• Semen Analysis
• Intra-Uterine Insemination (IUI)
• Sperm Function Tests
• Sperm DNA Fragmentation
• Semen Freezing
• Sperm Retrieval Techniques
• Semen Freezing & Semen Banking

Skilled andrologists pinpoint the causes of male infertility and prepare sperm for use prior to IVF, IUI and sperm freezing. play an important role in the treatment of male infertility, working closely with fertility specialists to optimize sperm for use in advanced assisted reproductive technology.

A semen sample can be collected by the male at home or at the Andrology collection room. After the semen sample has been collected, the main parameters analyzed include volume of semen, concentration of sperm, motility, and morphology. After the semen sample has been analyzed, the report is reviewed and signed by our Urologist.

Andrology lab performs semen analysis to evaluate samples for:

• Volume of seminal fluid
• Sperm concentration – the amount of sperm present in the ejaculate
• Motility – the sperm’s ability to propel themselves
• Progression – the sperm’s ability to move in a straight direction
• Morphology – the percentage of abnormally shaped sperm
• Anti-sperm antibodies – the presence of which can prevent fertilization or sperm movemen
• Sometimes, agglutination (also known as “clumping”) of sperm cells can be seen when the sample is visualized under the microscope. If the andrologist reports significant agglutination on the semen analysis report, then antisperm antibodies may be present and antisperm antibody testing may be recommended. There are 2 types of Antisperm Antibodies, IgA and IgG, which are from the immune system and may be attached to the head, midpiece, and/or tail of sperm and can potentially impact fertility.

Along with a standard semen analysis all samples examined ,patients undergo an evaluation for leukocytes, or white blood cells. Leukocytes can look very similar to immature sperm cells so it is important to be able to differentiate between the 2 cell types, which is accomplished by using a special stain that allows differentiation between the 2 types. If there are a large number of leukocytes in the semen, this is an indicator of infection or inflammation which will need to be treated by the Reproductive Urologist to improve fertility potential

Post-ejaculatory Urinalysis:

Some men will not have sperm in the semen due to a process known as retrograde ejaculation. This is when sperm go backwards into the bladder rather than out the urethra as they should, and they simply are urinated out with the man’s next voiding of his bladder. This may be seen in men with diabetes, spinal cord injuries, men who have had prostate surgery, are on specific medications, or have other potential risk factors for retrograde ejaculation·Assessment of retrograde ejaculation by obtaining a urine sample immediately after orgasm and can identify sperm in the urine and can process the sperm to be used with assistance to help achieve a pregnancy when applicable.

Viability Testing:

In certain circumstances a semen analysis may show sperm with zero motility, or sperm with no movement. In such cases, it is important to know if the sperm are actually viable to help understand their fertilizing potential with levels of assistance. A specialized viability test is performed in the situations to help elucidate the level of viability of the sperm.

Pentoxyifylline:

When sperm have no or low motility, they can be treated with an agent called Pentoxifylline, which can stimulate sperm motility. This is used to help identify the level of sperm viability as well as helping the andrologist/embryologist to select more viable sperm cells to use with levels of reproductive assistance.

Sperm DNA Fragmentation Index (DFI):

Although the traditional semen analysis parameters of semen volume, sperm concentration, motility, and morphology are certainly important in the assessment of a man’s fertility potential, they may be a relatively crude assessment. They do not tell us about the integrity of sperm’s DNA or its ability to fertilize an egg and maintain a pregnancy.Analysis of sperm DNA is a high level test revealing what percentage of sperm cells in a man’s semen have damaged DNA. When there is a high percentage of DNA damaged sperm, there are associations with lower fertilization and pregnancy rates and higher miscarriage rates. This test is being offered for select patients who have risk factors for having higher levels of DNA fragmentation and the need for this level of testing can be discussed in consultation with a infertility specialist.

Sperm Identification from PESA/TESE:

In men with no sperm in the semen due to an anatomic blockage, such as a vasectomy, percutaneous epididymal sperm extraction (PESA) or testicular sperm extraction (TESE) can be performed to retrieve sperm. This is performed by a Reproductive Urologist in the sperm retrieval suite adjacent to the IVF laboratory with a minimally invasive technique. The andrologist/embryologist assesses the sperm retrieved for use or for cryopreservation for future use.

Sperm Identification from Microdissection Testicular Sperm Extraction:

In cases of nonobstructive azoospermia (NOA), in which a male does not have sperm cells in his seminal fluid due to inadequate sperm production, not due to a blockage, but may have some small pockets of sperm cells within the testicle, a surgery known as Microdissection Testicular Sperm Extraction (microTESE) may be performed by a fellowship-trained Reproductive Urologist. This surgery involves the removal of small biopsies of testicular tissue in the Operating Room; embryologists accompany Reproductive Urologist in the Operating Room and are able to evaluate the testicular tissue under a high-powered microscope at that time in the Operating Room. Sperm obtained through this process can be used in conjunction with invitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) to help couples in this challenging situation conceive.

Sperm processing techniques for ART procedures

IVF: Sperm preparation isolates the best possible population of sperm to either combine with retrieved eggs or inject directly into the eggs using intracytoplasmic sperm injection (ICSI).

IUI: Sperm washing isolates the best-quality sperm and combines them with a nourishing fluid prior to IUI to optimize fertility.

Sperm for freezing and storage. This allows men with male factor infertility to collect enough healthy sperm for use in IVF or IUI procedures, and preserves the fertility of men who wish to delay parenthood due to factors such as cancer treatment or military deployment.

Our embryologist's job starts with an assessment of the male partner’s sperm. We evaluate every specimen for concentration (the number of sperm present in each cc of semen), motility (the percentage of sperm that are alive and swimming), and normal morphology (the percentage of sperm that have a normal shape). We then choose the best sperm preparation technique to use so that we can get the greatest number of normally shaped, motile sperm to add to the eggs.

Once the eggs have been retrieved, they must be identified, removed from their cumulus cells, and placed into culture so that they can continue to mature in the laboratory. Approximately 5-6 hours after retrieval, several thousand moving sperm are either added to a droplet of culture media containing each egg (insemination), or – in cases where the sperm specimen is not of very good quality – a single sperm is actually injected directly into each egg by our embryologists using a tiny needle directed by robotically controlled instruments (ICSI). These eggs are then returned to their incubator for 18 hours of development, during which time fertilization hopefully occurs.

A Week in the Life of an Embryo

Day 1: After documenting fertilization, each embryo is placed in culture media that mimics the environment normally found in the fallopian tube.

Day 2: Embryos are allowed to continue growing without being disturbed.

Day 3: Embryonic development is assessed and a decision is made about next steps. In most cases, we will return the embryos to the incubator where they will continue to grow. In rare cases, we consider embryo transfer, or even embryo biopsy on day 3. If we are going to do your embryo biopsy on day 3, an embryologist will remove a single cell from each viable embryo for preimplantation genetic screening (PGS) or diagnosis (PGD) at this time.

Day 4: Embryos are allowed to continue growing without being disturbed.

Day 5: Aside from Day 1 when we confirm fertilization, Day 5 is perhaps the most important day in an IVF cycle. Day 5 is the first day that embryos reach the critical blastocyst stage. If we are planning on doing a fresh embryo transfer, this is the day that it most often occurs. If, on the other hand, we are planning on freezing all embryos, this is the first day that we start this process. In addition, for those patients who desire genetic testing of their embryos, this is the first day that we start to perform embryo biopsies as well.

Days 6 and 7: Embryos are reassessed for vitrification (freezing) and biopsy (if indicated).