- Lifestyle: including smoking, alcohol and caffeine consumption, use of narcotics and stress
- Medical history: including sexually transmitted diseases, autoimmune disorders and other diseases
Male Fertility Testing And Evaluation
The most common cause of male infertility is unexplained minor abnormalities in the semen, detected in a semen analysis – these can often be improved by improvement of the person’s general health. The most common general health issues we see in the United States are excess weight, poor diet, and lack of adequate sleep and exercise. There is significant data to demonstrate that optimizing male preconception health has a direct positive impact upon pregnancy outcomes.
The infertility work-up requires that the male partner complete a personal history form that provides your IRMS physician with important information about his medical history. His responses help determine whether your initial screening will include only the basic components or some additional testing. The questions relate to:
Clinical screening required for the male partner includes blood tests for:
- 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 testing (PGT).
- Semen Analysis – Semen analysis can indicate a host of problems contributing to infertility and lets your IRMS 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.
How To Collect A Semen Sample?
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-pak™ 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 one of our IRMS locations 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:
- Abstain from sex or emission of semen for two to five days prior to collection
- Obtain Squibb’s™ 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. Other lubricants, including saliva from your partner, will make the sample invalid as they can act as a spermicide. If you are using a Male-PakTM condom, you can obtain that from us as well.
- Label the container with both your name and your partner’s name.
2. To Obtain Your Sample:
- Use onlySquibb’s™ Mineral Oil for lubrication, if needed.
- 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 To IRMS:
- Bring the sample to us within 60 minutes of collection.
- Protect it from heat and cold during transportation by carrying it in an inside pocket next to your body.
- CHAIN OF CUSTODY OF YOUR SAMPLE IS CRITICALLY IMPORTANT.
ONLY THE PERSON WHO HAS PRODUCED THE SAMPLE IS ALLOWED TO DROP IT OFF TO IRMS AND THAT PERSON MUST BRING A VALID FORM OF STATE OR FEDERAL PHOTO ID.
IF YOU ARE a SAGE Patient you must also provide the name and contact information for the referring OB/GYN.