Which treatment will be most ideal for you?
IUI (insemination)
Where the man’s DFI value is below 25, IUI treatment would be a good choice. The chances of having a child by IUI treatment are namely approximately 20% per cycle in cases where there are no problems with the packaging of the genetic material in the sperm cells (these figures are based on research from Malmö University Hospital).
Where the DFI value is above 25, however, there is only a 1.5% probability that the IUI treatment will result in a live birth. In such cases, IUI treatment would lead to unnecessary hormone treatments and disappointment. You will also be wasting your time and money.
Explanation: With respect to IUI treatment, the sperm cell must swim too far and fight too hard prior to reaching the egg and penetrating the thick egg membrane. If the sperm cell’s genetic material has been poorly packaged, it cannot withstand such hardship. When the sperm cell has found way into the egg, it will have produced so much energy that the genetic material will long since have fragmented (broken). Therefore, it will only be a matter of time, before the pregnancy will fail. If the DFI value is below 25, the genetic material will be packed so well that fragmentation will not have time to occur before the egg has been fertilised.
IVF (in vitro fertilisation)
Even with DFI values below 25, choosing the IUI treatment can, in some cases, be a bad idea. The woman may, for instance, have blocked fallopian tubes which may prevent the obtainment of pregnancy through IUI treatment. When other reasons exclude IUI treatment, and the DFI value is below 25, you should choose the IVF treatment.
Explanation: When the DFI value is below 25, the sperm cell’s genetic material is packaged in such a way that it will probably not fragment upon fertilisation (where the sperm cell spends energy on penetrating the thick egg membrane). Hence, there is no difference in the respective success rates of IVF and ICSI treatment.
ICSI (microinsemination)
When the DFI value is above 25, the ICSI treatment will be the most efficient type of fertility treatment. Here, the likelihood of a positive outcome is approximately 50% greater as compared with the IVF treatment.
In approximately 2-3% of involuntary childless couples, the DFI value will even be above 50. In such cases, it can be difficult to get a child, even through ICSI treatment. Prior to initiating ICSI treatment, it is therefore very important to look into any possible causes in the man that could explain the high DFI value.
Explanation: The ICSI treatment is very gentle towards sperm cells with the poorly packaged genetic material. ICSI treatment helps the sperm cell all the way into the egg. Contrary to IUI treatment, it will be spared the long journey through uterus and fallopian tubes. And, compared with IVF treatment, it will not have to penetrate the thick egg membrane, either. For DFI values above 25, ICSI treatment will therefore be the best suited type of fertility treatment. For DFI values above 50, however, the genetic material is extremely fragile. It will not take much for it to fragment. Even with respect to ICSI treatment, a reduced success rate should be expected. It is therefore important that you examine the causes, prior to initiating any fertility treatment. Maybe you should consider a treatment combining ICSI with the harvesting of sperm cells directly from the scrotum. Most recent research indicates that such sperm cells will be more robust and less susceptible to DNA fragmentation (Greco et al. 2005, Wertmann et al. 2010).
As mentioned in the section dealing with IVF treatment, female factors are also important when deciding upon fertility-treatment type. The recommendations mentioned above should be seen in the light of the packaging of the genetic material in the sperm cells. The success rates referred to here have been achieved in a research project ensuring that there were no simultaneous problems present in the woman (Bungum et al. 2007).