Sperm Chromatin Structure Assay
The sperm chromatin structure assay test (SCSA) is a test for sperm DNA fragmentation. Theoretically, men should have little or low levels of DNA fragmentation. We, now, realize that there is some degree of fragmentation in all sperm, but some men have high levels of DNA fragmentation (>30%). High levels of DNA fragmentation may lead to poor embryo quality, blastocyst rate, a lower pregnancy rate and a higher miscarriage rate.
A routine semen analysis is needed for basic information regarding sperm count, motility and morphology; it does not identify information about the genetic package (DNA) that the sperm is carrying. SCSA testing is the only way to identify potential problems about DNA fragmentation.
In our experience, men with high DNA fragmentation have a similar fertilization rate compared to men with lower fragmentation. However, pregnancy rates are significantly lower when DNA fragmentation is >30%. In other words, the quality of the sperm and it’s genetic package is more important than the sperm count or motility.
We offer sperm chromatin structure assay testing for all men prior to embarking on their fertility treatment. It has been extremely useful for many couples with
”unexplained” infertility, and may give insight for many couples with previous IVF and ICSI failures.
The DNA fragmentation rate can be used as a predictive tool for reproductive outcome based on the male factor perspective. If the fragmentation rate is low, we have high confidence that the male factor is normal. Knowledge of DNA fragmentation can be used to clarify problems when subsequent embryo or blastocyst development is poor.
We have no way of repairing a high DNA fragmentation rate. Many factors, including medical conditions, smoking, drug or alcohol abuse, environmental exposures to chemicals or toxins, viruses and previous illness, may all lead to high DNA fragmentation. At the Markham Fertility Centre, we have numerous pregnancies that have resulted from men with high DNA fragmentation (>30%). Although pregnancy rates are lower with increasing levels of DNA fragmentation, pregnancies are still possible. This may, in part, be explained by our belief in blastocyst transfer, thus, allowing our embryologists to select a couple’s best embryos on the 5th day of embryo culture.
We have numerous couples, that have suffered years of infertility, that have opted for donor sperm as a treatment option (once a high DNA fragmentation level has been identified) and have achieved a pregnancy within 1-3 cycles.
Hysterosalpingogram (HSG), Sono-Hysterosalpingogram, 3-D Ultrasound and Hysteroscopy
There are 3 basic factors required for a couple to achieve a pregnancy:
Normal, healthy sperm and DNA fragmentation
Normal, healthy oocyte (egg) quality
An anatomically normal uterus for implantation to occur
In our experience, the uterine factor for infertility is, often, over-looked. Failure of implantation may be a very difficult problem to correct, and for some, there appears to be no apparent reason preventing pregnancy. However, there are several conditions, that are correctable, that may interfere with embryo implantation. Hysterosalpingogram (HSG), sono-hysterosalpingogram, and 3-D ultrasound are out-patient diagnostic tests used to study the shape and contour of the uterine cavity. Hysteroscopy is a minor surgical procedure (either in-office with sedation or an out-patient procedure done in the hospital setting) that allows direct visualization of the uterine cavity.
All of these tests are used to identify factors that can prevent an embryo from implanting, such as uterine fibroids, polyps, a uterine septum or scar tissue from a previous surgical procedure. Many women that have been mistakenly diagnosed with a bicornuate uterus, (heart-shaped uterus) when they actually have a uterine septum.