Historically for decades the best predictor of a man’s fertility has been his semen parameters. These include semen volume, sperm counts, motility, and the morphology (percentage with normal appearance). These are certainly the basics that need to be at certain levels to have reasonable odds at pregnancy, but more and more, we are learning that the basic semen parameters are fairly crude assessments of a man’s fertility. At Austin Fertility & Reproductive Medicine/Westlake IVF Andrology laboratory, we are performing much higher levels of testing on sperm.
Along with a standard semen analysis all samples examined at the Andrology lab at Westlake IVF 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.
The Andrology laboratory at Westlake IVF offers a highly-specialized test called “Antisperm Antibody” testing. 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.
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. The andrologist at Westlake IVF assesses 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.
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.
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.
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. At Westlake IVF, a highly specialized sperm DNA fragmentation index evaluation is being offered. This 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 Reproductive Urologist at Austin Fertility & Reproductive Medicine.
There may be other testing that are being assessed from a research standpoint such as oxidative stress testing, sperm capacitation testing, and sperm DNA methylation testing, which are not standards yet, but may further contribute to our understanding of male infertility in the future.