The infertility work-up also requires that
the male partner complete a personal history form that provides your physician
with important information about your medical history. Your responses help
determine whether your initial screening will include only the basic
components or some additional testing. The questions relate to:
- Lifestyle, including smoking, alcohol and
caffeine consumption, use of narcotics and stress
- Medical history, including sexually
transmitted diseases, autoimmune disorders and other diseases
- Medications
- Surgery
Routine Blood Tests and Other Screening
Clinical screening required for the male partner includes blood tests for:
- HIV
- Hepatitis B and C
- Sexually transmitted diseases/VDRL
If indicated by your history, blood testing
or other factors, additional screening may be ordered. This may include:
Hemoglobin electrophoresis
Genetic screening and chromosomal
analysis to identify hereditary diseases. Some genetic testing is
done through analysis of blood samples. Genetic defects also can be
identified through examination of embryos as part of an IVF cycle, a
procedure called preimplantation
genetic diagnosis (PGD).
Psychological screening and
counseling to determine whether you fully understand and are
prepared to deal with the physical, emotional and legal ramifications of
infertility treatment.
Semen Analysis
Semen analysis can indicate a host of problems contributing to infertility
but, basically, it lets your physician know whether the male is producing
enough high-quality sperm to reach and fertilize an egg. As part of the male
work-up, andrologists (laboratory technicians with special training in this
area), examine a semen specimen to determine:
Semen Volume and Thickness
– how much fluid is ejaculated and whether it is too thick for normal
movement of sperm. A normal specimen will contain >2cc of fluid that is
free of hyperviscosity, abnormal thickening.
Sperm Count - how many sperm
are present in a milliliter of fluid. Normal is indicated by more than 20
million sperm in a milliliter of fluid.
Sperm Motility and Movement
– how many sperm are moving and whether they are moving forward. More than
50% of sperm should be moving, with more than >2% showing good forward
movement.
Sperm Morphology – how many
have a normal shape, including an oval head and tail. In a good sample,
>4% of sperm will have a normal shape.
The andrologist also determines whether your
sample contains too many white blood cells, indicating the presence of
bacteria, sexually transmitted diseases or infection of the urinary tract. If
the specimen is positive for infection, antibiotics or other treatment may be
required before proceeding with other infertility care. If your test results
indicate other abnormalities that must be examined further, you will be
referred to a urologist for a complete examination.
In addition, your semen will be screened for antisperm antibodies. These
substances result when a male’s immune system mistakes sperm for foreign
bodies that must be destroyed. The antibodies make the sperm clump together or
otherwise lose their ability to move, precluding fertilization. Treatment
includes steroids or sperm washing, Intrauterine
Insemination (IUI) or in
vitro fertilization (IVF).
Proper collection, handling and preparation of semen are necessary to ensure
an accurate analysis. Treatment decisions will be based in part on the
availability of high quality sperm. The analysis may indicate that assistance
is required to increase the chances of fertilization, and IUI or (IVF) may be
required. Both procedures require another sample on the day they are
performed, so the sperm can be washed and prepared. Severe male infertility,
resulting in few or no sperm in the ejaculate, may require surgical procedures
such as microsurgical
epididymal sperm aspiration (MESA) or testicular
sperm aspiration (TESA). In these cases, intracytoplasmic
sperm injection (ICSI) is used. This technique involves the injection of a
single sperm, extracted from tissue, directly into an egg that has been
retrieved from the female. Donor sperm is required if the male partner’s
sperm cannot be used.
Instructions for Collection of Semen
The semen sample used for analysis must be fresh and handled properly to
preserve its quality and avoid contamination. It should be collected, by
masturbation, into a sterile container, or into a non-spermicidal Male-pakTM
condom during sexual intercourse. To ensure accuracy of the analysis, it is
important that you abstain from sex or emission of semen for two to five days
prior to sperm collection. The specimen must include all of the ejaculate and,
once collected, it cannot be subjected to heat, cold or other factors
affecting semen quality.
We prefer that you provide your sample in a private collection room at our
office to avoid problems that can occur during transportation. You will be
given a sterile container to collect the ejaculate and mineral oil to use as a
lubricant, if needed. The sample will be given to an andrologist, using a
pass-through between the collection room and laboratory.
Should you choose to bring a sample with you from home, it is very important
that you follow these directions carefully:
1. To prepare for your sample:
a. Abstain from sex or emission of
semen for two to five days prior to collection
b. Obtain Squibb’sTM
Mineral Oil and a sterile container from our office or a pharmacy. This
oil is the only lubricant you should use when collecting
sperm for your sample. Others, including saliva from your partner, will
make the sample invalid. If you are using a Male-PakTM
condom, you can obtain that from us as well.
c. Label the container with both your name and your
partner’s name.
2. To obtain your sample:
a. Use only
Squibb’sTM
Mineral Oil for lubrication, if needed.
b. Emit the sample into the sterile container and be sure to
collect the entire ejaculate. When using the condom, be careful not
to lose any ejaculate as you remove and place it in the sterile container.
3. To transport your sample:
a. Bring the sample to us within
90 minutes of collection.
b. Protect it from heat and cold during transportation by carrying
it in an inside pocket next to your body.
