To start, if you’re reading this because you have experienced pregnancy loss, I’m so empathetic, and my heart wraps you in much love and compassion. Unfortunately, our culture has not found a way to acknowledge, mourn, celebrate, or understand pregnancy loss in the way that we have ritualized the death of a human that has walked on this earth. As mothers and fathers of these angel babies, we often carry deep grief, trauma, and sadness as we silently try to pick up the pieces of the hopes, dreams, and visions we had of our child or children. Please know you are not alone.
Our questions about the loss of our child or children often go unanswered. The causes of Recurrent Pregnancy Loss (RPL), defined as two or more losses, are as follows:
- Unexplained (40-50%)
- Autoimmune/Clotting Disorder (15-20%)
- Endocrine/Hormonal (15-20%)
- Anatomic (10-15%)
- Genetic (2-5%)
Conventional Female Workup for RPL
The workup for RPL is almost always centered on the female partner and includes:
- Ultrasound
- HSG or Sonohistogram
- Endocrine Work Up (Thyroid, Prolactin, etc.)
- Antiphospholipid Syndrome
- Endometrial biopsy (sometimes)
- Karyotype
Conventional Male Workup for RPL
If the male partner has any workup, it is generally a:
- Semen analysis
- Karyotype (sometimes)
The semen analysis will show changes in sperm shape (morphology), motility, count, white blood cells (indicating the potential of infection or autoimmunity), and agglutination (clumping). The karyotype offers insight into changes with the chromosomal material, but the prevalence of these changes is only ~3%.
After I had experienced three losses following natural conception, the reproductive endocrinologist we consulted, unfortunately, told us that since we were getting pregnant, there was NO REASON TO CHECK MY PARTNER AT ALL. Not even a semen analysis! I believe this was an enormous oversight. It derailed us, and come to find out later, there was an issue with his sperm.
While the semen analysis and karyotype are a really good place to start with RPL, I don’t think it provides us with all of the accessible information.
Sperm DNA Fragmentation
If you dive into the research, there is data showing that sperm can still have underlying DNA Fragmentation even if the karyotype and semen analysis are classified as normal. So I imagine that this is often missed in a standard workup. DNA fragmentation is separation or breakage within the DNA of the sperm. The damaged DNA can alter early embryogenesis. This means that the egg may still be fertilized, but as the early embryo is developing, it is interrupted or changed in a way that makes the embryo incompatible with continued development and will ultimately lead to a loss. Sperm integrity is also essential in placental proliferation. DNA fragmentation can happen during spermiogenesis (development and maturation of sperm) or in route from the testicles into the ejaculate due to oxidative stress. Increased DNA fragmentation has been associated with RPL in the literature.
Testing for Sperm DNA Fragmentation
Unfortunately, the American Society for Reproductive Medicine (ASRM) does not currently recommend routine testing for DNA fragmentation despite a known association with pregnancy loss. This is likely because there are no current treatment guidelines, but I imagine this recommendation will change in the coming years. The European Society of Human Reproduction and Endocrinology (ESHRE) guidelines recommend the assessment of sperm DNA fragmentation in RPL to better understand potential contributors to loss.
There are a few specialty labs that offer an assessment of sperm DNA fragmentation. Most of the fertility clinics will have associations with these labs and offer testing through their clinics. This is the best way to approach testing as the fertility clinic andrology labs will assure appropriate collection and transport of the semen specimen, critical for adequate testing just as it is for semen analysis.
What Potentially Causes Sperm DNA Fragmentation?
- Age
- Alcohol
- Caffeine
- Environmental Toxins
- BPA
- Phthalates
- Pesticides
- etc.
- Obesity
- Oxidative Stress
- Smoking
- Varicoceles
- Electromagnetic Radiation
This is not an exhaustive list, as I’m sure there are many possibilities, yet unknown.
What Can Be Done About Sperm DNA Fragmentation?
Good news! Many of the potential causes of DNA Fragmentation and poor sperm health are modifiable. Men are making new sperm all the time. In fact, the development and maturation of sperm is around 75 days. So, if you’re experiencing infertility or loss, you could start with the suggestions below to really start boosting sperm health.
Lifestyle Changes
- Reduce BPA exposure
- Eliminate plastic food and drink containers
- Don’t touch thermal receipts
- Ditch food in metal cans (the lining is often coated with BPA)
- Food should NEVER be heated in plastic
- The dishwasher is too hot for plastic
- Reduce Phthalate exposure
- See the info above about plastic
- Don’t use vinyl flooring in your house
- Avoid anything with fragrance, perfume, and parfum (perfume, air freshener, cleaning products, personal care products, etc.)
- Choose personal care products that do not contain phthalates
- Avoid pesticides, herbicides, insecticides, and fungicides
- Filter your bathing water
- Maintain an optimal body weight
- BMI 20-25
- Don’t use your laptop on of your lap
- Find a place for your phone away from your body out of your pants pocket
- Keep your testicles cool
- No hot tubs, hot baths, heating pads, electric blankets, heated seats
- Wear loose-fitting underwear and pants
- Reduce time in tight-fitting shorts on a bike seat
Diet & Nutrition
- Eliminate alcohol and caffeine
- Filter your drinking and cooking water
- Organic food is your best choice
- Choose a diet rich in colorful fruits and vegetables (8-10 servings a day)
- Supplement with antioxidants
- CoQ10
- Glutathione
- NAC
- Selenium
- Vitamin E
- Vitamin C
- Zinc
Help From Your Doctor
Additionally, there are some things your doctor could help you out with if you have DNA Fragmentation:
- Varicocele repair if appropriate
- Certain sperm preparations for IUI and IVF show less damage to sperm
- TESE (testicular sperm extraction)
My point is, male contribution to RPL is real! Ultimately, even if your plan is IVF with ICSI (intracytoplasmic sperm injection) and PGT-A (preimplantation genetic testing for aneuploidy of the embryo), make sure your male partner is checked for DNA Fragmentation if you’ve experienced pregnancy loss. BE YOUR OWN BEST ADVOCATE! The few extra hundred dollars and a little more effort are worth it. If it comes back that the DNA Fragmentation Index is high, include some of these recommendations or work with someone who can help! The onus should not always be on the female partner. Remember this is a team sport.
And finally, I am sending so much love and baby dust!
Additional Resources
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References
Disclaimer: This website and post include general information about nutrition, health, and fertility. This content is not medical advice. It is not a replacement for medical advice, diagnosis, or treatment of any health condition or illness. With that said, if the reader or any other person has a medical condition, concern, or illness, they should consult with their personal doctor or another appropriately licensed healthcare provider. The reader should also never disregard professional medical advice or delay in seeking advice because of something discussed in this information. It is imperative to consult your doctor or another appropriately licensed healthcare provider before implementing any changes to your diet, fitness routine, lifestyle, medications, or nutritional supplements.
Information provided in this document and the use of any products or services related to this document by you does not create a doctor-patient relationship between you and Tamara Darragh, ND, DC. Statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.
