Do you really need ICSI?

ICSI (intracytoplasmic sperm injection) is a successful treatment when there are male fertility problems, but it is often used more widely in fertility clinics – and some offer ICSI to many patients where there is no male factor problem at all. Now, new research presented at ESHRE (the European Society of Human Reproduction and Embryology) shows that there is no benefit to offering ICSI unless there is a male fertility issue.

ICSI was developed in the 1990s as a breakthrough treatment for men who would otherwise have had to use donor sperm to become a parent, but now it is used so often that twice as many ICSI cycles are carried out around the world as IVF cycles. In some countries all assisted conception cycles are ICSI.

This large study of almost 5000 patients in Belgium and Spain being treated with ICSI or IVF found there was no benefit to using ICSI where there was no male fertility problem. The results of the study were presented by Dr Panagiotis Drakapoulos from UZ Brussels, the Belgian centre where ICSI was developed more than 25 years ago. The study was a collaboration between the Brussels centre and 14 clinics in Spain.

The reason given for using ICSI is often that it is thought it results in a higher chance of fertilisation and more embryos, but this large study showed no overall difference in outcome using IVF or ICSI regardless of whether the female patients had large numbers of eggs (more than 15) or not so many (1-3) – so there is no rationale for using it to try to improve outcomes in cycles where there are just a few eggs.

The use of ICSI varies around the world, with the highest rates in many countries of Eastern and Mediterranean Europe. There is a slightly lower use in some Nordic countries, the UK and France. In its latest review of treatment trends in the UK, the HFEA reported that ICSI use ‘continued to increase until 2014, but it is now in decline, possibly due to clinical opinion that it’s not needed in all contexts of IVF’. 

This reflects the message from this study, which, according to Dr Drakapoulos, found ‘no justification for the use of ICSI in non-male factor infertility’. He added that the number of eggs retrieved ‘should not play any role in selecting the insemination method’. Dr Drakapoulos also highlighted the extra financial cost of ICSI over IVF.

Men have a biological clock too

We’re all very aware of the female biological clock, but what we don’t hear so so much about is the fact that male sperm counts decline and DNA damage in sperm cells may increase as men get over. The fact that some high-profile men have become fathers when they are pensioners perpetuates the myth that male fertility lasts forever.

In fact, evidence shows men do have a biological clock with a decline in natural male fertility and an increase in the miscarriage rate as men get older. New evidence at ESHRE from one London fertility clinic shows that IVF/ICSI is less likely to succeed if a male partner is over 51 too.

Dr Guy Morris from the Centre for Reproductive and Genetic Health (CRGH) in London presented results at the ESHRE (European Society of Human Reproduction and Embryology) conference of an analysis of more than 5000 IVF/ICSI cycles which found that although there was no difference in miscarriage rates, there was a significant reduction in the chances of success

The results showed that that clinical pregnancy rate declined as men got older – from 49.9% when men were under 35, to 42.5% for men aged 36-40, 35.2% for those aged 41-45, 32.8% for those aged 46-50, and 30.5% in the over 51s.

The researchers also noted that 80% of couples where the male partners were over 51 were treated with ICSI, a treatment developed for male infertility. Dr Morris said: ‘There may well be a public perception that male fertility is independent of age. Stories of celebrity men fathering children into their 60s may give a skewed perspective on the potential risks of delaying fatherhood. Indeed, in natural conception and pregnancy it is only recently that evidence of risks associated with later fatherhood has become available. These more recent studies contrast with decades of evidence of the impact that maternal age has on fertility outcomes. In the context of this emerging evidence for the deleterious effect of increasing paternal age, our data certainly support the importance of educating men about their fertility and the risks of delaying fatherhood.’ 

Seasonal sperm

New research from the United States has found that men produce better sperm in the spring and autumn, although the reasons for this remain unclear. A big study analysed sperm samples from more than 29,000 men over a period of 17 years, and found that there were more moving sperm in the spring and more normally-shaped sperm in the autumn.

The researchers, from Icahn School of Medicine in Mount Sinai in New York presented their research at the annual conference of the American Society for Reproductive Medicine in Denver. They have suggested that the milder weather might have something to do with this as the sperm will stay cool but men are likely to be more physically active and that they may be less likely to be drinking too much alcohol than in the summer or at Christmas. As it takes three months to produce sperm, it is not entirely clear what the causes may be – but the researchers make it clear that more research is needed to be able to confirm that their findings would have an impact on the chances of a successful pregnancy at different times of year.

Let’s talk about men

There have been a number of reports in the media recently about a decline in male fertility so alarming that it “could make humans extinct”   after a study suggested that sperm counts seemed to have halved in the last forty years. The study found a decline in men in North America, Europe, Australia, and New Zealand, but it isn’t clear why this might be happening.

Other experts have suggested that there may be room for some scepticism about the findings from the research team led by Dr Hagai Levine at the Hebrew University of Jerusalem. Although the research is said to be of high quality, some are concerned that it may be too early to be quite so pessimistic about the future, but it is clear that this is an issue which we should be concerned about and looking into more closely.

