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Dr. Andrew Rynne

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What does this SA and DFI report regarding IUI indicate?

Answered by
Dr. Mahesh Koregol

Infertility Specialist

Practicing since :2000

Answered : 3768 Questions

Posted on Wed, 13 Aug 2014 in Infertility Problem
Question: Hello Doctor,
I am 33yrs old weighing 91kgs and planning for an IUI. I got my SA & DFI report with following details (result based on first sample):
DNA Fragmentation Index (DFI) : 58%
- Sperm Conc: 13mill/ml
- Sperm Motility : 16% (Slow progressive 14% & non progressive 2%)
- Morphology : Normal forms 2%
- Ultrasonography of scrotum suggests 'Bilateral Vericocele'. Dilated veins measuring upto 2.4mm on right side & 2.6mm on left side and show reflux on valsalva.

Q1: What is the grade & how severe is the Vericocele? Would a corrective surgery improve the SA & DFI parameters?

I am under medication (Cerenos & Paternia) to improve above parameters.

Q2: Can we go for an IUI this cycle? Is there possibility of undesirable results like early miscarriage or abnormality if IUI leads to pregnancy? The chances are very low for success as I understand but my Doc is optimistic to give it a try. My wife is under Clomid this cycle (administered for follicular study) and has 1 mature follicle.

Please advice what should be our next steps, can DNA fragmentation & Sperm paraleters be corrected with any medication/surgery for Vericocele correction?
Answered by Dr. Mahesh Koregol 54 minutes later
Brief Answer:

Detailed Answer:

I read your query and I understand your concerns.

Following is my reply

1. This appears to be moderate varicocele. The surgery is not necessary as it may not improve SA parameters or DFI.

2. No use of IUI in such poor semen parameters. It will not work probably with such poor sperm.

3. The chances of pregnancy are very less. Even if there is pregnancy the chances of pregnancy exists.

4. The medicines may not improve the parameters of semen.

5. Next cycle I suggest you go for ICSI ( Intracytoplasmic sperm injection) considering your age and semen parameters. Not to waste more time on IUI.

Let me know if you have any more questions.

Dr. Mahesh Koregol
IVF and infertility Specialist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Mahesh Koregol 26 hours later
Thanks Doctor for answering our queries, I am clear on not going for IUI.

- Another thing I missed to include was at the time of SA I did blood test for few parameters:

- FSH               : 5.2 mIU/ml
- LH               : 5.6 mIU/ml
- Serum Prolactin      : 9.8 ng/mL
- E2               : 23pg/mL
- Serum Testesterone     : 2.410 ng/ml
- Serum FREE Testesterone : 53.1 pg/ml

Serum Testesterone levels were below the prescribed range of [2.8 - 11.0]

- Can you suggest 2 or 3 trusted places where I can get SA + DFI test done in XXXXXXX This is to eliminate any aberration in results.

- Is there no remote chance of SA/DFI improvement by Vericocele correction or Testesterone level improvement?

- Is it possible to improve the DFI index by supplements or targeted diet (with required nutrients like zinc etc..)

- I am asking this because even for ICSI the selected Sperm may be motile & morphologicaly good but the DNA characteristics may not be checked.

- If a Sperm with poor DNA is picked for ICSI are there chances of unsuccessful or unhealthy child birth.
- Is there a relation of healthy sperm (motile & good morphology) with DNA i.e., will DNA be intact in a healthy sperm?

Thanks in advance.
Answered by Dr. Mahesh Koregol 27 minutes later
Brief Answer:

Detailed Answer:

1. Your DNA fragmentation index will be high as your sperm count is low and unhealthy.

2. They correlate and report seem to be right. So no need to repeat.

3. Such semen picture results in poor embryo quality as you suspect.

4. But there are methods like PGD to check embryo DNA integrity before embryo transfer during ICSI cycle.

5. If you are in XXXXXXX come to XXXXXXX IVI Fertility at Sadashivanagar near mekhri circle between 2 to 6 PM do that I can examine you.

Dr. Mahesh Koregol
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Mahesh Koregol 3 days later

Thanks for your response.

After 3 weeks of being on medication (Cernos & Paternia) I repeated the Testosterone & Semen analysis yesterday. To my XXXXXXX the results were worse compared to 3 weeks earlier report which was without any medication.

- Testosterone :~1.4 ng/ml (3 weeks earlier it was 2.410 ng/ml)
- DFI : 55% (3 weeks earlier was 58% - Improved)
- Sperm Conc : 5mil/ml (3 weeks earlier 13mill/ml)
- Sperm Motility : 10% (3 weeks earlier 16%)
- Morphology : 2% Normal forms (Same)

Can you help me understand why this drop in parameters even after medication.
I had also taken 2 injections shots as well (1 HCG & another also for Testosterone). Seems like lower testosterone levels correlate with lower SA parameters.
Answered by Dr. Mahesh Koregol 7 hours later
Brief Answer:
Semen analysis

Detailed Answer:

That is what I had told you earlier.

These medicines are of little value. Wont make really much difference.

Your semen parameters vary in a range from one to 20 million per ml. Same with DFI.

Whatever you do its a bad report. Count variations by 10 million is negligible in your case.

Better go for ICSI soon before it worsens further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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