MALE FERTILITY STUDY
Diagnostic techniques
WHAT IS THE STUDY OF MALE FERTILITY?
The study of male fertility or andrology can be key to fertility treatments and should not be neglected. We recommend a good study of male fertility, as it can provide very useful information in the diagnosis and possible solutions. Depending on the first results obtained and the previous history of the couple, it may be advisable to carry out more specific andrological studies and tests, of functionality and/or genetics. In some cases, a visit to the specialist in the male reproductive system, the andrologist, will even be required.
TESTS THAT CAN BE PERFORMED
AS REQUIRED IN EACH CASE
SEMINOGRAM
Consiste en el estudio de la muestra de semen. El semen es una secreción formada por plasma seminal, procedente de las vesículas seminales y de la próstata, y por los espermatozoides (células reproductoras masculinas producidas en los testículos). El seminograma valora algunos aspectos macroscópicos del eyaculado como el volumen, licuefacción, viscosidad, PH, aglutinación, etc, pero su máximo interés está en el estudio microscópico.
Los parámetros microscópicos y la vez más relevantes para el estudio espermático son:
- Sperm concentration: number of spermatozoa in the sample
- Spermatozoa mobility: assessment of the spermatozoa’s natural capacity. According to how they move, they are classified in different degrees:
- Fast progressive spermatozoa (grade “a” or +++)
- Slow progressive spermatozoa (grade “b” or ++)
- Non-progressive spermatozoa (grade “c” or +)
- Non-mobile spermatozoa (grade “d” )
- Sperm morphology: the spermatozoa are analysed according to the shape and size of the cap, the midsection and which.
The knowledge of these basic parameters will help us to understand the fertile potential of man, but we must know that there is a great biological variability in sperm production, even within the same patient. Therefore, it is important that the interpretation of the results be carried out by a specialist, since the diagnosis obtained does not guarantee fertility. Normally, in order to carry out a complete and validated study, it is advisable to evaluate 2 samples from the same individual with a difference of 2-3 weeks in order to know the seminal situation in a more representative way of this person.
MOTILE SPERM RECOVERY TEST (REM TEST)
It consists of eliminating the seminal plasma, the spermatozoa with no or little mobility, and those with bad morphology and, on the other hand, recovering and concentrating the population of spermatozoa with good mobility and morphology.
This test allows us to evaluate the efficiency of the recovery of good quality spermatozoa from an ejaculate and, therefore, to determine the most appropriate assisted reproduction treatment according to the number of spermatozoa recovered.
If the total number of progressive spermatozoa recovered exceeds 5 million, it will be possible to perform an Artificial Insemination with all its effectiveness, provided this therapeutic technique is indicated. If the number of spermatozoa recovered is less than 5 million, the indicated treatment would be an In Vitro Fertilization.
IVF CONTROL
In the IVF Control, the same procedure as in a REM Test is carried out and, in addition, the treated sample obtained is analysed within 24 hours to assess the survival of the spermatozoa and check that there is no bacterial contamination. If bacterial contamination is observed, a seminal culture will be performed on a new sample and an antibiogram will be taken to determine whether the administration of a specific long-term antibiotic (10-21 days) should be indicated before carrying out any type of treatment.
FISH – GENETIC STUDY OF SPERM
FISH (Fluorescent In Situ Hybridization) is a cytogenetic technique that allows us to quantify the number of chromosomes in a spermatozoon by marking them with a fluorescent probe. In order to be genetically normal, sperm must have 23 chromosomes, i.e. a single copy of each chromosome (non-reproductive cells in the human body have 46 chromosomes). The objective of knowing if the spermatozoa contain the correct number of chromosomes is to determine if the process by which the spermatozoa are formed, meiosis, is correct and therefore they are spermatozoa that can provide the correct genetic information to the embryo they generate. It is known that alterations with the number of chromosomes in the sperm can cause sterility and infertility.
Usually, this study includes the analysis of 5 chromosomes (13, 18, 21, X and Y) which are the most frequently altered.
Indications:
Moderate and/or severe alterations of semen
Male with altered karyotype
Repeat abortions
Sterility of unknown origin
IVF bankruptcies
Interpretation of the results:
When a man is diagnosed with an altered FISH, it means he has a percentage of sperm with an abnormal number of chromosomes (either over- or under-chromosomes) compared to a fertile control population. This, in turn, means that these sperm generate more frequently embryos with chromosomal alterations that have a low probability of implantation and on the other hand, a high probability of miscarriage. In these cases, it is recommended to perform a Pre-implantation Genetic Diagnosis (PGD) associated to an In Vitro Fertilization to select for the transfer to the maternal uterus only those embryos that are chromosomically normal.
STUDY OF DNA FRAGMENTATION IN SPERM
For a sperm to have good fertile potential, it must contain complete and stable genetic material at the time of fertilization, otherwise it generates low-quality embryos that become less pregnant and result in more frequent abortions.
Sperm DNA fragmentation is produced by several causes: increase in testicular temperature (use of tight clothing, fever or varicocele); presence of oxidant molecules in the semen; metabolic alterations (in cases of overweight or diabetes); use of certain medications, advanced age (over 45 years), toxic habits (tobacco, alcohol …)
The higher the sperm DNA fragmentation rate (FI), the lower the fertilizing capacity of this individual.
0-15% Fragmentation – Values within normality
15% -30% Fragmentation -Increased fragmentation
+ 30% Fragmentation – Compromised fertilisation capacity
Measuring DNA fragmentation provides clinicians with valuable information to indicate treatments with antioxidants or the therapeutic application of MACS or FERTILE for the selection of non-fragmented sperm from a sperm sample in the same In Vitro Fertilization treatment.
MAKE AN APPOINTMENT
It’s quite simple. All you have to do is contact Embriogyn and make an appointment with our specialists at the time that suits you best. In case you can’t come in person to the clinic, visits can also be arranged via Skype.