Male Factors in Recurrent Pregnancy Loss

Dr. Braverman discusses the role of the male in the causes of recurrent pregnancy loss and why it is so important to include the male partner in this work-up.

It's surprising that many patients who come to my practice are not aware that their recurrent pregnancy loss can actually be due to a male factor. The assumption is made incorrectly that if they were able to conceive that there was probably not a contribution from the sperm in the loss. Well, again, this couldn't be further from the truth and in fact there are a significant number of patients who fail to conceive or have recurrent miscarriage and the only factor comes from the male. Well, this can be broken down into two issues – the first is to look at the sperm and to go over the semen analysis very carefully.

I have a lot of patients who come to the practice who would be told that their semen analysis was normal, but when I get the report and I look at it I find subtleties that were missed by the initial evaluators. Probably the most common thing that gets missed the morphology or the shape of the sperm, because even when mildly abnormal, it can lead to significant issues: inability for the sperm to penetrate the egg, oxidative damage to the head of the sperm which effects its motility, mobility and the ability again to penetrate the egg or fragmentation in the DNA that's actually in the head of the sperm. And when an abnormal or fragment of DNA gets injected into the egg this embryo that's developed may not develop properly and again can lead to failure to conceive at all or can lead to early recurrent miscarriages.

We can actually do a test to measure the amount of DNA fragmentation contained in the semen analysis and when those levels are significant these are the areas that we can treat and significantly reduce the likelihood that this patient is going to suffer recurrent pregnancy loss or at least significantly improve the chances that she will conceive naturally. Not every one of these conditions is treatable but certainly when we find inflammatory components or we find infectious components we have a great success in these treatments.

The secondary which is fairly new is the process of evaluating the seminal fluid for chemicals that are imperative for the generation of tolerance or paternal genes by the mother's immune system. In fact, when men have very low levels of these chemicals in the seminal fluid it is one of the reasons that we see early repetitive recurrent pregnancy loss. We are actually able to supply these chemicals vaginally and try and increase the likelihood that the genetics contained in the sperm will be carefully evaluated by the eternal immune system and accept it so when the embryo finally arrives to the uterine lining the mother's immune system is already prepared for acceptance. So, it is very important when patients come to our practice that the male factor gets a complete analysis which we do here at my practice and many times treatment of the male will decrease the chances of recurrent pregnancy loss or failure to conceive.

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