Semen Analysis - Why You May Consider It

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Why would you be doing a Semen Analysis (SA)?

Since male factor accounts for about 35% of infertility, a RE’s office will administer a SA as one of the first tests they’ll do to diagnose you as a couple.
A SA measures the following:
Volume (measured in mL)
Liquefaction time
Sperm count (both the overall count and per mL)
Sperm motility (the percentage of sperm that are moving – these are your “swimmers”). Most clinics also measure how many sperm are moving forward, which is called the “forward motility” test.
Morphology (the percentage of sperm that have a normal shape).
The SA also measures the pH balance, number of white blood cells, and amount of fructose in the sample.

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What you can expect

Giving a sample
Generally, clinics require that you to not ejaculate for 48 hours before the test, BUT also do not abstain for more than 72 hours. In layman’s terms: they want you to ejaculate once between 2 and 3 days before the SA, but then abstain until after the SA.
Obviously, this is not a painful process, but it can be embarrassing. I have heard stories where someone’s husband had to use a bathroom off the waiting area to produce his sample – the poor guy! In most clinics, especially the bigger ones, though, they have a room set up with magazines (and even movies) for you to do his thing. And in most cases they’ll let the wife go in with him if he so desires.
Some clinics also allow for the sample to be produced at home if you live close to your clinic. Once the sample is produced, though, you need to keep it warm and get it to the clinic within 1 hour, or some of the sperm begin to die off.

Results
Generally you’ll get the results back within a couple of days of the SA, but it depends on your clinic. We got our SA results the following day.

Normal parameters of sperm are the following (*Based on World Heath Organization criteria, 1992. Table excerpted from Berger, G.S., Goldstein, M., and Fuerst, M. (1995). The Couple’s Guide to Fertility. New York: Doubleday):

Normal Ranges for a Semen Analysis*
Liquify?: Yes – within one hour
pH: 7.5 to 8.1
% Motility: Greater than or equal to 50%
% of 3-4 + Forward Motile Sperm: Greater than or equal to 50%
Sperm Concentration: 20-200 million per mL
Total Sperm Count: Greater than or equal to 40 million
Total Motile Sperm: Greater than or equal to 20 million per mL
White Blood Cells: Less than or equal to 1 million per mL
% Normal Morphology: Greater than or equal to 30%

Problems that might arise

There aren’t many problems that will present themselves in terms of the collection process, unless you miss the cup or can’t ejaculate.
If the results come back abnormal, your RE will suggest that you see a urologist, who can provide a further diagnosis. Additionally, at times, you can bypass sperm issues by trying IUI or even IVF with ICSI to get pregnant. I have also heard from my RE that there are other nifty high-tech sperm extraction procedures that can give you a chance of getting pregnant – even if your husband has a zero sperm count. At the same time, there will be men who will need to use donor insemination if this is your diagnoses.

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New Study Finds Sperm Quality Decreases as Males Age

Colorado Researchers Confirm Men, like Women, have a Ticking Biological Clock that Impacts Fertility



DENVER, Oct. 17, 2011 /PRNewswire via COMTEX/ -- A new study conducted by the Colorado Center for Reproductive Medicine (CCRM) in conjunction with the National Foundation for Fertility Research (NFFR) concludes that sperm from middle-aged and older male mice is less likely to lead to a successful pregnancy. The study, the first-of-its-kind, found that sperm quality began to decrease in males at mid-life, 12 months and older (equivalent to forty and older for human males).



"This is not a study observing male factor infertility. Rather, this is a study about once fertile males becoming infertile because of age," said Mandy Katz-Jaffe, PhD, Scientific Director of NFFR. "We were able to document when sperm from older males begins to suffer quality problems, and to understand the impact of older sperm on reproductive outcome."



This is the first longitudinal study following males over a lifetime to directly correlate sperm aging with reproductive success. Ten young male mice with proven fertility were mated every month during their lifetimes as they naturally aged with fertile young females. "This study is unique because we were able to remove infertility related to the female aging from the equation and focus solely on the male," said Katz-Jaffe. "This is something that is impossible to accomplish with human studies."



