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Monday, February 02, 2004

Distracted 

Well, I'd planned to blog about the zoo some as I spent a few hours there yesterday and took some pictures, but now I'm a bit distracted. Evelin got an e-mail this morning from the fertility clinic and we're not sure exactly what it means.

We'd been hoping that the sperm analysis, aneuploidy, and chromosomal assay tests would help us figure out one way or another where the cause of our multiple miscarriages lay. Instead, we got some borderline results that just leave a few questions open until we either have a consult or the doctor replies to my e-mail. (This is the testing that we have been waiting for results from since late December.)

Basically, two main tests were run on the sperm sample: an aneuploidy test to see if there are any chromosomal abnormalities in the sperm (detected with Fluorescent in situ Hybridization, or FISH) and a Sperm Chromatin Structure Assay (SCSA), which looks at DNA fragmentation and stainability.

The SCSA yields two results: the DNA Fragmentation Index (DFI), which is the percentage of sperm with moderate and high levels of DNA fragmentation (percent moderate fragmentation plus percent high fragmentation); and the High DNA Stainability (HDS), which the percentage of sperm with immature chromatin. HDS sperm have less chromatin condensation, which leads to increased DNA stainability (the higher the DNA content in a cell, the lesser concentration of free dye and thus lower stainability).

[ASIDE: Stichting Medische Voortplanting Voorburg in the Netherlands has a very complete Glossary of Acronyms in Reproductive Medicine.]

DFI came back at 29.2%, which is just barely in the "good" range (excellent is <15%; good is 15%-29.9%; poor is >30%), and HDS came back at 7.8%, which is "normal" (>15% is high). The aneuploidy test came back at 8% of sperm showing signs of aneuploidy, which is higher than normal, but not by much ("normal" is 2.9%-7.7%). Sperm count was 138×106/ml (not sure where that is in terms of "normal").

The final diagnosis from the doctor was "good to fair fertility potential," but considering our history of multiple miscarriages and the very low percentage of embryos that made it through PGD for transfer (3 out of 32) -- and, of course, none of those "took" -- we have to wonder if being borderline in terms of DFI and aneuploidy is just too many strikes against us.

These results also leave us wondering about Evelin's eggs. If the results had been conclusively "good" for me, then it would indicate a problem with Evelin's egg reserve. But since my results are borderline, does that mean that she also has borderline issues, too, and that my borderline status and her borderline status tips us over the edge? Or are her eggs fine and my borderline status isn't so borderline once we get out of the lab? Or is it just a craps shoot, and one day some of my good guys could meet up with one of Evelin's good eggs?

Frustrating. And waiting. And, I guess, still going to the donor egg, donor sperm, and adoption information seminars ...

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