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IVF Journey: On SDF and Antioxidants, Sorting Chips

Zymot sperm sorting chip

I offer up my own experience here since it may help older/infertile men seeking to be fathers. It’s anecdotal, not statistical, but I did go from zero sperm to 4 to millions in a year. And my first try turned out badly with the eight eggs assigned to me — only two developed, and they were genetically abnormal, which meant more cost and delay to have our egg donor back again. By then more time had passed and presumably the Zymot sorting chip picked out better sperm for ICSI, so it was successful — four good embryos from 20 eggs, which is more than usual.

Disclaimer: this is not medical advice, just what happened to me, so if you are persuaded to follow a similar regimen, there is no guarantee it will work. If you are infertile in middle age and are seeing the clock run out, you would be wise to consult a fertility specialist.

My first try at IVF didn’t result in any viable embryos, presumably because there was SDF (Sperm DNA Fragmentation) — damage to the DNA of the sperm, thought to be the result of oxidative stress on the way from production to delivery and rustiness of the sperm production process in older males. The IVF doctor warned me that such cases can be permanent or take over a year to remedy with medical assistance.

Sperm DNA Fragmentation (SDF):

Men with sperm motility defects often have high levels of sperm DNA fragmentation. The degree of DNA fragmentation in sperm cells can predict outcomes for in vitro fertilization (IVF) and its expansion intracytoplasmic sperm injection (ICSI). The sperm chromatin dispersion test (SCD) and TUNEL assay are both effective in detecting sperm DNA damage. Using bright-field microscopy, the SCD test appears to be more sensitive than the TUNEL assay.

Its main units of measurement is the DNA Fragmentation Index (DFI). A DFI of 20% or more significantly reduces the success rates after ICSI. (more)

I never had an actual test for SDF, but the failure of 8 eggs to produce one viable embryo with my sperm strongly suggested SDF. One of the many causes of SDF is oxidative stress, so it can help (and do little harm) to up your intake of antioxidants.

March 27 2020

We had a great Zoom teleconference with Dr. [Redacted], who’s quite knowledgable (world expert and of course not cheap.) He commended me on my self-help recovery treatment. He also badmouthed compounding pharmacy rHCG and offered to prescribe the regular pharma variety (high-priced, no doubt.)

He’s plugging use of a “Darwinian selection” chip which selects the best by making them compete to swim down a microfluidic channel. This is the culmination of similar ideas in a Petri dish. I may be a good candidate for such since the last test showed 300K sperm, half motile. The more drastic collection from the testicles may not be necessary. The doctor consults for the chip company [Zymot], and he also suggested a line of antioxidant supplements he developed. I checked the ingredients of his branded supplement, and I had already been taking all of them with one exception, so it was less costly to just buy the missing ingredient and add that to my usual vitamins.

Dr. [Redacted] name-dropped [gay Silicon Valley billionaire], who he said “is in the same boat,” not wanting to have his sperm selected by a community-college-educated technician. I appreciate *justified* elitism… but people do come from around the world to our IVF doctor. It costs little extra to use the Zymot or similar sorting chips, so it would be wise for all older men to consider it.

I rarely meet anyone who knows more about much of anything than I do, so that was refreshing. And no one knows when the ASRM will relax the “no procedures unless ongoing” restriction. There’s more data on pregnancy effects (limited) and transfer of the virus to the baby (doesn’t seem to happen), so it’d be nice if they allowed the plans of millions to proceed. Which reminds me of the “no cataract surgery because it’s not critical” ruling. Postponing trans surgery (medically unnecessary, should be discouraged for minors) is no loss, but this is a taste of M4A: some high council will decide on political grounds whether your treatment is necessary or not.

As it turns out, implantation of the first boy was delayed over six months by the ASRM guidelines, which were in turn guidelines of the CMS (Centers for Medicare and Medicaid Services) which decided hospitals and clinics should postpone all non-emergency procedures to keep beds and staffing free for COVID-19 patients. This emptied hospitals and laid off staff, postponing important surgery (cancer biopsies, for one) and causing worse outcomes for millions of people. And how many tens or hundreds of thousands of IVF babies will now never be born?

Repeating the drug regimen from the previous post:

Clomiphene, 50 mg / every other day

“selective estrogen receptor modulator (SERM)”

Anastrazole, 1 mg /day – suppresses estrogen production via aromatase inhibition.

hCG, .25 ml / every other day – chemically similar to luteinizing hormone, so shields testosterone and sperm production from negative feedback loops. Restored my levels of FSH (follicle-stimulating hormone) to normal in six months.