This study found that when proven fertile male mice reached mid-life (12 months = forties):



Eggs were less likely to be fertilized by aged sperm.



Embryos were less likely to develop in vitro.



Embryos were less likely to implant in the uterus.



Natural conceptions were far fewer. Only 50 percent achieved pregnancy naturally at 12 months (forties) and 10 percent naturally at 15 months (fifties).



Assisted reproductive technologies (ART) improved the chance of clinical pregnancy.



The few successful natural conceptions with aged sperm resulted in significantly smaller fetuses and placental weight.



"There is much focus in society on the 'maternal biological clock.' This study shows us that we also need to be concerned about the 'paternal clock,'" said William Schoolcraft, M.D., Founder and Medical Director of CCRM. "Men in their thirties should consider freezing sperm if they plan to wait to have children. Men in their forties and fifties should consult a reproductive endocrinologist if their partner is unable to conceive after six months of active trying."



About the Colorado Center for Reproductive Medicine



Founded in 1987 by Dr. William Schoolcraft, the Colorado Center for Reproductive Medicine is one of the nation's leading infertility treatment centers, providing a wide spectrum of infertility treatments ranging from basic infertility care to advanced in vitro fertilization (IVF) technology. Today, joined by Drs. Eric Surrey, Debra Minjarez and Robert Gustofson, Dr. Schoolcraft and his staff achieve some of the highest pregnancy rates in the country. CCRM has been ranked "The #1 Fertility Center in the U.S., with the Greatest Chance of Success" by Child.com. For more information, visit www.ColoCRM.com .



About the National Foundation for Fertility Research



The National Foundation for Fertility Research is 501 (c) (3) non-profit collaborative of internationally known researchers dedicated to advancing the field of reproductive medicine. The mission of NFFR is to ensure that all who seek fertility treatment have that joyous moment when they hold their baby for the very first time. Under the direction of Dr. Mandy Katz-Jaffe and her team of senior scientists and embryologists, NFFR research studies will continue to bring hope and new opportunities to couples seeking fertility treatment. For more information, visit www.fertilityresearch.org .



SOURCE Colorado Center for Reproductive Medicine (CCRM)



Copyright (C) 2011 PR Newswire. All rights reserved

The Sperm Chromatin Structure Assay (SCSA) and DNA Fragmentation: What Is It and What Does It Mean?

This article from a Resolve 2006 newsletter written by Dr. Werthman

Until several years ago the belief among most reproductive specialists was that if a man had live sperm then they were suitable for use with IVF / ICSI and if the female partner didn’t get pregnant or a miscarriage ensued then it was probably an egg quality issue. Several studies had implied that the conventional sperm parameters (count, motility and morphology) as measured on a routine semen analysis had no bearing on success when ICSI was used. Many couples pursued egg donation after failed IVF attempts because the husband’s semen parameters were relatively normal and yet conception hadn’t occurred. Some of these same couples were still unable to conceive even with the “better quality” donor eggs leaving both the doctors and the couples frustrated and perplexed. Some couples then went on to use both egg donors and surrogates thinking it was both an egg quality and implantation issue, again without success. The only commonality was the husband’s sperm.

About a year and a half ago a relatively new concept was introduced to clinical practice; sperm quality was 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. What has recently been shown in several studies is very interesting and in some ways unexpected. Sperm DNA fragmentation has little or nothing to do with the parameters that we measure on the routine semen analysis. It has little to do with the shape of the sperm or whether the sperm are moving. It is a completely independent variable. Men with otherwise normal semen analyses can have a high degree of DNA damage and men with what was called very poor sperm quality can have very little DNA damage. More importantly what has also been demonstrated is 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. Sperm with high DNA fragmentation may fertilize an egg and embryo development stops before implantation or may even initiate a pregnancy but there is a significantly higher likelihood that it will result in miscarriage. By testing for sperm DNA fragmentation, many cases of formally “unexplained” infertility can now be explained. Many of those couples who have been previously unable to conceive with what would be considered extreme measures have been diagnosed with high sperm DNA fragmentation and treated. It is now very clear to see that having this information about the quality of the sperm can be tremendously helpful to couples and their physicians.

