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Updated: Sep 19, 2021


Recently, embryologists and successful IVF patients alike, celebrated world embryologist day. The birth of Louise Brown on the 25th of July more than four decades ago stood as a living testament to the success of the in vitro fertilisation process and with it a new avenue for would be parents struggling with infertility was born. If you haven’t already had some exposure to infertility or had to deal it yourself, it is quite likely that you will come across it, either through a friend, a family member, or even a co-worker. Roughly 1 in every 6 couples struggle with some form of infertility. 1 in every 6!


Think about it, statistically speaking it is very likely you already know someone who is having trouble getting pregnant. Now, while the onus of infertility has historically fallen on women, this is not actually the case! What you might not know is that in fact over 30% of the time infertility is solely caused by a male factor and about 55% of the time is a combination of both male and female factors. Having healthy sperm cells is essential to not just a portion but all IVF procedures. Yet while IVF has resulted in over 8 million births over the last 40 years, we have to ask, can we feel confident that infertility treatments are improving? The answer is yes, absolutely! There are many wonderful research centres and clinicians working tirelessly to improve the outcomes for fertility patients. But unfortunately, it may not be improving as quickly as you might think and is more focused in some areas of treatment than others; Particularly when it comes to male infertility and sperm.


While many aspects of IVF are undergoing technological improvements that can benefit patient outcomes such as the advent of artificial intelligence and time lapse photography (for embryos), the overall success for IVF treatments has stagnated to roughly 33% per treatment (cycle) (where an embryo is implanted) over the last 10 years (Nosrati et al., 2017). In Australia, 23.2% of (all) cycles resulted in a clinical pregnancy and just 18.4% (15,475) in a live birth, while the overall clinical pregnancy rate for cycles reaching embryo transfer was 34.4%(UNSW, 2020). Which begs the question, have we hit the peak or are there other aspects of IVF that we should be focusing on?

Science follows trends like many other things, and during our investigations into IVF technology we found that while female fertility potential has been the subject of much research, sperm selection (an essential part of IVF) and cryopreservation technology has remained fundamentally unchanged since the birth of Louise Brown over 4 decades ago. Studies have shown that gold standard techniques for sperm selection such as density gradient centrifugation, apply huge mechanical forces that can damage the DNA of sperm cells (Muratori et al., 2019; Nosrati et al., 2017), and that having sperm with lots of DNA damage more than doubles the chance of miscarriage (Borges et al., 2019). Where fertility preservation is concerned, approximately 40% of sperm on average suffer cryodamage in the form of death, motility loss or DNA damage.




The takeaway? We need to take better care of our sperm! Both in the clinics and at home, if we want to maintain our fertility potential. First of all, there is a lot we can do to improve our fertility at home that a lot of men don’t even consider and are often surprised about. The term being “getting fit for pregnancy” which has been wonderfully elaborated upon by Professor David Gardner where he explains the idea that many of our lifestyle choices impact the quality of our gametes (sperm and eggs), and we should really be thinking in advance about preparing them before we start trying to conceive by changing our diets, managing our stress, sleep and not smoking among other things. My vice is the exorbitant amount of coffee I consume a day. However, as far as IVF technology is progressing, I have been pleasantly surprised to find there was a general acceptance that more attention needs to be paid to sperm processing and the male side of IVF technology. And it’s not only the clinics, several research groups and startups (such as Warkiani Lab, AMB Labs and Microgenesis) are developing technologies for sperm preparation and are making the transition into clinics. The largest hurdle lies in the adoption of these new technologies, and their optimisation to benefit the IVF workflow and ultimately clinical results through collaborative engagements. Many clinics are (understandably) hesitant to change their existing procedures for fear of negatively impacting their success rates, affording only incremental changes largely seen in methods rather than technology, allowing some rather antiquated approaches to persist.


Ultimately change is driven by a collaborative effort stemming from awareness. So, look out for new technologies in the IVF space, enquire about what your clinic of choice is doing to improve their treatment options compared to their counterparts (especially when it comes to sperm processing) and talk you your healthcare professionals early about taking care of your fertility.



References

Borges, E., Zanetti, B. F., Setti, A. S., Braga, D. P. de A. F., Provenza, R. R., & Iaconelli, A. (2019). Sperm DNA fragmentation is correlated with poor embryo development, lower implantation rate, and higher miscarriage rate in reproductive cycles of non–male factor infertility. Fertility and Sterility, 112(3), 483–490. https://doi.org/10.1016/j.fertnstert.2019.04.029

Muratori, M., Tarozzi, N., Carpentiero, F., Danti, S., Perrone, F. M., Cambi, M., Casini, A., Azzari, C., Boni, L., Maggi, M., Borini, A., & Baldi, E. (2019). Sperm selection with density gradient centrifugation and swim up: effect on DNA fragmentation in viable spermatozoa. Scientific Reports, 9(1), 1–12. https://doi.org/10.1038/s41598-019-43981-2

Nosrati, R., Graham, P. J., Zhang, B., Riordon, J., Lagunov, A., Hannam, T. G., Escobedo, C., Jarvi, K., & Sinton, D. (2017). Microfluidics for sperm analysis and selection. Nature Reviews Urology, 14(12), 707–730. https://doi.org/10.1038/nrurol.2017.175

UNSW. (2020). Assisted reproductive technology in Australia and New Zealand 2018.


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