Semen & Sperm Testing

About 25% of all infertility is caused by a sperm defect and 40-50% of infertility cases have a sperm defect as the main cause, or a contributing cause. It can be hard to determine whether the sperm problem is the only cause, or just a contributing cause to infertility. We know that men with very low sperm counts can sometimes have children - and some men with normal sperm counts can be infertile. Male infertility treatments begin with the testing, analysis and diagnosis of the cause of infertility - in order to restore fertility.

Physical Examination & History

Before starting any treatment , a physical examination of the male partner is performed in addition to a thorough evaluation of the patient’s medical history and lifestyle.

Semen Analysis

Our semen analyses are performed in a laboratory using a semen sample collected from the patient within the past hour. For accurate diagnosis, we ask the patient to abstain from sexual activity for two to five days preceding the collection. The analysis will give information about the following male factor criteria:

• Volume (amount of ejaculate)
• Concentration (sperm count)
• Motility (ability to move)
• Morphology (size and shape)
• Clumping
• Presence of white or red blood cells
• Hyperviscosity (thickening of seminal fluid)

Note: The Fertility Center of California is affiliated with MFS. We recommend choosing FCC for your lab work because Dr. Bastuba can easily step into the laboratory (located in the same building as MFS) to provide expert physician analysis. Most laboratories cannot call upon the patient's physician within a moments notice. However, we will happily work with ANY laboratory of your choosing!

SCSA® Testing & Interpretation

Dr. Bastuba offers interpretation of Sperm Chromatin Structure Assay (SCSA®) testing to his patients. SCSA® testing evaluates the level of DNA fragmentation in sperm, which is not detected by a conventional semen analysis (SA). Even sperm that appears to be normal in a routine SA may have extensive DNA fragmentation. Couples that have been idiopathic infertile for years and have shown high DFI values (DNA Fragmentation Index) have often turned to a sperm donor with success.

During a normal semen analysis, human eye measurements of the outside shape of sperm are taken. This sperm morphology is like the outside shape of an airplane and may relate to how easily it moves through a substance. SCSA® testing looks at the “cargo” inside the plane and how the DNA integrity may relate to early embryogenesis (the process of a developing embryo) that has been shown to be associated with miscarriages.

These heart-breaking events can have a significant impact on the overall success rates for couples undergoing IVF. Extensive research is now ongoing in this country and throughout the world to further determine the relationship to abnormal SCSA® testing and fertility potential in various situations. While this testing is ongoing most authorities already agree that it is likely to be an important test for the future and it will become more useful as more information is gathered. For more information go to www.SCSAdiagnostics.com.

While it is not currently the standard of care, many IVF programs are looking at this information closely before proceeding to IVF. As the DFI is elevated, sometimes male-side evaluation is warranted to see if the DFI can be lowered beneath what is felt to be the statistical threshold level of ~30%. A DFI of <15% has been shown to provide the highest fertility potential.

SCSA® Testing vs. Semen Analysis

The SCSA® test does not replace the traditional semen analysis, but rather complements it with additional information. The principle of the SCSA® is that a dye, acridine orange, binds to fragmented DNA and produces a red color while sperm without DNA fragmentation are green in color. SCSA® testing is done by passing 5,000 sperm through a narrow glass channel intersected by a laser beam. The laser beam causes the sperm to produce a green to red color. The nature and extent of sperm DNA fragmentation is determined by two independent measurements of the same semen sample. The precision of measurements is extremely high with only a variation of ~1% between measurements.

The details of the SCSA data are calculated by software called SCSAsoft® which is specifically designed to handle a large amount of complex data. The two primary measures are: 1) % DFI, i.e., the percent of sperm with fragmented DNA. Data accumulated on thousands of semen samples, created a statistical threshold level of 30% DFI. This means if a man has >30% DFI, he is placed into a statistical group of men that have been shown to take a longer time to have a natural pregnancy, need more IVF cycles or more embryos transferred per cycle and a near doubling of the spontaneous miscarriage rate or no pregnancy rate. Thus, samples above 30% DFI does not preclude a full term normal pregnancy, but it provides an indicator for increased patient management to maximize a pregnancy. 2) High DNA stainable (HDS) sperm. These sperm are immature sperm that have some irregularities that inhibit fertilization in vivo or routine IVF. A high percentage of such sperm in a semen sample may suggest the use of ICSI for maximizing as pregnancy.

Sperm Chromatin Structure may be altered by various abnormalities such as varicoceles, poor nutrition, life-style activities such as smoking, hot tub use, poor nutrition, heat to testis, air pollution, exposure to pesticides, various prescription or over the counter medications, high fever and diseases such as cancer. The DFI may also be elevated by infections of the prostate and epididymis. Therefore Dr. Bastuba often recommends both semen analysis and SCSA® Testing since the tests analyze different aspects of the sperm and may lead to a more effective diagnostic and therapeutic regiment.

Genetic Testing

Genetic factors may interfere with the reproductive processes by affecting either the number or quality (or both) of sperm production and may affect the structure or function of the male reproductive tract. At this time, only a limited number of genes are available for diagnosis. The identification of any genetic defect provides important, and possibly definitive, information about the cause of male infertility. In addition, patients who are considering in-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) can be counseled about the risk of passing on genetic defects to their offspring. Detection of any of these genetic abnormalities will allow us to better diagnose and treat causes of male infertility.

Diagnostic Tests

Testicular biopsy involves taking a small piece of tissue from the testis while the man is under either local or general anesthetic. The tissue is carefully prepared and assessed under a microscope to determine the presence of sperm-producing cells and whether the sperm production process is normal. In a man with a zero sperm count, this test is done to determine if a blockage is present or if poor sperm production is the cause. In men with severe sperm production problems, this test can also determine whether small areas of sperm production are present in the testis, in which case sperm from the biopsy tissue may be used in infertility treatment. Even just a few normal sperm found in the biopsy tissue can be used in the assisted reproductive technique called intracytoplasmic sperm injection (ICSI) where a single sperm is injected into the egg by piercing the shell of the egg.

There are two types of testicular biopsy procedures:

• A needle biopsy is a technique that can be performed under local anesthesia that involves passing a small needle into the testis to obtain a sample of tissue about half the size of a match head.

• An open biopsy involves removing a larger fragment of tissue about the size of a couple of grains of rice after cutting through the skin and the thick outer covering of the testis. This procedure is typically performed while the man is under general anesthesia.

Additional Testing

Further testing may be necessary:

• Strict Sperm Morphology
• Endocrine Tests
• Sperm Penetration Assay (SPA)
• Antisperm Antibody Measurement
• Vasography
• Scrotal Ultrasonography or Venographys