There are several ways to test for sperm DNA fragmentation; the most widely used and statistically robust test is called the Sperm Chromatin Structure Assay or SCSA. The patient semen samples are frozen and shipped in a liquid nitrogen container to the SCSA reference laboratory in South Dakota. The sperm are thawed out and a stress is applied (low pH). The sperm are then labeled with a special orange colored dye that only attaches to the ends of broken DNA within the sperm cell. If the DNA is intact then no dye will attach to the sperm. A machine called a flow cytometer is used to analyze ten thousand sperm from the sample. The sperm are passed single file by a beam of light that hits the dye inside the sperm cell and reflects light at a specific wavelength causing the sperm to appear either orange (damaged) or green (normal). A computer counts the percentage of green versus orange-labeled sperm and software allows for creation of a graphic plot of the percent of damaged sperm giving an index known as the DNA fragmentation Index (DFI).

The data from thousands of patients has been analyzed and correlated with the patient’s clinical outcomes and references ranges were compiled. A normal sample has less then 15% of the sperm with DNA damage. Men with poor fertility potential have greater then 30% of their sperm damaged. A DFI Between 16% and 29% is considered good to fair fertility potential but becomes poorer as it approaches 27%. These numbers are thresholds meaning that above 30% the outcome for most couples was failure to have a birth even though only 30+ percent of the sperm were damaged. Under 15% most couples achieved success. The logical questions that arose were: what about the rest of the undamaged sperm in the sample? Why don’t those sperm work? What causes sperm DNA fragmentation? Can the DNA fragmentation be reduced and the sperm improved? If so, How?

DNA fragmentation can be thought of as a marker for other types of damage to the sperm. It is a kin to seeing the tip of the iceberg. Apparently, in semen samples with greater then 30% DNA fragmentation, other abnormalities are occurring with the non-fragmented sperm that the SCSA doesn’t measure and that is why samples used with DFIs above this level do not usually result in births.

The causes of high DNA fragmentation are those same causes of male factor infertility that we have known about for years such as chemical/toxin exposure, heat exposure, varicocele, infection, age, smoking, testicular cancer, radiation, and anything that increases the free radical levels in the semen among a list of many other things. It is very important to understand that sperm DNA fragmentation can change with time and it can be improved in many cases. The goal of a male factor evaluation is to seek out the causes of poor sperm quality and try to correct them so conception can occur naturally or to improve the sperm quality for IVF and maximize the chances of success. In situations where DFI can’t be improved there is evidence to suggest that removing the sperm directly from the testicle via biopsy and using it with ICSI may lead to better outcomes then using poor quality ejaculated sperm. Other options include counseling patients regarding the use of donor sperm either by insemination or fertilizing a portion of the eggs harvested for ICSI with donor sperm and a portion with the patient’s sperm, once again to maximize odds.

The clinical utility of the SCSA is readily apparent. All men with an abnormal semen analysis are candidates for this test as well as men with normal semen analyses who have failed IVF for unexplained reasons. Those couples using egg donors or surrogates may also benefit from screening prior to going thru the procedures because the effort and costs are so great. Men with poor DFI should have a male factor evaluation including a physical examination by a male reproductive specialist. These new concepts have a significant implication on how we practice and what we recommend to couples but we must bear in mind that this test does not have a predictive values of 100% as healthy babies have been born from men with high DFI but this is fairly uncommon.

There are herbal medicine formulas which are exceedingly high in antioxidant properties. At The Berkley Center for Reproductive Wellness we have had great success in treating this disorder.

Study Shows Acupuncture Treatment May Help Male Infertility Problems

Acupuncture may help some men overcome infertility problems by improving the quality of their sperm, according to a new study.

Researchers found that acupuncture treatment reduced the number of structural abnormalities in sperm and increased the overall number of normal sperm in a group of men with infertility problems.

They say the results suggest that acupuncture may complement traditional infertility treatments and help men reach their full reproductive potential.

