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Semen Analysis and advanced tests of the male partner

Why is a semen test required?

Male infertility may contribute to over half of all infertility issues. So, investigations into male infertility are vital if a couple are experiencing delay in getting pregnant. A semen analysis is the basic and most important test used in the diagnosis of male infertility. A man might be completely healthy, but a semen test may indicate that he produces few or poor-quality sperm. Sometimes a semen test uncovers that sperms are totally absent. This could indicate a blockage in the testicular ducts or failure of testicular function. A physical examination and hormone assessment may be able to find the cause.

What does a semen test include ?

A semen analysis checks the volume, consistency and appearance of semen prior to assessing the sperm themselves. The number of sperm (count), the speed and proportion of swimming sperm (motility), sperm size and shape (morphology), and presence of infection are all factors that have an impact on fertility.
 
In a semen analysis, the semen sample is assessed for:
 

  • Volume (the amount of semen produced): The “normal range” for this is wide, anything more than 1.5ml is considered normal. Any spillage must be reported to the lab.
  • Viscosity (the consistency of the fluid)
  • pH (acidic or basic nature)
  • Count (the number of sperm): This should be more than 15 million sperm per ml. Semen analyses can vary significantly and many men with a completely normal semen profile will occasionally have a low count. Recording the duration of abstinence before the collection is important.
  • Motility (the speed and proportion of moving sperm): A normal result for progressive motility is greater than 32%. Ideally the specimen should be collected in the laboratory as transport delays may affect motility. Otherwise, low motility samples are usually re-tested again after an interval.
  • Morphology (sperm size and shape): A normal result for morphology is greater than 4%. This test refers to the shape of the sperm. Abnormalities may be detected in the sperm structure in the tail, head and neck.

Steps involved in IUI

    • Trial Wash
      It is a sperm preparation test which involves removing any immotile and dead sperm from the sample, and preparing the sperm into a highly motile, clean pellet. What is being “washed” in a sperm washing procedure are the various constituents of semen and the remainder of the ejaculate not necessary to achieve fertilization of the egg. In this process, the number of sperms is reduced from the initial semen sample and gives better accuracy whether semen sample is suitable for any planned ART treatment.

    • DNA fragmentation test?
      DNA fragmentation of sperm nuclei has a detrimental effect on reproductive results. A sperm DNA fragmentation test uses flow cytometry to measure sperm chromatin stability and an estimate of the proportion of spermatozoa with fragmented DNA. Any couple undergoing assisted reproduction treatment may be required to undergo a sperm DNA fragmentation test. The test is generally recommended for men over the age of 40, those having varicocoele, history of smoking, who have had urinary-genital infections or have been treated for cancer. Any cause for high oxidative stress in the male may lead to increased DNA fragmentation.
      A sperm DNA fragmentation test can help couples who have had miscarriages or recurring failed cycles, poor fertilization or poor embryos in IVF or long standing idiopathic infertility.
      Even if general parameters of sperm such as motility, concentration, morphology are all within the normal range, sperm may still be the cause of unsuccessful results after the artificial insemination procedure. DNA fragmentation of sperm is manifested as a rupture of DNA strands in both, or just one DNA helix. If the rupture affects genes which are vital for the implantation and development of an embryo, then the embryo may not survive or may lead to miscarriage.

    • Tests in Retrograde Ejaculation
      Men with retrograde ejaculation may pass some or all of their semen into the bladder during ejaculation. The ejaculated sample samples and the sample that needs to be retrieved from the bladder are both examined to ascertain the presence of sperms. Specific urinary alkalinisers may be given prior to semen collection in such patients.

    • Hypo-Osmotic Swelling (HOS) Test
      This fairly simple test is used to distinguish immotile and dead sperms based on the semipermeability (ability to allow fluid to pass through it’s membrane) of the intact sperm cell. A live sperm cell will “swell” when placed in a solution that is “hypo-osmotic”, expanding the cell’s volume whereas the dead sperm will not . This test is easy to score and provides valuable information on the integrity and behavior of the cell membrane of the sperm tail.

    • Azoospermia (Zero Sperm Counts) and Genetic Links
      Recent advances in genetics have provided the “reasons” for severe male infertility (very low or zero sperm counts) in many men whose fertility problems were previously poorly understood. It is now known that 20-30% of men with such low (under 10 million/ml) or zero sperm counts have a now identifiable genetic cause for their problem. Y chromosome microdeletion and karyotype of the male may be advised in such cases along with certain hormonal tests, if indicated. It remains very important to not only treat these men, but to provide such couples with genetic information related to the problem causing it. This is important because many of these genetic issues may potentially be passed along to children conceived with the help of IVF. Men with Congenital bilateral absence of the vas deferens (CBAVD) should be tested for cystic fibrosis.

Farida Khan

My husband and I are very happy with the treatment we received. It was not that expensive either. We got a lot of confidence and we’re definitely planning to come back soon.

Saroj

After 20 years of marriage, we have been blessed with a baby girl. This blessing is not only from God but also from Dr. Manish Banker. We had tried various options and had undergone many treatments at different hospitals in Mumbai, but all efforts were in vain. After all these failed efforts, finally, Dr.Manish performed a miracle. I congratulate Dr. Banker for the astonishing success of 30,140 dreams

Ami Udayan Dave

The journey from being an employee to a patient was smooth and ultimately joyful as we were blessed with our first child. While the journey had its own set of anxieties, all is well that ends well. I am very grateful to the Centre in general and to each and every staff member in particular who played a very important role during the process. I wish others like me the best of life. Have faith and everything will turn out just fine.

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