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The Fertility Institutes have Board Certified, Male Reproductive MEDICAL (Urologist/Andrologist) AND LABORATORY (Embryologist/Andrologist) Specialists Available At Each Location, Including MEXICO. We provide all advanced male reproductive semen and sperm testing in-house and with our affiliated laboratories worldwide.
Laboratories performing sperm "counts", in general, vary in the details that they provide the physician requesting the "count". A general sperm count as part of a fertility evaluation should include the total density or count (20 million per ml or above), and the motile density (8 million per ml or higher). The motile density is perhaps the most important part of the semen analysis, as it reports the total number of sperm thought capable of progressing from the site of sperm deposition to the site of fertilization. This value is essential in both allowing a determination regarding whether or not a semen analysis is "normal", as well as in providing prognostic information should advanced reproductive medical assistance be required. (Numbers in italics are what "normal" values should be.)
Definitions of "abnormal" counts:
Sperm Morphology (Shape and Appearance)
The evaluation of sperm size, shape and appearance characteristics should be assesed by carefully observing a stained sperm sample under the microscope. The addition of colored "dyes" (stains) to the sperm allow the observer to distinguish important normal landmarks (characteristics) as well as abnormal findings. Several methods of staining sperm are used, and the method employed should be one with which the examiner is comfortable and experienced.
Several different shapes or forms of human sperm have been identified and characterized. These forms fall into one of four main categories: normal forms, abnormal head, abnormal tail and immature germ cells (IGC).
Sperm "Motility" (Movement)
Sperm motility studies identify the number of motile (moving) sperm seen in an ejaculate specimen. Here again, as in many other sperm studies, many laboratories use "normal" values that are out of date and inaccurate. Many labs will assess sperm motility upon receipt of the specimen, and again at hourly time intervals for four to twenty four hours. It is well known that sperm motility is a temperature dependent sperm function, so the handling and processing of specimens is critical. It is for this reason that we, except in very rare instances, require that specimens be evaluated only in a laboratory such as our own, where we are able to tightly control laboratory conditions. We have found the repeated testing of sperm over time for motility adds little to the evaluation of motility over the initial sperm motility assessment. Sperm are known not to survive well for extended periods of time in semen, and in nature, sperm very rapidly leave the semen to enter the cervical mucus. Many laboratories consider "normal" sperm motility to be 60% or greater. Our own studies, in agreement with many others have found men with 40% or greater sperm motility to be "normal".
AsthenozoospermiaChemical and Biochemical Semen Characteristics
Semen acid-base balance (pH)Computer Assisted Semen Analysis (CASA)
The use of computer asisted semen analysis has advanced the ability to study and understand sperm function as it relates to human infertility. The major advances have been in the ability to more accurately determine sperm concentration (counts) and motility (movement). Generally, sperm are "looked" at by a computerized digitizing tablet through a microscope. The computer has been "taught" by the laboratory personnel what sperm look like, and how they move. When the computer then "sees" a sperm under the microscope, it is able to draw a digitized picture of each individual sperm, including the speed and path this sperm takes while moving under the microscope. A great deal has been learned about the normal and abnormal "micro"characteristics of sperm employing this method. The method is, however, not foolproof. The computer is only as intelligent as it's programmer. Small changes in the computer program can alter the sperm calculations significantly. The computers must constantly be monitored and updated. In our laboratories, all grossly abnormal CASA assays are always verified by both a repeat analysis as well as with a "hands on" human second look opinion. We feel that any abnormal sperm count must be verified by a manual counting and assesment method.
Sperm Penetration Assays (SPA, "Hamster Tests")
There have been many attempts made to develop a Laboratory test that will accurately predict the ability of a human sperm to fertilize a human egg. Dr. Aitken and his group many years ago demonstrated a correlation between sperm movement characteristics and sperm fertilizing ability as evaluated by the zona pellucida-free hamster egg penetration test. In this test, the species specific barrier to penetration (not fertilization) is removed from the ova (eggs) of the hamster. These oocytes are then exposed to prepared sperm from the man being tested. There is some feeling that if a man's sperm are able to penetrate the hamster eggs in the laboratory, there is a higher likelihood that his sperm will ultimately be able to fertilize a human egg if so exposed. This test is not uniformly accepted, due to the high false negative (no penetration of the hamster egg, but wife gets pregnant anyway) rate and the sometimes seen false positive (penetrates the hamster egg but does not fertilize human eggs in vitro) rate of this test. Our experience has been that good performance in the hamster test can provide some limited reassurance of the likelihood that a man's sperm will be able to achieve fertilization if given the chance. If men fail the hamster test, we rely upon in vitro fertilization with ICSI. This protocol has provided us with excellent success rates in men whose sperm function remains questionable. It should be noted that most men that fail the hamster test, are able to achieve normal fertilization with ICSI. For a detailed explanation of the "hamster test" click here.