Acupuncture May Ease Male Infertility

The male partner is a factor in up to 50% of infertile couples, write the researchers. In many cases, the cause of male infertility is unknown.

Previous studies of acupuncture and male infertility have suggested that acupuncture can improve sperm production and motility and count.

In this study, researchers looked at the effects of acupuncture on the structural health of sperm in men with infertility of unknown cause. The findings appear in the July issue of Fertility and Sterility.

Twenty-eight infertile men received acupuncture treatments twice a week for five weeks, and 12 received no treatment and served as a comparison group.

Researchers analyzed sperm samples at the beginning and end of the study and found significant improvements in sperm quality in the acupuncture group compared with the other group.

Acupuncture treatment was associated with fewer structural defects in the sperm and an increase in the number of normal sperm in ejaculate.

But other sperm abnormalities, such as immature sperm or sperm death, were unaffected by acupuncture.

The researchers write that acupuncture treatment is a simple, noninvasive method that can improve sperm quality.

SOURCE: Pei, J. Fertility and Sterility, July 2005; vol 84: pp 141-147.

Corroboration of my previous post on male contribution to viable embryo

We evaluated cytogenetic results occurring with first trimester pregnancy loss, and assessed the type and frequency of chromosomal abnormalities after assisted reproductive treatment (ART) and compared them with a control group. We also compared the rate of chromosomal abnormalities according to infertility causes in ICSI group.

Methods: A retrospective cohort analysis was made of all patients who were referred to the Genetics Laboratory of Fertility Center of CHA Gangnam Medical Center from 2005 to 2009 because of clinical abortion with a subsequent dilation and evacuation (D&E) performed, and patients were grouped by type of conception as follows: conventional IVF (in vitro fertilization) (n=114), ICSI (intracytoplasmic sperm injection) (n=140), and control (natural conception or intrauterine insemination [IUI]) (n=128).

Statistical analysis was performed using SPSS software.

Results: A total 406 specimens were referred to laboratory, ten abortuses were excluded, and in 14 cases, we did not get any spontaneous metaphase, chromosomal constitutions of 382 specimens were successfully obtained with conventional cytogenetic methods. Overall, 52.62% of the miscarriages were found to be cytogenetically abnormal among all patients, the frequency was 48.4% in the control group, 54.3% of miscarriages after ICSI and 55.3% after conventional IVF (p=0.503).

The most prevalent abnormalities were autosomal trisomy, however, nine (11.69%) sex chromosome aneuploidy were noted in the ICSI group vs. four (6.45%) and two (3.23%) cases in the conventional IVF group and control group.

We compared chromosomal abnormalities of miscarriages after ICSI according to infertility factor. 55.71% underwent ICSI due to male factors, 44.29% due to non-male factors.

ICSI group having male factors showed significantly higher risk of chromosomal abnormalities than ICSI group having non-male factors (65.8% vs. 34.2%, p=0.009, odds ratio=1.529, 95% CI=1.092-2.141).

Conclusions: No increased risk of chromosomal abnormalities due to ART was found with the exception of a greater number of sex chromosomal abnormalities in the ICSI group with male factor infertility.

Therefore, these alterations could be correlated with the underlying parental risk of abnormalities and not with the ICSI procedure itself.

Author: Ji won KimWoo Sik LeeTae Ki YoonHyun Ha SeokJung Hyun ChoYou Shin KimSang Woo LyuSung Han Shim

Credits/Source: BMC Medical Genetics 2010, 11:153

The Male Contribution to Viable Embryos

Centriole definition: a structure found in the cell cytoplasm (cytoplasm: all of the contents outside of the nucleus and enclosed within the cell membrane of a cell) that plays a role in embryo development.

Sperm centrioles were traced from fertilization to the hatching blastocyst stage. The sperm centriole is introduced into the egg at fertilization.

As the male and female aspects of the developing embryo (called pro nuclei) fuse (called syngamy) to become a shared environment of both male and female DNA, centrioles play a pivotal role in cell division (cleavage) of the embryo.

This division, when the embryo goes from a single cell organism to a two cell organism to a four cell organism to an eight cell organism to a sixteen cell organism is called mitosis or cleavage.

