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Andrology study

The male study is as important as the female study and should not be left aside. On the contrary, we advise that the assessment of a sterile couple begins precisely by the male factor as it can provide very useful information for diagnosis and is a simple and quick procedure. On the basis of the preliminary results obtained and the previous history of the couple, more specific studies and andrological tests related to functionality and/or genetics may be required. Some cases may even require consultation with a specialist on the male reproductive system, the andrologist.

Male Fertility Tests Performed
in the Andrology Lab

Seminogram

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It is the analysis of a semen sample. The semen is a secresion consisting of seminal plasma, coming from the seminal vesicles and the prostate and the spermatozoa (male reproductive cells produced in the testicles). The seminogram reveals information on some macroscopic aspects of the ejaculate like volume, liquefaction, viscosity, PH, agglutination, etc, but the most important aspect is the microscopic study.

The microscopic parametres which are most relevant for sperm analysis are:

  • Sperm concentration: the quantity of sperm in the sample.
  • Sperm motility: assessment of the swimming ability of sperm. According to how they move they are classified in different grades:
    • Fast progressive spermatozoa (type a or “+++” according to WHO criteria (World Health Organization)
    • Slow progressive spermatozoa (type b or “++”according to WHO criteria)
    • Non-progressive sperm (type c or “+”according to WHO criteria)
    • Immotile spermatozoa (type d or “0” according to WHO criteria)
  • Sperm morphology: the sperm cells are analysed according to the shape of the head, the midpiece and the tail.
  • The parameters set by WHO in 2010 and the strict criteria of sperm morphology set by Kruger are used to establish normality in semen tests. Knowing these basic parameters will help us understand the male fertile potential. However, there is a great biological variation in sperm production in the same patient. It is therefore very important that the interpretation of the results is undertaken by a specialist, because the diagnosis reached is no guarantee of fertility. Moreover, the study is considered to reveal the seminal situation of a patient only if 2 samples of the same individual are assessed with a 2-3 week interval.

    Motile Sperm Recovery Test (MSR)

    It consists, on the one hand, of eliminating the seminal plasma, the spermatozoa with low or null motility and bad morphology and on the other hand, recovering the population of spermatozoa with good motility and morphology. This process can also be called “sperm capacitation”.

    This test helps to assess the efficiency of the recovery of progressive sperm in the ejaculate and thus, choose the most suitable assisted reproduction technique based on the quantity of recovered spermatozoa.

    ivf spain If the total quantity of recovered progressve spermatozoa exceeds 5 million, Artificial Insemination can be carried out with full effectiveness, as long as this is the indicated treatment. If the quantity of recovered spermatozoa is lower than 5 million, the indicated treatment would be In Vitro Fertilization.

    There are different methods to perform sperm capacitation (washing, swim-up, density gradients). In each case, the biologist chooses the proper method according to the characteristics of the semen sample with the objective to gain the highest efficiency from each kind of sperm sample.

    IVF Control.

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    This test entails a procedure similar to that of Motile Sperm Recovery Test (MSR) with the addition of an analysis carried out 24 hours later to assess sperm survival and rule out the presence of bacterian contamination.

    When bacterian contamination is detected, the doctor indicates a 10 to 21-day course of specific long-term antibiotics before beginning treatment as contamination at sperm level can jeopardize any fertility treatment.

    FISH – genetic study of sperm

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    FISH (Fluorescent In Situ Hybridization) is a cytogenetic technique used to study the quantity of chromosomes in a cell marking them with a fluorescent probe in order to allow specific identification of each one of them. When FISH is applied on the spermatozoa in a semen sample, the aim is to check the gain or loss of chromosomes in the male reproductive cells. Spermatozoa that is genetically normal must have 23 chromosomes, that is, only one copy of each chromosome (non repproductive cells in the human body contain 46 chromosomes). The purpose of knowing whether the spermatozoa contain the right number of chromosomes is to find out whether the process by which spermatozoa are formed, meiosis, is right and the spermatozoa can provide the accurate genetic information to the offspring. Alterations in the number of chromosomes in the sperm can cause sterility and infertility.

    Normally, this study includes the analisys of 5 chromosomes (13, 18, 21, X and Y) as these are the ones that most frequently present alterations.

