Every man is different, and the cause and scope of male infertility varies from man to man as well. At the Center for Male Reproductive Medicine in Los Angeles, we use a set of detailed tests in order to determine the extent of male infertility that you are dealing with, the causes for male infertility, and the best possible ways to overcome the exact type of male infertility that you are experiencing.
By using a variety of sophisticated tests, we can achieve a complete understanding of your situation. All these tests allow us to direct a couple into the therapy that may help them conceive the quickest and least expensive/invasive way.
Semen analysis is the most fundamental tests used in the diagnosis and analysis of male infertility problems. This testing provides important information about the quality and quantity of a man's sperm.
The semen sample is analyzed for volume, viscosity (thickness), pH and color of the ejaculate, sperm concentration and other factors. The sample is also examined for the presence of white or red blood cells which may indicate infection or inflammation. We perform both manual and computer assisted semen analyses (also known as CASA). From this simple test, we can tell how many sperm are present, how many appear normal and how many are moving.
A semen analysis does not assess sperm function. It does not answer the question “are the sperm good enough to conceive”. More sophisticated tests of sperm quality such as the Sperm Chromatin Structure Assay (SCSA) can better help assess the “health” of the sperm when looking deeper into the causes or reasons for male infertility.
The semen sample should be collected at the laboratory in a special sterile container after a 2-3 day period of abstinence from ejaculation. Alternatively, the sample may be brought in from home within 1 hour of ejaculation.
The sample should be maintained at body temperature which can easily be done by placing the container in a shirt pocket. No lubrication should be used while obtaining the sample as it can be toxic to sperm.
Occasionally, due to religious reasons, the sample may have to be obtained during intercourse. A special condom designed for this purpose will be provided.
A minimum of two semen analyses provided several weeks apart, and collected in a similar manner, is recommended because sperm counts tend to fluctuate. We never rely solely on one sperm count.
Sperm DNA Fragmentation Analysis
As mentioned above, testing the sperm for the level of DNA damage can help us determine how the sperm will perform under various conditions, such as natural conception, Intra-uterine Insemination (IUI) and In-Vitro Fertilization (IVF).
In addition to the parameters tested in a sperm analysis, sperm quality is dependent on the amount of damage to the sperm DNA or DNA fragmentation. Simply put, DNA is arranged in a double helix or ladder configuration with side rails and rungs. If the rungs are broken, then the ladder is unsteady and won’t function properly.
Studies have demonstrated that the degree of DNA fragmentation correlates very highly with the inability of the sperm to initiate a birth regardless of the technology used to fertilize the egg such as insemination, IVF or ICSI. Spermatazoa with high DNA fragmentation may fertilize an egg, but embryo development stops before implantation or, if it initiates a pregnancy, there is a significantly higher likelihood that it will result in miscarriage.
By combining this information with the parameters of the semen analysis and high density sustainability (a test that looks at sperm chromatin maturity) and the oxidative stress assay (OSA) which measures the levels of toxins in the semen, a much clearer picture can be obtained of a man’s fertility potential when evaluating possible causes of male infertility.