisted reproductive technologies having a slightly increased risk of birth defects. What was important about this study is that it also looked at couples who had fertility issues but who managed to conceive spontaneously. This is valuable as we all want to know is this observed association due to the drugs and the lab processes involved in an IVF programme or is it due to the possibly suboptimal sperm and eggs which are causing a couple's infertility. This new study showed a similar increase in birth defects in couples with infertility who then conceived without treatment. This is a new finding.
They also found that the increase in birth defects was in children born after ICSI but not IVF. Children born from frozen and then thawed embryos showed no increase in birth defects even when they were from ICSI cycles. Possible explanations for this include a reduced chance of a suboptimal embryo surviving the thawing process or the absence of ovarian stimulating drugs.
It is really important that all people going through fertility treatments are aware of these findings and can make real informed decisions about their options going forward.

IVM or IVF without drugs

We are excited to start In Vitro Maturation at Fertility Associates. This is a technique in which immature eggs are removed from the ovaries and matured in the lab, injected with sperm and the resulting embryos replaced in the uterus. The technique is  best suited for women with polycystic ovaries who have difficulties with standard stimulation drugs. It means that women do not have to use the hormone injections or risk ovarian hyperstimulation syndrome.
It has been around for a while but pregnancy rates have been modest so not many IVF units have been interested in pursuing IVM. There have been improvements in culture processes in the lab and a better understanding of physiology mean that pregnancy rates have looked better.This is why we were keen to get started with IVM.
We don't know yet about the results of the first cycle but are are delighted to be continuing our history of firsts in NZ with reproductive technologies.
If you'd like to know more about IVM, please email Fertility Associates on info@fertilityassociates.co.nz

Ureaplasma and Miscarriage

Two studies have suggested that a male infection with ureaplasma may increase the risk of miscarriage after ICSI treatment. Ureaplasma is a bacteria which may grow in the reproductive tract. It is notoriously difficult to grow in the lab and so is seldom tested. There are no symptoms. We performed a study looking at how common ureaplasma was in our population. We asked all men having a semen analysis if they were happy to be tested for this.18% of men were positive. The study was tricky to do as we needed to taxi the samples to the lab immediately.
At Fertility Associates we have decided to ask all couples starting IVF to take a single dose of azithromycin (an antibiotic) as a precautionary measure. Many IVF clinics world-wide give prophylactic antibiotics to the man and woman prior to IVF treatment, so the concept is not new.  Although ureaplasma may impact more on the outcome of an ICSI cycle, we decided to treat all people doing IVF as well, as there are some circumstances when ICSI may be required because of sperm quality on the day of egg collection.
Read more about Ureaplasma and Azithromycin in our Fertility Facts sheets here