Almost half of the couples, undergoing infertility treatments, suffer from male factor infertility. Andrology lab is therefore an indivisible part of our facility and offers a wide spectrum of analysis, tests and interventions:
• spermiogram – sperm analysis – to test the quality
• Kruger’s stict analysis of the sperm morphology – to determine the sperm’s ability to penetrate the egg
• Sperm survival test – motility (movement) of sperm 24 hours after collection.
• Sperm preparation for intrauterine inseminationn (IUI)
• Cryo preservation (freezing) of sperm and its storage for use in the future
• IVF and ICSI (in vitro fertilization and intra-cytoplasmic sperm injection)
• TESE for men with azoospermia (there are no sperm in the ejaculate)
In order for the sperm analysis evaluation to be beneficial, it must be carried out after 3-4 days of sexual abstinence and sample obtained via masturbation should be delived to the laboratory that tests the sperm, within 30 minutes. In the laboratory, they evaluate the volume of obtained sample, number of sperm per 1ml, their movement and the shape of the heads, necks and tails (morphology). If sperm analysis shows some abnormality it is recommended to repeat the test and if the abnormality is detected repeatedly, it is recommended to see an urologist (andrologist, infertility specialist).
Genetic testing for men with certain male factor infertility
Normospermia – parameters for normal sperm according to WHO
Volume: 1.5 to 5 ml.
Quantity: More than 20 milliion sperm per 1 ml.
Motility: More than 50%, after preparation more than 70% motile sperm.
Morphology: Basic above 30% Strict above 15% of normal sperm.
Criteria for genetic testing with male factor infertility are:
Sperm concentration : < 10 million/ml
Sperm motility: < 25% before preparation
Sperm morphology: < 5% normal – strict criteria
Azoospermia – absence of sperm in the ejaculate
Genetic factors of male infertility
A. Abnormality chromosom
Approximately 5-15% of men with some form of sperm abnormality suffer also from abnormality of their chromosomes that can be diagnosed from a blood sample. Men, that meet some of the above listed criteria, should undergo genetic testing. Men, with proven genetic disorder, risk that their born offspring will suffer from the same genetic disorder and their sons will also suffer from infertility in the future. In case, genetic abnormality of the fetus is suspected, pre-natal genetic testing should be carried out during pregnancy.
B. Y chromosome microdeletion (YCM)
10-20% of men with severe sperm abnormality, but with normal number of chromosomes (caryotype) are carriers of Y chromosome defect. Only a very small piece can be missing – area that cannot be detected with a common analysis. This type of handicap is called microdeletion and can be detected only with DNA analysis. There are very important genes in this part of Y chromosome, and they are responsible for production and development of sperm.
In case these genes on Y chromosome are missing, infertility issues arise. YCM test should be carried out for all men with a major spermatogenensis disorder and with a normal caryotype.
C. Cystic fibrosis and Congenital absence of the vas deferens (CAVD)
In case of male infertility CAVD is th cause in 1-2%, most often found in men with azoospermia. It is very likely that men with CAVD are also carriers of Cystic fibrosis (CF) gene. CF is a recessive heriditary disorder, which means, that both parents must be carriers of this chromosomal disorder in order for this disease to manifest. CF causes the glands in the body to produce thick mucus that causes breathing difficulties, infections, damage to the lungs and digestive difficulties. More than 80% of men with CAVD are carriers of at least one CF mutation gene. It is very important that men, with azoospermia and/or CAVD and their partners, are exactly evaluated for the risk that their children will suffer from CF. Many studies showed that there is a 1% chance that children born after ICSI may have some chromosomal abnormalities. There is no reason to suspect that ICSI alone causes any genetic abnormality. In case of pregnancy after ICSI it is recommended to carry out pre-natal genetic diagnosis. Men with some form of male factor infertilty are advised a consultation with a geneticist before undergoing treatment with ICSI.
Our facility has its own sperm bank, where samples of volunteer, anonymous and medically tested donors are stored. Sperm donor can be any young man that meets the following criteria:
• age from 18 to 35
• good medical history
• without any abnormalities in familial history
• with negative genetic testing
• with negative results to testing for sexually transmitted diseases