Infertility Causes > Man > Semen Analysis

Overview - Evaluation - Treatment Options - Diagnosis

SEMEN ANALYSIS

Difficulty conceiving is related to some compromise of the sperm count or sperm function in as many as forty percent of all couples. Therefore, a semen analysis should be one of the very first tests done. A semen analysis is easy (ignoring the embarrassment some men may feel), inexpensive and noninvasive. Evaluation of the sperm is a point of discrimination: The sperm count will dictate which options are reasonable for a couple to pursue in their attempts to conceive. A severely compromised sperm count may, for example, mean that only rather sophisticated procedures are worthwhile, whereas a normal count would allow consideration of much more conservative procedures.

Heartland Laboratory and Andrology Services performs semen analyses using WHO criteria. This allows calculation of TMNS (Total Motile Normal Seprm). This number is extremely useful as it can be used to determine which treatment option will result in an acceptable chance of success. For example, general guidelines suggest that twenty million are needed for intercourse to be successful, 10 million for inseminations to have a good chance of success, about four million for IVF alone to be successful, and below that number ICSI must be considered.

SDFA

The Sperm DNA Fragmentation Assay is a test performed in the laboratory that assesses the extent to which the DNA inside the sperm has been fragmented. Some fragmentation is normal, but an excessive degree of fragmentation makes successful conception increasingly more difficult.

DNA Fragmentation Index (DFI) – the percentage of cells that have significant fragmentation:
0-15% high fertility potential
> 15% and < 30% good to fair fertility potential
30% and higher low to poor fertility potential

There are treatments available for elevated fragmentation indices: avoidance of toxins such as cigarette smoking and alcohol, avoidance of environmental toxins, consumption of increased doses of vitamins E and C, and correction of a varicocele if one is demonstrated on examination by a urologist.

A couple of studies (one from Italy, one from Oregon), have suggested that the degree of fragmentation can be significantly reduced by obtaining the sperm directly from the testicles rather than following ejaculation. We have now used this approach on five couples in which the male had a significantly elevated fragmentation index, and three of those couples have successfully conceived. Preliminary data in our hands strongly suggests that this is worthwhile.

SDD

The Sperm DNA Decondensation test assesses the capacity of the DNA inside the sperm to undergo the changes that are necessary for normal fertilization of an egg. An inability of the DNA to undergo these changes renders normal fertilization and therefore pregnancy virtually impossible. In this test, over 80% of the sperm must demonstrate normal capacity for decondensation.

Correction of abnormal SDD results involves many of the same steps listed above for the SDFA.

We currently perform both of these assays through Repromedix. Arrangements for these assays can be arranged through Heartland Laboratory and Andrology Services and through Carle Clinic Reproductive Medicine.

© 2005 Jarrett Fertility Group