    Indications:

    • Moderate and/or severe semen alterations
    • Male abnormal karyotype
    • Repeated abortions
    • Sterility of unknown origin
    • IVF (Invitro fertilization) failed attempts

    Results interpretation:
    When a male is disgnosed with an altered FISH this means that he has a percentage of spermatozoa with an abnormal quantity of chromosomes (whether too many or too few) in comparison to a fertile control group. That, in turn, implies that such spermatozoa produce embryos with chromosomic alterations leading to low implantation and, on the other hand, high probabilities of abortion.

    In these cases, Preimplantation Genetic Diagnosis (DGP) in combination with In Vitro Fertilization is recommended for the selection of the embryos with the right number of chromosomes to be transferred into the uterus.

    DNA fragmentation test in sperm

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    Good fertility potential in sperm requires optimal and stable genetic material at the time of fertilization.There are several causes producing DNA fragmentation in the sperm: increased testicular temperature (wearing tight clothes, fever or varicocele); the presence of oxidant molecules in the semen; metabolic alterations (in cases of overweight or diabetes); the use of certain medication, advanced age (over 45 years), toxic habits (tobacco, alcohol, etc.).

    DNA fragmentation in sperm is inversely related to the fertilization capacity of an individual. Therefore, the higher the DNA fragmentation, the lower the fertilization capacity of such individual.  

    An approximate threshold value of up to 15% of fragmentation is considered normal. A degree of fragmentation between 15 and 30% indicates a substantial increase in fragmentation and a value over 30% would be pathological as the fertilizing capacity of an individual is severely compromised.

    The level of DNA fragmentation can lead to the use of antioxidant therapy or to the application of Annexin V Columns for the selection of non-fragmented spermatozoa in a sample.

    Annexin V Columns (MACS)

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    Selection of sperm with non-fragmented DNA using an immunomagnetic separation technique. (Annexin V Columns MACS).

    Sperm quality is one of the key factors in the success of Assisted Reproduction Techniques. To increase pregnancy rates it is essential to improve sperm selection.

    How is this selection done?

    Immunomagnetic cell selection technology has been used successfully for years in different medical fields to aisolate important cells. It is the first time this technology is clinically used in the field of assisted reproduction. Specifically, immumonagnetic cell selection is based on a natural system of the body itself called programmed cell death (apoptosis). This phenomenon induces sperm destruction even if the sperm presents apparently normal form and motility. The use of this technique that Embriogyn has pioneered in Spain helps to eliminate the damaged spermatozoa, thus improving their fertilization capacity leading to a successful pregnancy.

    How does it work?

    A proteine called Annexin V binded to a magnetic particle can recognize and attach itself to fragmented or degenerated spermatozoa. This selective attachment permits their separation from healthy spermatozoa.

    Indications:

    • DNA fragmentation tests above 15%
    • Males who have undergone chimio or radiotherapy
    • Altered FISH
    • Severe seminal alterations
    • Males with testicular varicocele
    • Repeated abortions
    • Sterility of unknown origin
    • Invitro fertilization treatment failed attempts
    • Males of advanced age
    • Males with toxic habits (tobacco,alcohol…)

    Semen samples can be frozen and kept at -196ºC, by means of a safe, widely tested procedure that allows its maintenance for an indefinite period of time as established by Assisted Reproduction Law 14/2006 ensuring sperm survival of around 95% post defreezing.

    There are several reasons why patients decide to freeze semen samples, for instance:

    • Before vasectomy (definitive male sterilization)
    • Before undergoing chimio or radiotherapy, as these treatments can reduce and/or completely block the capacity to produce sperm.
    • Very low quality samples at risk of deriving into azoospermia (absence of sperm in the ejaculate)
    • Testicular biospsies (TESE) or epididymal aspiration (TESA)
    • Difficulty to produce ejaculate
    • Impossibility to be present on the day the sample is needed whether because of work or personal reasons, etc.
    • Sperm bank

    Sperm sample freezing

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    Sperm sample freezingAssisted Reproduction Law 14/2006 (http://www.boe.es/buscar/pdf/2006/BOE-A-2006-9292-consolidado.pdf) ensuring sperm survival of around 95% post defreezing.

      There are several reasons why patients decide to freeze semen samples, for instance:

    • Before vasectomy (definitive male sterilization)
    • Before undergoing chimio or radiotherapy, as these treatments can reduce and/or completely block the capacity to produce sperm.
    • Very low quality samples at risk of deriving into azoospermia (absence of sperm in the ejaculate)
    • Testicular biospsies (TESE) or epididymal aspiration (TESA)
    • Difficulty to produce ejaculate
    • Impossibility to be present on the day the sample is needed whether because of work or personal reasons, etc.
    • Sperm bank