There will be hormone tests that will be assessed in the male at the time of initial investigation. The standard tests and their order of succession, purpose and the procedures involved are noted in the diagnostic tests section. Scheduling of tests may vary according to your individual circumstances but the general rule of thumb is to proceed from the simple and low-risk tests, to those tests which may be more invasive. It is absolutely necessary that both partners be investigated simultaneously. Laboratory tests will be done at the time of the initial interview, including extensive hormonal profiles of the male and female.
A semen analysis is the single most important test in the evaluation of the male. A semen analysis will be performed to detect if the infertility is due to the male factor. The semen specimen is assessed for volume of ejaculate, motility, concentration and sperm count. Early detection of male factor infertility may influence the further course of testing of the woman, or the male will undergo a more in-depth evaluation of his sperm (sperm wash assessment - see below), while the woman completes her tests. Abstinence of ejaculation must be no less than three days and no more than five days.
Sperm Wash Assessment
A sperm wash assessment is a very in-depth evaluation of the sperm. Not only do we look at the basic parameters of the semen specimen, such as volume, motility, concentration and sperm count, we perform a computer analysis (CASA) and a full washing (removing of the seminal fluid) as would be done for an intrauterine insemination. Other tests that may be performed are: Strict Sperm Morphology, Anti-Sperm Antibody (MAR), Vital Staining, and Endtz’s Test for the detection of white blood cells in semen.
Under the leadership of Dr. Tamer Said, all of our technicians are trained to give detailed information about each one of the components of the sperm. We know that the ability to accurately assess the sperm correlates with the ability of the sperm to affect fertilization and normal embryo developments. Depending on these findings we may assess certain sub-components of the sperm head (such as acrosomes), mid piece or tail (movements abnormalities), that may be detected with more advanced tests such as molecular biology techniques or electron microscopy. At this time, we are attempting to enhance the motility to the maximum we possibly can. The semen specimen is washed with a special medium that removes the seminal fluid and dead sperm. Only the most healthy, motile sperm are used for insemination. This technique is necessary for all couples undergoing investigation.
Sperm DNA Damage
Currently, the sperm DNA integrity stands as an independent measure of sperm quality. This parameter could be overlooked leading to failure of conception during natural conception or during the course of Assisted Reproductive Techniques. DNA fragmentation in sperm may be the result of many factors including, but not limited to disease, diet, drug use, high fever, elevated testicular temperature, air pollution, cigarette smoking and advanced age. At ReproMed, we offer the Sperm Chromatin Structure Assay (SCSA®), the most standardized methods, for assessment of sperm DNA Damage.
Vasectomy is one of the common methods for male contraception. Nevertheless, spermatozoa tend to persist in seminal fluid for variable durations following the vasectomy procedure. That is the reason why most physicians advise patients to use an alternative method of contraception for few weeks following the operation. A post-vasectomy screen is available for those patients who have recently had a vasectomy. This method provides assurance regarding the results of the procedure.
Sperm Binding Assay
Hyaluronan binding assay (HBA) determines the maturity of sperm in a fresh semen sample. The assay is based on the ability of mature sperm to bind to the substance hyaluronan, which is a major component of the external coating of female ova (eggs). The ability to bind to hyaluronan is not present in immature sperm and is necessary for proper sperm function. In addition, HBA represents a more convenient and reproducible laboratory test for identifying candidates for intracytoplasmic sperm injection (ICSI), an advanced assisted reproductive technique.
The goal of testicular biopsy in patients where no sperm could be found in the ejaculate (azoospermia) is the discovery of reasonably normal spermatogenesis indicating a surgically correctable obstructive lesion. With the advent of newer assisted reproductive techniques, the clinical relevance of testicular biopsy has changed in recent years.
The testicular biopsy may provide critical information in demonstrating whether normal spermatogenesis exists or not. The detection of normal spermatogenesis in testicular biopsy remains necessary for the diagnosis of obstructive azoospermia. It is important to note that the information collected from a single testicular biopsy does not necessarily represent the universal condition of both testicles. Currently, it is well established that mature spermatozoa can be found even in men previously diagnosed with non-obstructive azoospermia.