Antioxidant Supplements: One commercial supplement (FH Pro for Men) has this ingredient list:

Vitamin A (as beta-carotene) 1500 mcg, Vitamin C (as ascorbic acid) 120 mg, Vitamin D (as cholecalciferol) 30 mcg, Vitamin E (as d-alpha tocopheryl succinate and mixed tocopherols) 134 mg, Vitamin K1 (phytonadione) 40 mcg, Vitamin K2 (menaquinone-4) 40 mcg , Thiamin (as thiamine HCl) 3 mg, Riboflavin (as riboflavin 5 phosphate) 3.4 mg, Niacin (as niacinamide) 20 mg, Vitamin B6 (as pyridoxal 5 phosphate) 25 mg, Folate (from L-5-Methyltetrahydrofolate, calcium) 1360 mcg DFE, Vitamin B12 (as methylcobalamin) 1000 mcg, Biotin (as d-biotin) 600 mcg, Pantothenic acid (as d-calcium pantothenate) 20 mg, Iodine (as potassium iodide) 150 mcg, Zinc (as zinc citrate) 30 mg, Selenium (as selenomethionine) 140 mcg, Copper (as copper sulfate) 1 mg, Manganese (as manganese bisglycinate chelate) 2 mg, Chromium (as chromium picolinate) 120 mcg, Molybdenum (as molybdenum glycinate chelate) 75 mcg, L-carnitine L-tartrate 2000 mg, L-arginine HCl 350 mg, CoQ10 (as ubiquinone) 200 mg, N-acetyl cysteine 200 mg, Grape seed extract 20 mg, Lycopene 10 mg, Benfotiamine 1 mg, Vegetable capsule (hypromellose), Microcrystalline cellulose, Magnesium stearate, Silicon dioxide.

See this study for results with this commercial supplement. Some of these ingredients are questionable. Taking an array of antioxidants is normally not especially beneficial (results of studies are mixed — no effects or even deleterious effects), but in case of SDF, six months of these will probably help.

You can buy this high-priced premixed formula as capsules here (FH Pro for Men) or do it yourself at lower cost (but less convenience.) If you don’t mind taking lots of pills twice a day in hopes it will help with SDF, here’s what I took:

Amazon links for these (note that if you buy through these Amazon affiliate links, a tiny percentage of your purchase costs comes back to me; it’s always appreciated.):

A “Spectrum Silver” equivalent

Kirkland 50+ Multivitamin

Antioxidant Vitamin C

Vitamin-D-3-2000iu

Vitamin-K-2-100mcg

Niacinamide-500mg

Methyl-Folate-1000mcg

Methyl Folate 1000mcg

Calcium-Magnesium-Zinc

Calcium Magnesium Zinc tablets

Acetyl-L-Carnitine bulk powder

Acetyl-L-Carnitine bulk powder. This is more cost-effective; add to a protein shake or other strongly-flavored liquid to cover the taste.

L-Arginine Powder

L-Arginine Powder. This tastes so foul it spoils anything liquid. I found it best to dissolve it in warm water to drink quickly, then immediately rinse.

Coenzyme Q10 (Ubiquinol)-100mg

CoEnzyme Q10 (Ubiquinol)

N Acetyl Cysteine (NAC)

The drugs in the list previously mentioned all require prescriptions. The HCG in particular is used not only by men restoring fertility, but by women doing an IVF cycle; a diet fad (which is now fading) had people injecting themselves with large bootleg quantities to lose weight.

Here’s what a packaged pharmacy bottle looks like — inside the box is a vial of lyophilized (dried and preserved particulate) HCG and a vial of sterile water. Since the FDA no longer allows compounding pharmacies to do this for you, you have to mix it yourself by using a syringe to move water from the water vial to the hCG vial. The result is a water-based, injectable HCG that begins to spoil immediately, so use it in 30-60 days at most.

Packaged HCG

The syringes for these subcutaneous (just beneath the skin) injections are readily available because they are used in the billions for self-administered insulin shots. The procedure is to find an area underlain by fat (often around the naval) and pinch the skin to insert the very fine and short needle before injecting. This is usually nearly painless. The syringes look like this:

B-D .3 ml syringe

Having Children – Progress Report

I generally write on attachment theory and relationship topics to report on research results and the personal experiences of others. I try not to let my own personal experiences show too much because I’m trying for a neutral, nonjudgmental view. I have been too busy with other projects to keep up the writing and reporting here — but in a few years there will be enough new research to do another book on attachment. But for now I have more important projects!

It’s perhaps slightly embarrassing that I have weighed in on child-rearing topics but never had children until now. So we’re almost too old to undertake such a project, but we have the time and the space for it now.

