Dear Professor Winston,

I am 31, with anovulatory PCOS (thin) and my husband is 32 with excellent sperm count (morphology & motility) but recently diagnosed with 50% DNA Fragmentation (we think due to a Lysosomal genetic condition he has). We have a 4 year old daughter who was conceived naturally immediately following Ovarian Diathermy. Since 2013 we have done 7 x ovulation induction cycles which were negative. We have done 1x IVF antagonist without ICSI and had nothing fertilise. We then did 2x IVF Long protocol with ICSI and PICSI and got pregnant both times, but both times the embryo stopped developing at 7 weeks (after previously seeing a heartbeat). Should I be concerned that I have had two similar miscarriages? Is this indicative of bad quality embryos? Is it a direct cause of the DNA Fragmentation? Do we have any hope of holding a baby to term based on these facts? What should our next move be? Realistically should we be considering donor sperm? Yours sincerely, M


Dear M,

I would have thought you have every chance of another successful pregnancy. Just bear in mind, as I keep on repeating, that humans only have around 20% chance of a single embryo developing, growing normally and implanting without miscarriage in each cycle. Unfortunately, people undergoing IVF like to (understandably) believe that the chance is greater than it is so often start to grasp at unproven treatments. The DNA fragmentation may indicate a higher than average number of abnormal sperm with the risk of abnormal fertilisation which could easily explain the miscarriages. But In your case you seem to be on exactly the right lines and, given your history of a previous successful pregnancy in addition to another pregnancy, I think you have an excellent chance of success eventually. I think I would be rather reluctant to consider donor sperm at this stage but I would certainly advise you to stay with the team treating you who I think are getting things right.

Best wishes
Robert Winston

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