The postcoital test (also known as the Huhner test or the Sims-Huhner test) is a valuable office test that should be carried out in selected patients early in their infertility evaluation. While this is a very popular and widely used test, there are no widely accepted normal values for the interpretation of this test. Simply, the postcoital (after intercourse) test evaluates the women's cervical mucus at the time of ovulation and how the mucus interacts with her husband's sperm as ovulation is about to occur. The couple is instructed to avoid sexual intercourse for two days prior to the exam. When evidence of impending ovulation is detected (LH testing, hormone blood tests, ultrasound, etc.) the couple is instructed to have intercourse and then present to the office 6 to 10 hours later (standard test). At this time, a small drop of mucus is painlessly removed from the endo (inner) cervix, and this drop is examined under the microscope. A favorable result would find many sperm in thin watery mucus, with good forward, active motion through the mucus. If the initial test is good, a second delayed exam (18-24 hours after intercourse) may be required if infertility persists. If the initial test is poor, a repeat exam carried out 2-3 hours after intercourse may be needed. The timing of the postcoital exam is very important. If carried out too soon after intercourse, sperm that appear normal at that time may later die, giving a false sense of security. Patients should assure that the test timing is appropriate, and that they are not just being squeezed in to a busy schedule at a convenient time. A normal test largely excludes the cervix as a contributor to any fertility problem.
Normal (above) and abnormal (below)"post-coital" exams. Highly successful treatment is available for abnormal findings.
Sperm Washing and Freezing
Sperm "washing" techniques have been applied to treat a wide variety of sperm and semen disorders, as well as to prepare "normal" sperm for intrauterine insemination in the treatment of some female disorders. What is being "washed" in a sperm washing procedure are the various constituents of semen and the remainder of the ejaculate not deemed necessary to achieve fertilization of the egg. An ejaculate is not a sterile specimen and may contain both aerobic (oxygen dependednt) and anaerobic bacteria. In addition cellular debris from the vas deferens, the prostate, the seminal vesicles and thr urethra may be present. All of these components are "washed" from the specimen in the sperm wash procedure.
Antisperm antibodies have been well documented in the scientific literature as having the potential to cause impairment of fertility in humans. Sperm antibodies are detectable in either the male or female partner in approximately 10% of infertile couples. While these antibodies may be present, they may not be ultimately implicated as the cause of the infertility, making the search for antibodies in infertile couples both important and frustrating for the physician.
Antibodies, in general, are biochemical "time-bombs" that develop in the immune systems of all normal human beings. They are there to protect us from foreign "invaders" (viruses, bacteria, foreign objects, etc.) that would otherwise have the potential to attack and harm vital parts of the body. A newborn infant is supplied with a temporary supply of vital antibodies from the mother. This supply may be initially be replenished and transmitted from breast milk from the mother. Ultimately, antibodies to harmful outsiders develop slowly and reliably over time as a growing human is exposed to more and more "coughs, clods and flu's" from the outside world. Vaccines are a way to trick the body into producing long term protective antibodies without the body having to first suffer the disease. Antibody protection can, on occasion, "short circuit". In these instances, the abnormal function of the antibodies can lead to a variety of diseases. Some common examles are certain forms of severe arthritis, lupus, diabetes, and in reproduction, premature menopause (ovarian failure) and antisperm antibodies.
What happens in many immunologic disorders is the immune system that is normally ONLY supposed to make antibodies to protect from harmful threats begins to see "normal" tissue as a threat. In the case of arthritis, the immune system mistakenly decides that a person's bone joints have become a threat and begins to attack the joints. This persistent immune attack leads to an eventual painful destruction of the involved joints. In the case of antisperm antibodies, either the man begins to see his own sperm as a foreign "threat" or his female partner, whose immune system is supposed to tolerate sperm as non-threatening, begins to lose this tolerance and produces a destructive antibody that may damage the sperm and make it incapable of performing it's egg penetration and fertilization duties.
Antisperm antibody testing is complex, as at least three different antibodies can have a damaging effect on sperm. Each of these antibodies must be specifically looked for in the investigation of the male and female. A new test, due for release to laboratories in early 2001 is able to determine biochemically if sperm have been damaged by any cause within the male reporiductive tract, making them incapable of fertilizing the egg. This new assay promises to make our ability to assess sperm function much more accurate. Initial use of this investigation assay has shown it to be nearly 100% accurate in determining is a sperm can fertilize an egg without help, either naturally or with in vitro fertilization, of if intervention in the fertility laboratory with ICSI will be required.
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