The first few minutes of Idiocracy humorously cover the modern issue of long-delayed (and often foregone) children amongst the highly-educated, well-off young people of today, who may well stay in academia and avoid commitment until they are in their 30s and 40s, thinking “we must have stable jobs and resources before we have a child.” This is biologically risky since women’s eggs begin to slowly decline in quality after 25, and drastically after 40. Males, too, decline in sperm quality with age, though not as quickly (since sperm are generated from stem cells on demand, rather than being stored as buds from birth as eggs are.) Couples who want to have children but find their fertility has waned sometimes use IVF. A would-be mother whose eggs are too dicey can use a donated egg, and if unable to carry, a gestational carrier (the modern term for surrogate.) Anonymous male sperm donations are (compared to eggs) relatively cheap if it’s the male who has the issue with fertility. IVF procedures have improved greatly in this decade, and it’s a good thing because women are tending to postpone children for careers and men’s sperm is rapidly declining in potency. In a few generations perhaps most children will be IVF babies — presuming the price declines from the current $40-100K per child.

So I’m going to write more about these much more personal topics. We have (as mentioned elsewhere) embarked on our first child; we started in August of 2019, and our first is due in April of 2021 (21 months after our decision, delayed by COVID-19 shutdowns and other snags.) We found a great egg donor and have a second (and perhaps third) frozen embryo ready to start this month. The embryos have been screened and graded, and PGT-A genetic tests (not completely reliable) say they are all healthy boys.

Ultrasound at 20 weeks

We moved from a comfortable home on a golf course in the Palm Springs area because public schools weren’t very good there, and since there were no children in miles (the average age of our neighbors being 70), we moved to Carmel Valley in San Diego, which has fantastic schools and a neighborhood that will have hundreds of children within walking distance. We want them to grow up like we did, free to roam the suburban area by bike and walking, to build peer relationships with a wide variety of other children.

I’m planning to post the history of our IVF experience before the first baby arrives. The initial 6 months of caring for an infant are pretty much all-absorbing, so I won’t have time to post much until after that.

Thanksgiving Note: Out of Action, Health Scare

US Thanksgiving Day is being celebrated. The turkey’s in the oven, it’s cold and raining, the game is on, and we have much to be thankful for.

If you’re a regular reader, you’ve noticed I’ve posted rarely in the past six months. Lots of projects away from writing, family issues, distractions.

On Nov. 1st, we were in Austria a few days into a lengthy itinerary which was to include a Danube cruise, a Nile cruise, and visits to Petra in Jordan, then Jerusalem. On a bus tour to Salzburg, Austria, we stopped at a rest stop and on returning from the bathroom, I had a grand mal seizure in the parking lot. I woke up in the ambulance to the regional hospital, the Salzkammergut Klinikum Vöcklabruck. I was seen in the ER and had a workup before having another seizure an hour after the first. I woke up the next day in the stroke intensive care unit, not because I had a stroke (no evidence of anything at all unusual in MRIs or EEG) but because monitoring and care was continuous so if there had been any further activity they’d know immediately and be able to do scans and tests as it was happening.

Nothing more happened, but because it was now an Austrian holiday coming into a weekend, I had to stay three more days so the MRIs could be done when staff returned. Our holiday terminated there and we spent a few days in Vienna waiting for clearance to travel. Our travel insurance company, Allianz, was incredibly helpful and booked flights back on Air France (which I couldn’t recommend, but it was the first available flight.) The river tour company, Tauck, also went above and beyond, and this week refunded the entire cruise fee. I highly commend them for Americans touring overseas.

Having a grand mal seizure is similar to ECT (Electro-Convulsive Therapy, aka “shock treatment.”) Both hemispheres are involved in a storm of neural activity, wiping all memory of the event and time around it. I was mentally fuzzy afterwards and nothing was quite where it had been in my head. I did notice in Vienna that colors were more vivid and experiences less filtered; it could well be that the scrambling of normal neural activity is in some ways good for you, as when it relieves an obsessive depression by simply hammering the negative thought loops and memories that reinforce them.

It happens that we are also deep into the IVF process, aiming for two children, and today we heard that at least three embryos have matured on Day 5, with two more developing still. That’s something to be thankful for. The IVF effort and the new house we’re building in a more appropriate neighborhood for children has taken up most of my time for many months. So I have been less available to update here and supervise the Jeb Kinnison Forum, which luckily is mostly self-policing. Some of the participants there are at least as good as I am in handing out advice on attachment issues, though of course there is a lot of personal experience chit-chat and people with chips on their shoulders from their relationship breakups.

So Happy Thanksgiving for those who are celebrating it today!