STUDY OF THE
MALE FERTILITY
Diagnostic techniques
WHAT IS THE STUDY OF MALE FERTILITY?
The study of male fertility or andrology can be key in fertility treatments and should not be neglected. We recommend doing a good male fertility study, as it can provide very useful information in the diagnosis and possible solutions. Depending on the initial results obtained and the couple’s previous history, 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 of the male reproductive system, the andrologist, will even be required.
TESTS THAT CAN BE PERFORMED
ACCORDING TO THE NEEDS IN EACH CASE
SEMINOGRAM
It consists of studying the semen sample. Semen is a secretion formed by seminal plasma, coming from the seminal vesicles and the prostate, and by spermatozoa (male reproductive cells produced in the testicles). The seminogram assesses some macroscopic aspects of the ejaculate such as volume, liquefaction, viscosity, PH, agglutination, etc., but its greatest interest is in the microscopic study.
The microscopic parameters that are most relevant for sperm study are:
- Sperm concentration : amount of sperm in the sample
- Sperm motility: assessment of the swimming ability of spermatozoa. Depending on how they move, they are classified into different degrees:
- Rapidly progressive spermatozoa (grade “a” or +++)
- Slow progressive spermatozoa (grade “b” or ++)
- Non-progressive spermatozoa (grade “c” or +)
- Immotile spermatozoa (grade “d”)
- Sperm morphology: sperm are analyzed according to the shape and size of the head, middle piece and tail.
Knowledge of these basic parameters will help us understand the fertile potential of men, but it is important to know that there is great biological variability in sperm production, even within the same patient. For this reason, it is important that the interpretation of the results is carried out by a specialist, since the diagnosis obtained does not guarantee fertility. Normally, 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 to know the seminal situation in a more representative way of that person.
MOBILE SPERMATOZOID RECOVERY TEST (REM TEST)
It consists of eliminating seminal plasma, sperm with no or little mobility, and those with poor morphology and, on the other hand, recovering and concentrating the population of sperm with good mobility and morphology.
This test allows us to assess the efficiency of recovering good quality sperm from an ejaculate and therefore determine the most appropriate assisted reproduction treatment based on the number of sperm recovered.
If the total number of progressive spermatozoa recovered is greater than 5 million, it will be possible to perform Artificial Insemination with all its effectiveness, provided that this therapeutic technique is indicated. If the number of spermatozoa recovered is less than 5 million, the indicated treatment would be In Vitro Fertilization.
IVF CONTROL
In the IVF Control, the same procedure is performed as in an REM Test and, in addition, the treated sample obtained is analyzed within 24 hours to assess the survival of the sperm and verify that there is no bacterial contamination. In the event that bacterial contamination is observed, a seminal culture will be performed on a new sample and an antibiogram will be performed to determine if it is necessary to indicate the administration of a specific long-term antibiotic (10-21 days) before performing any type of treatment.
FISH – GENETIC STUDY OF SPERMATOZOIDS
FISH (Fluorescent In Situ Hybridization) is a cytogenetic technique that allows the quantification of the number of chromosomes in a spermatozoon by marking them with a fluorescent probe. To be genetically normal, spermatozoa must have 23 chromosomes, that is, a single copy of each chromosome (the non-reproductive cells of the human body have 46 chromosomes). The objective of knowing whether spermatozoa contain the correct number of chromosomes is to determine whether the process by which spermatozoa are formed, meiosis, is correct and therefore these are spermatozoa that can provide the correct genetic information to the embryo they generate. It is known that alterations in the number of chromosomes in spermatozoa can cause sterility and infertility.
Usually, this study includes the analysis of 5 chromosomes (13, 18, 21, X and Y) which are the ones that most frequently present alterations.
Indications:
- Moderate and/or severe changes in semen
- Man with altered karyotype
- Repeat miscarriages
- Sterility of unknown origin
- IVF Bankruptcies
Interpretation of results:
When a man is diagnosed with an altered FISH, it means that he has a percentage of sperm with an abnormal number of chromosomes (either with more or fewer chromosomes) compared to a fertile control population. This, in turn, means that these sperm more frequently generate embryos with chromosomal alterations that have a low probability of implantation and, on the other hand, a high probability of abortion. In these cases, it is recommended to perform a Preimplantation Genetic Diagnosis (PGD) associated with an In Vitro Fertilization to select for transfer to the maternal uterus only those embryos that are chromosomally normal.
STUDY OF DNA FRAGMENTATION IN SPERMATOZOIDS
For a sperm to have good fertile potential, it must contain intact and stable genetic material at the time of fertilization; otherwise, it generates low-quality embryos that are less likely to get pregnant and lead to more frequent abortions.
There are several causes that produce sperm DNA fragmentation: increased testicular temperature (wearing tight clothing, fever or varicocele); presence of oxidizing molecules in semen; metabolic alterations (in cases of overweight or diabetes); use of certain medications, advanced age (over 45 years old), toxic habits (smoking, alcohol, etc.).
The higher the sperm DNA fragmentation index, the lower the fertilizing capacity of that individual.
0-15% Fragmentation – Values within normal limits
15 %-30% Fragmentation -Increased fragmentation
+30% Fragmentation – Compromised fertilization capacity
The measurement of DNA fragmentation provides very valuable information to clinicians 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.