Is It Possible to Medically Increase Testosterone and Still Maintain Fertility? A look at Clomiphen
This is a review of a paper exploring conversion of hypogonadal (low testosterone) men from clomiphene to Natesto.
Only 5% of the volume of the “raw” ejaculate is composed of sperm. The remainder comes from secretions made by the prostate, seminal vesicles and cowpers glands. Those secretions enable sperm to survive until they can travel into the cervical crypts, then into the uterus and into the fallopian tube to fertilize an egg. For purposes of IUI (or IVF) sperm must be separated from the raw ejaculate. Most commonly a technique called a gradient wash is used which involves layering semen on top of a higher density solution and then centrifuging the combination, pulling the sperm down to the bottom while leaving the rest of the raw ejaculate behind.
Increased “DNA fragmentation” within sperm has been associated with lower pregnancy and higher miscarriage rates in a variety of publications. A recent poster presented at the ASRM (American Society of Reproductive Medicine) Meeting in Denver this past week (October 2018) demonstrated that processing sperm using the Zymot microfluidics chip, when compared to using a gradient wash resulted in sperm with significantly lower DNA fragmentation.
The paper submitted by Chinnasamy et al from UCSF and Stanford University compared results of 62 “split” semen specimens. Findings showed that use fo the Zymot device resulted in specimens with lower DNA Fragmentation (as measured by TUNEL assay) compared to both centrifuged specimens and to sperm from the raw ejaculate.
As to conclusions regarding improved pregnancy results, results are still pending. There is controversy as to the clinical utility of DNA fragmentation; however, it is hoped that this technology may serve to improve results of fertility treatment now and in the future.
