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Researcher

Diane De Neubourg

  • Research Expertise:Tailored management of subfertile patients will lead to an increased number of couples fulfilling their wish to have a child. Background Infertility is defined as the failure to become pregnant during a twelve months period of regular unprotected sexual intercourse. Infertility and subfertility are affecting 9% of the couples with a desire to have a child. Apart from the obvious reasons for non-conception such as a bilateral tubal block, anovulation, extremely low sperm count or absence of sperm in the ejaculate, severe endometriosis and premature ovarian insufficiency, most couples are suffering from subfertility and this is by far the majority. Subfertile couples have one or more aspects that are under the norm after fertility investigation and these are usually combined with factors such as increasing older age of the women (men), lower sexual intercourse frequency, busy jobs, more planning and lack of time. Although these patients are often categorized as having mild to moderate endometriosis, mild male subfertility or having no obvious reasons for not conceiving (unexplained or idiopathic infertility), this in itself is usually not the explanation for their involuntary childlessness. This subfertility is explained by the fact that reproduction is a matter of chance depending on the subtle balance between success and failure of complex and mostly poorly understood sequential processes that may lead to a pregnancy such as spermatogenesis, oogenesis, ovulation, sexual intercourse, transport of gametes, fertilization, embryogenesis and last but not least implantation. Besides the patient population with a clear indication for treatment all other couples (the majority) are facing subfertility rather than infertility. This poses a tremendous challenge to the treating physician to balance his or her advice between expectant management or active treatment such as intra-uterine insemination (IUI) or IVF/ICSI. The decision for one or the other depends on numerous factors whereby scientific information and patient preferences should lead to the best option for the couple. What we have been underestimating is that in our continuous strive to increase the quality of our treatment, patients may experience the biggest difficulty in “holding on” to the therapy and discontinuation or dropout from fertility treatment is underestimated. Discontinuation is to a large extent explained by the burden of the treatment, both physically as psychological. Objectives The research I want to continue focusses on both improvement of efficacy and safety but also be patient centered by taking into account patient’s preferences to keep our patients “on board”. As part of the research project “How does detection of DNA damage in sperm influence the patient’s chance of conception? “we will investigate the role of sperm DNA fragmentation as a sperm function test with the potential to discriminate and select couples with optimal chances for intra-uterine insemination. A Belgian multicenter study will be started and coordinated by myself to investigate the dropout rate and reasons for drop-out in case of the availability of cryopreserved embryos in a large Belgian ART population. We are conducting a study where we investigate whether a digital pre-conceptional lifestyle assistant in fertility treatment can be a trustworthy toolbox in assisting patients during their treatment and increasing cumulative ongoing pregnancy rates. I am the chief-investigator in an investigator- led KCE sponsored trial in 12 Belgian fertility centers to investigate whether the addition of Lipiodol during tubal patency testing (Hyfosy) will lead to a higher chance of conception which will lead to fewer patients that have to undergo more invasive fertility treatments subsequently
  • Keywords:FERTILITY, REPRODUCTION, SPERM QUALITY, Medicine
  • Disciplines:Reproductive medicine
  • Research techniques:Measurement of sperm DNA fragmentation Male infertility accounts for nearly 20-70% of diagnoses whilst most of male factor infertility cannot be treated adequately. The current diagnosis of male infertility is based on semen criteria updated by the WHO in 2010. These guidelines would consider a man normal with reference values of greater than 15 million sperm, greater than 4% normal morphology, and 32% progressive motility. Although the WHO classification suggests accuracy through a methodology harmonized across laboratories, the relevance for the choice of treatment and the predictive value for an infertile couple embarking on medically assisted reproduction is questionable. Numerous studies utilizing different techniques for assessing sperm DNA fragmentation support the existence of a significant association between sperm DNA damage and pregnancy outcomes. Moreover, a significant number of subfertile men have abnormal DNA integrity despite normal semen parameters. The level of DNA fragmentation correlates negatively with pregnancy and delivery in both natural and assisted conceptions. We perform direct DNA fragmentation testing with terminal deoxyuridine nick end labeling (TUNEL) assay on fresh sperm samples both on the total and vital fraction, before and after density gradient . (Punjabi U, Van Mulders H, Goovaerts I, Peeters K, Clasen K,Janssens P, Zemtsova O, De Neubourg D. Sperm DNA fragmentation in the total and vital fractions before and after density gradient centrifugation: Significance in male fertility diagnosis. Clin Biochem. 2018 Dec;62:47-54. doi: 10.1016/j.clinbiochem.2018.05.011) We are now testing the hypothesis that DNA fragmentation testing can play a diagnostic and thus pivotal role in selecting the patient who will benefit from intra-uterine insemination therapy leading to a higher clinical pregnancy and live birth rate compared to the standard semen criteria.
  • Users of research expertise:Patients Couples with childwish Researchers investigating the impact on the sperm quality. Patient organisations Government Fertility experts