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Infertility treatment, kidney failure, intracytoplasmic sperm injection, success rate of IVF

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My name is XXXXXXX I live in Australia. My husband and I are undergoing infertility treatment and so far haven’t been given many answers.

My husband (34yrs) had a renal transplant 11 years ago, and has been diagnosed with oligoasthenoteratozoospermia. 86% of his sperm were immotile, 7% non-progressive, 7% Slow progressive, Nil rapid progressive. Morphology is at 1%. Vitality n/a%. He is on immunosupressants and results come back normal. We have been trying to conceive for 3 years. He has previously naturally fathered a healthy child (although seeking DNA testing) 6 years ago. I am 27 years old and am healthy. We did our first round of IVF with ICSI last month, and achieved a pregnancy but the embryo has just rejected after a few weeks. I have no family history of infertility or miscarriage and have a feeling this could be due to my husband’s medical condition? Due to my age, my fertility clinic will only implant 1 embryo at a time. Given my husband’s transplant, and his diagnosis, do you know whether his health is a major factor in achieving a pregnancy with IVF/ICSI? Does his condition and medications affect the strength of an embryo and its ability to survive once transplanted? If after a second transfer, the same thing were to happen again, do you think implanting more than one embryo would increase our chances of success? Do you know of any tests that can be done to check the health of his sperm? My husband is also a regular drinker – not to excess but on a regular basis – could this also affect the health of his sperm and the strength of an embryo?

I should add; my husband’s renal transplant doctor is adamant that his transplant and medication has nothing to do with his fertility issues, as all his other patients have fathered children without a problem. He says he’s never heard of this happening.

Our fertility doctor says she is suspicious of his medication and that may be causing the problem and spontaneously fathering a child was probably just ‘one of those things’. But the only way we could achieve a pregnancy is through IVF/ICSI. After consulting with my husband’s transplant doctor she says perhaps that’s just the way my husband is and he has always had this problem.

Thank you very much, I appreciate a response or any advice, but if you can’t respond, I understand.
Sat, 6 Oct 2012 in Infertility Problem
Answered by Dr. Deepak Anvekar 9 hours later

Thanks for your query.

Patient's with end-organ failure (eg. kidney failure) experience hypothalamic-pituitary-gonadal dysfunction and delayed sperm maturation. But usually Gonadal dysfunction resolves by 6 months after successful renal transplantation which is followed by fertility returning to normal.

Post-transplant medications do not significantly influence human germ cell function. Case reports suggest unimpaired fertility in patients with autoimmune diseases ingesting corticosteroids and/or azathioprine.

Since it is already 11 years since your husband's transplant, and all his tests have been normal so far, there is nothing that I see preventing future IVF methods to succeed.

Having said that, it is also not uncommon that couples undergoing IVF, requiring multiple attempts for successful conception and parenthood. Since you are still young, future attempts after proper preparation have a very high chances of success. In addition if feasible (that will be decided by your doctors) implantation of multiple embryos will definitely help to increase the chances of a successful pregnancy

There are no tests that can evaluate the health of a individual sperm.

Since the semen analysis has shown sperms with only 1 % normal sperms, proper selection of sperms and Intracytoplasmic Sperm Injection will be the key to have a embryo that will have a normal implantation and development.

IVF with ICSI success rates vary according to the specifics of the individual case, the ICSI technique used, the skill of the individual performing the procedure, the overall quality of the laboratory, the quality of the eggs, and the embryo transfer skills of the infertility specialist physician. Of these, the main determinant of IVF success is the quality of the embryos. The quality of the eggs is a crucial factor determining quality and viability of embryos.

With time and proper techniques used, you should be able to conceive.

Hope I have answered your query. If you have any more queries, I will be available to answer them as well.

I wish you success.

Best Regards
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