What often gets forgotten in the discussion about male fertility and sperm counts is the emotional impact for men of dealing with this – and you may be interested in this article with interviews from a number of men about how their experiences of infertility.

Final call for male participants – involuntary childlessness research

Some of you may remember that we have been supporting a researcher, Megumi Fieldsend, in her search for participants for her work on involuntary childlessness. Megumi is now putting out a final call for men who might be willing to help her study on  “life without children – lived experience of a man who wanted to be a dad”. She is aiming to carry out her final interviews by the end of July so if you know someone who might be a potential participant, could you ask him if he would be interested in taking part in Megumi’s research project?

There are set criteria for participation, and if you have any questions about the study or want to check about the criteria, please do get in touch with Megumi who will be happy to answer any questions. You can contact her by calling 0778 026 3685 or by emailing her at
megfieldsend@gmail.com

Men wanted to answer survey on fertility

Men can often feel rather left out when it comes to fertility treatment – and the support available to couples can often seem very female-focused. Now, a team from Leeds Beckett University have partnered with Fertility Network UK to try to find out more about men’s experiences of fertility problems. They believe not enough is known about how men cope with fertility issues and will use the results of the research to help to raise awareness of men’s needs.

They will also produce a report at the end of the study and present the findings to health care professionals to ensure that the male perspective is taken into consideration in fertility clinics and in fertility counselling settings.

This survey is completely anonymous so please do fill it in – or get your partner to – and ensure that the researchers get a good response and can start to encourage changes in the support for men during treatment.

You can find the survey here 

Are you going to bed too late?

Could your sleep patterns be affecting your sperm count? New research from China has found that going to bed after midnight along with sleeping much less or much more than average seems to have an impact on sperm.

The research team looked at more than nine hundred men who had regular sleep patterns and divided them into groups who were all given different sleep durations and bedtimes. They then carried out semen analyses over a period of six months, and found that those who were having the shortest sleep had lower sperm counts and lower motility.  They also found that those who went to bed after midnight had lower sperm counts regardless of how long they then slept for.

So, if you are trying to conceive, it’s certainly worth ensuring you get to bed before midnight – and that you don’t get too little or too much sleep. You can find the full paper from the team at China’s Harbin Medical University, which was published in the Medical Science Monitor, here 

Male fertility evening

It is often noted that there’s a lack of support for men going through fertility problems and it is certainly true that much of the help on offer is aimed primarily at women. Now, for the first time, one London clinic is offering tailored support for men.

Andrology Solutions is running a male fertility evening on February 16th with a guest speaker, Gareth Down, and a team of andrologists at hand to answer any male fertility questions. You can find out more here.

Life without children for men

Researcher Megumi Fieldsend who has carried out previous work looking at childlessness is working on a new project  “Life without children – lived experience of a man who wanted to be a dad”. She would like to talk to childless men who are in heterosexual relationships with no adopted children, step-children or children of a partner from a previous marriage/relationship and she would like to carry out interviews as soon as possible. There are some other criteria which Megumi can discuss with anyone who might be interested, If you, or anyone you know, falls into this category and might be willing to talk to Megumi for her research project you can contact her at megfieldsend@gmail.com

National Fertility Awareness Week starts on Monday

955banner-1

 

 

National Fertility Awareness Week starts on Monday 31st October and runs through to Sunday 6th November 2016. It is your week and you can help Fertility Network UK to raise awareness during the week.

Fertility issues are all too often misrepresented and misunderstood. It’s common for media attention to be focused on stereotypes of fertility struggles: the 30 – or 40 – something career woman who’s left it too late; the against-the-odds IVF success story or the woman who’s apparently easily come to terms with childlessness – but this is far from the real picture.

During National Fertility Awareness Week, Fertility Network UK aims to highlight the unseen, intimate and day-to-day reality of fertility issues, to overturn commonly-held misconceptions about fertility and to shine a spotlight on untold fertility stories.

In the UK, 1 in 6 couples experience the pain fertility issues bring. Even if you don’t have direct experience, you probably know someone who does – a family member, friend or work colleague. We hope people will join in, raise funds and help change perceptions about fertility issues.’

The five focus areas for this year’s media campaign are:

  • The myth of the middle-aged would-be-mum: fertility issues in your 20s and early 30s
  • The truth about fertility treatment: we know that 75% of individual IVF cycles are unsuccessful and that most people who become parents after treatment go through more than one cycle. What is it like to face multiple rounds of treatment?
  • The hidden half: men are just as likely as women to suffer from fertility issues
  • Facing up to childlessness: coming to terms with childlessness is too often portrayed as a straightforward process when the reality is far from that
  • Life after successful IVF: the taboo of secondary infertility and can life as the parent of an IVF miracle ever be normal?

You can find out more about how to get involved at the National Fertility Awareness Week website and on Twitter with the hashtags #NFAWUK #HiddenFaces #fertilityin5