New treatment guidelines on recurrent miscarriage are reiterating that damaged sperm may be one cause — an interesting development considering the rise of egg freezing to preserve fertility.

Key Takeaways:

• The American Society for Reproductive Medicine (ASRM) released new treatment guidelines on handling recurrent miscarriage.

• The organization is recommending that sperm be tested for DNA damage in cases of repeated miscarriage.

• While the ASRM has done research into sperm damage and the effect it has on fertility, it is now placing a greater focus on it.

• Women are frequently treated as the main cause of infertility, yet the role men play in infertility is still largely overlooked in the national conversation.

The Details:

A new committee opinion from ASRM delved into recurrent miscarriage and what could potentially be causing it. This includes redefining recurrent pregnancy loss (RPL) as two or more miscarriages before 22 weeks, even if it is a chemical miscarriage, meaning women no longer need an ultrasound with a visible gestational sac present for the miscarriage to count.

The miscarriages also do not need to be consecutive, meaning two miscarriages of any kind should be deemed as RPL and doctors can begin investigating potential causes.

The ASRM noted numerous possible factors in recurrent miscarriage, including:

• parental chromosomes

• pre-existing health conditions in the parents

• state of the uterus itself

• damaged sperm

In 2012, the ASRM acknowledged that sperm DNA fragmentation was a potential issue, but didn't yet recommend routine testing, as the research was still new and inconclusive. Now, however, the research is more clear.

The group cited two recent meta-analyses:

• The first found that men whose partners experienced RPL had 11–12 percentage points higher sperm DNA fragmentation scores than fertile controls.

• Another found that couples with high sperm DNA fragmentation had more than twice the risk of repeated miscarriage compared with those with low fragmentation.

For years, investigations into miscarriage have largely focused on women. The new guidance gives greater weight to evidence that DNA damage in sperm may also play a role, and says testing men for sperm DNA fragmentation can now be considered in otherwise unexplained cases.

Fertility doctor Carrie Bedient told Scientific American she experienced first-hand the effect damaged sperm can have, as well as how it can be corrected:

"In the man’s case, the test results revealed a moderate level of DNA damage. Bedient gave him some frank advice on how to rehabilitate his sperm. 'Hey, I need you to clean up everything you can,” she recalls telling him. He vowed to stop drinking alcohol, stop smoking, start exercising and take vitamin supplements—and it worked."

It also isn't an issue of just ordinary sperm testing; everything may look normal in typical test results, yet some of those sperm can still be carrying damaged DNA.

Why It Matters:

As the ASRM recently acknowledged, the national conversation still treats infertility primarily as a women’s issue, even though male factors are the sole cause in 20–30% of infertility cases and contribute to another 20–30%.

This means roughly half of infertile couples have some male-factor component, and yet, women still undergo the majority of fertility testing and treatment, regardless of the underlying cause.

This is especially relevant, as egg freezing and the use of donor eggs becomes more culturally acceptable and prominent. While these are not a guarantee of future fertility, they are often treated as such.

Women are routinely encouraged to freeze their eggs or use donor eggs if they didn't, all while men rarely receive a similar message. But the reality of paternal age, sperm health, and sperm DNA damage complicates the idea that reproductive planning is solely a woman's responsibility.

As Bedient pointed out, the DNA damage in sperm can often be addressed. While it isn't guaranteed to work, finding out that sperm has DNA damage and taking action to fix it can prevent couples from resorting to donor sperm, and the ethical problems and potential trauma it could cause for their children.

The Bottom Line:

Men who want children should understand that their age and health can affect reproductive outcomes too, and focus on things like restorative reproductive medicine, in which doctors identify and treat an underlying condition when possible, rather than simply bypass it with donor materials and in vitro fertilization.