I wanted to talk about how men play a role in recurrent pregnancy loss (RPL). When a couple come for an evaluation for recurrent pregnancy loss (2 or more miscarriages), almost all the work up is focused on finding something wrong with the woman. Most doctors may or may not test the male partner and if they do usually it will be to check the male partner’s chromosomes. However, men are half of the equation of a pregnancy. I wanted to share with the community that there is growing evidence that men play a role in recurrent pregnancy loss.
For men, we can look at their sperm and this can be done by a semen analysis which is routine practice as part of an infertility work up and we can also look with more specialized tests for DNA damage of sperm, called sperm DNA fragmentation studies. Male factor and recurrent pregnancy loss is less well studied. However, there is evidence that abnormalities in sperm is associated with recurrent pregnancy loss. Several studies have investigated the percentage of normal looking sperm (morphology) between men with RPL and fertile men and found that men with RPL have a lower amount of normal looking sperm than fertile men. Moreover, there have been several studies that have shown that even men with normal semen parameters i.e. everything is normal can have increase in DNA damage of the sperm, which can be assessed by specialized tests called sperm DNA fragmentation tests. If there is DNA damage of sperm it is hypothesized that this may increase risk of genetic problems in the baby which may lead to a pregnancy loss. The studies to date have been on smaller number of men and used different sperm tests so no firm conclusion on causation can be taken from these studies and more studies of larger numbers of men will need to be performed. However, it is clear that there is an association of male factor and RPL. I routinely perform a semen analysis on my couples and offer sperm DNA fragmentation testing. The sperm DNA fragmentation testing has not made it to the list of insurance approved tests for RPL so most insurance will not cover it. However, I hope that one day routine sperm work up for men with RPL will be covered.