Sperm centrioles were detected at all stages of embryonic cleavage from the 1-cell through 8-cell stages, right up to the hatching blastocyst stage.

It is evident that the sperm centrosome ( formed from centrioles and having to do with cell division) is the functional active centrosome in humans, while the female is inactive.

Did you know? Embryos having 7-9 cells on day 3 have an increased chance of developing to the blastocyst stage. A blastocyst is a 5 day embryo and is considered to be of significant quality.

Embryos with <7 cells or >9 cells are less likely to make it to the blastocyst stage.1

My question is this: if a woman consistently produces 4 or 6 cell embryos during a stimulated IVF cycle is it not possible that the male partner’s sperm has some ultra structural defect whereupon centriole quality is subfunctional?

Since we know that the male contribution of healthy centrioles is necessary to facilitate cleavage of embryos to the blastocyst stage, it is my ardent recommendation that male partners of all women who are trying to conceive should also be treated with acupuncture and herbs.

Even when the male partner presents within the normal range for volume, count, morphology and motility, centriole health cannot be easily determined.

Case: A female patient has 15 eggs retrieved during an IVF cycle; 10 fertilize, and 7 survive. She has 7, day 3 embryos ranging in size from 6 to 10 cells with zero fragmentation and a healthy10mm endometrial lining. The reproductive endocrinologist transfers three of these beautiful embryos and the cycle fails.

Why? We do not know for sure: it could be that the embryos were chromosomally abnormal. This can be due to chromosomally abnormal eggs or sperm. It can also be due to the fact that the male centriole health and function were not optimal. This may be considered a ‘hidden’ cause of infertility.

The use of acupuncture and certain herbal medicines can vigorously stimulate blood flow to the testicles carrying oxygen and nutrients, as well as hormones from the brain, as well as electrolytes, while simultaneously carrying debris or dead cells away from the testicles.

This increased delivery of the ‘good’ and increased excretion of the ‘bad’ may improve ultra structural properties of the sperm including centriole quality and function and thereby improve embryo quality and help facilitate cleavage to the blastocyst stage and thereby potentiate take home baby rates.

Summary: It is my opinion, based on clinical experience, that both partners should be treated with acupuncture and herbal medicine when wishing to start or grow a family and is having difficulty doing so.


1. Alikani M, Caulderon G, Tomkin G, et al. Cleavage anomalies in early human embryos for transfer after in vitro fertilization. Human Reprod 1997; 12(7): 1545-1549

Poor Sperm Quality Equals Poor Embryo Quality

At the Berkley Center for Reproductive Wellness we have been treating male factor infertility for many years based on the knowledge of 3000 years of traditional Chinese medicine. Acupuncture and herbal medicine in conjunction with certain vitamins and amino acids promote significant change in pathologic sperm. We have had excellent results in improving sperm count, improving morphology and motility as well as reducing sperm DNA fragmentation percentages.

The importance of this cannot be overstated. In the typical IVF Center, doctors will note that sperm quality is important in that in its pathological state in may not be able to penetrate the egg and facilitate fertilization. This can be overcome with intra-cytoplasmic sperm injection or ICSI. While fertilization with ICSI is possible and often occurs, a good embryo quite often is not produced and pregnancy does not ensue.

A ‘good’ embryo is created by combining a ‘good’ egg and a ‘good’ sperm. Embryos created with poor quality sperm are, in my opinion, based on thirteen years of clinical experience, one of the main reasons for failed IVF cycles including those undergoing donor egg transfers even though fertilization with ICSI is facilitated.
Frequently the doctor will report that the embryo is “beautiful”, yet the cycle fails. You can no more judge the quality of an embryo by visualization than one can judge the health of a person by visualization. For example, the healthiest looking man can be HIV positive. Or, the healthiest looking woman can have breast cancer. One cannot judge a book by its cover.

The best and most reliable means of improving fertility outcomes either as a result of intercourse, IUI or IVF is to first improve the quality of the components that are responsible for the creation of the embryo; sperm and egg.