Andrology
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Andrology is the branch of medicine concerned with diseases specific to the male sex, particularly infertility and sexual dysfunction. Sample identification is our top priority. At the time of collection all male partners are asked to label BOTH the side of the collection cup, as well as the top, with both partner’s first and last names, the date, and the time collected. Once the sample reaches the andrology lab we assign it a unique accession number. All test tubes, pipettes and any material that will come in contact with the sample are labeled with the patient’s name. Rigorous identification checks are performed throughout the processing of the sample. All information on the vial is compared to the patient’s chart by both the clinician performing the insemination, and a member of the lab personnel. The sample is then identified by the patient prior to insemination.
Semen Analysis
A Semen Analysis is an overall evaluation of the quality of a semen sample. It is a quick and simple method of either diagnosing or ruling out the male partner as a contributing factor for infertility. A complete semen analysis should be done at the beginning of a couple’s course of infertility treatment. A simple semen analysis is also conducted on every sample collected for use in a fertility treatment procedure.
The following parameters are measured and compared to standard values that are defined by the World Health Organization:
- Volume – the amount of seminal fluid present. Normal volume ranges between 2-5 mL.
- Concentration – the number of sperm per milliliter of sample. Normal sperm concentration is greater than 20 Million per mL.
- Motility – the percentage of the sperm that are actually moving. The motile sperm are considered viable, however the viability of non-motile sperm cannot be determined by sight. Normal motility is greater than 50%.
- Progression – a measure of how well the motile sperm are moving in a forward direction. Normal progressing sperm are between 2+ and 3+ on a scale of 0-3+.
- Morphology – the shape of the sperm. The size and shape of the head, midpiece and tail are examined. A specimen with greater than 14% normal sperm structure is considered normal.
- The color, pH, and the number of red and white blood cells are also recorded.
Semen Cryopreservation
Semen cryopreservation is the process whereby sperm is frozen for future use. Any male who is planning to undergo medical procedures that may leave him sterile may wish to consider semen cryopreservation. Cancer treatments such as radiation and chemotherapy often reduce fertility or cause sterility. Certain surgical procedures or intensive medication therapy may also result in reduced fertility or sterility. Semen cryopreservation allows semen samples to be stored prior to any procedure of this type, helping to insure the preservation of fertility. Often times, male partners who are scheduled to be out of town during the course of infertility treatment, will freeze a semen sample for use during their absence. Males having difficulty collecting a sample on demand for a procedure may also choose to freeze a sample in advance.
A simple semen analysis is first conducted on the sample. A cryoprotectant, which protects the sperm during the freezing process, is added to the semen sample and gently mixed. The suspension is cooled in a refrigerator for a length of time, and placed into liquid nitrogen vapors. The vials are then labeled with the patient’s information, filled with the sample, arranged on a metal cane that is labeled and assigned to only one patient, and then plunged into liquid nitrogen. They are maintained in a liquid nitrogen tank for long term storage.
Semen Preparation for ART Procedures
Semen samples must be prepared for all ART procedures including IUI, IVF, and ICSI. In addition to sperm, seminal fluids contain red or white blood cells, particulates, bacteria, and proteins, which may cause cramping if placed directly into the uterus. During standard intercourse, the vagina acts as a natural filter, allowing only the sperm to enter the uterus, and thereafter the fallopian tubes. Through IUI, the sperm is placed directly into the uterus, and thus the sample must be “washed” to remove the undesired debris before the procedure.
The semen sample is added to wash media and centrifuged. Centrifuging spins the specimen, leaving an upper layer containing the unwanted debris and seminal plasma, and the bottom layer containing the concentrated sperm. The upper layer is removed, and fresh wash is added to the sperm layer. The specimen can then be utilized for insemination or for IVF/ICSI.
