Condition & Treatments
/ Failed IVF: the male factor
IVF hasn't worked? Check the male side before the next cycle.
When IVF fails, attention usually turns to the eggs and the womb. But sperm contributes half of the embryo's DNA. A man can have a "normal" semen test and still have problems that affect fertilisation, embryo quality and miscarriage.
A male factor is involved in about half of all couples with infertility [1].
I N S H O R T
A standard semen test measures count, movement and shape. It does not show sperm DNA damage, hidden infection or hormone problems.
Many of these can be treated in around three months, the time it takes to make new sperm.
Prof Raheem works with your IVF clinic, so findings feed straight into your next cycle.
Signs the male side needs a closer look
-
Poor fertilisation rates, or embryos that stop developing.
-
Repeated implantation failure or miscarriage.
-
Semen results that were borderline, or were never repeated.
-
The male partner has never been examined by a specialist.
Tests
Full examination and scrotal ultrasound, to look for varicocele and other problems
Sperm DNA fragmentation, to measure damage a normal semen test can't see
Hormone profile, to check the signals that control sperm production.
Semen culture, to rule out infection of the prostate or seminal vesicles.
Genetic tests, where the count is very low
Treatment options
Treating the cause:
varicocele repair, antibiotics for infection, or hormone treatment.
Reducing DNA damage:
lifestyle changes, targeted antioxidants and shorter abstinence before the sample.
Testicular sperm for high DNA damage:
for men with a good count but high DNA fragmentation, sperm taken directly from the testis on the day of egg collection carries much less DNA damage than ejaculated sperm.
Fresh or frozen sperm for egg collection day:
sperm frozen in advance, or fresh sperm retrieval on the same day as egg collection, co-ordinated with your clinic.
Ways to lowersperm DNA damage before your next cycle
Sperm takes around three months to be made, so the DNA fragmentation test is usually repeated about 3months after treatment starts.
-
Varicocele repair. One of the most common causes of high DNA damage, and repair can reduce it. Treating infection and inflammation.
-
Hidden infection of the prostate, seminal vesicles or epididymis, or white cells in the semen, is found with semen culture and semen microbiome testing, and treated with targeted antibiotics. Correcting hormone problems, such as low testosterone or high oestradiol.
-
Lifestyle changes. Stopping smoking and cannabis, cutting alcohol, losing excess weight, and avoiding heat from hot baths, saunas and laptops.
-
Reviewing medicines and exposures, including recent fever or illness, which can raise DNA damage for up to three months.
-
Targeted antioxidants, at the right dose and for the right length of time.
-
Shorter abstinence. Ejaculating more often, and producing the IVF sample after 1 to 2 days rather than longer.
-
Testicular sperm on the day of egg collection, if DNA damage stays high despite treatment.
S P E C I A L I S T S E R V I C E
After failed IVF, especially when tests have confirmed high sperm DNA fragmentation (a high DFI), Prof Raheem can retrieve sperm directly from the testis on the same day as your partner's egg collection, so it is used fresh for ICSI.
-
Why it can help after failed IVF. Testicular sperm usually carries two to three times less DNA damage than ejaculated sperm, because much of the damage happens as sperm travel through the tubes. Studies have reported higher pregnancy and live birth rates and fewer miscarriages with testicular sperm in men with high DNA damage, although the evidence is still limited
-
Why fresh, on the day. Using the sperm straight away avoids freezing and thawing, which can reduce the number of usable sperm and how well they move. Prof Raheem has researched this directly, comparing ICSI outcomes with fresh and frozen surgically retrieved sperm at UCLH
-
Why few specialists offer it. Egg collection is timed by your partner's cycle and usually confirmed only a day or two in advance, so the operating theatre, surgeon and embryology lab all have to be ready at short notice. It takes close co-ordination with your IVF clinic, and relatively few specialists are set up to offer it.
-
Planned together. Prof Raheem works directly with your IVF team to time the retrieval, and agrees a back-up plan in advance.
Why this matters to your care
Prof Raheem set up the joint fertility clinic at UCLH, where Andrology, gynaecology and embryology worked together. He brings the same approach to your IVF team: one plan, shared with your consent.
Should we delay our next cycle?
+
Often by around three months, if treatment can improve sperm. Prof Raheem will weigh this against your partner's age.
Our clinic said the sperm was fine. Is it worth checking?
+
Yes, if IVF has failed more than once or there have been miscarriages. A normal semen test doesn't rule out a male factor
Can you talk to our IVF clinic?
+
Yes. With your consent, findings and recommendations are sent to your clinic.
Prof Raheem's published work on this topic
References
1. Agarwal A, et al. A unique view on male infertility around the globe. Reproductive Biology and Endocrinology, 2015. Link