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The Male Fertility Panel

Semen Tests

Semen Analysis: The semen analysis forms the basis of the initial evaluation for assessing male-factor infertility. Multiple analyses are necessary because semen findings normally fluctuate for a given individual. Therefore, prior to establishing a reliable fertility baseline, two to three semen analyses should be performed. Abstinence for a shorter period can decrease ejaculate volume and sperm count whereas prolonged abstinence may impair sperm motility. Because of this, for each analysis patients are instructed to abstain from ejaculating for 2 to 4 days. It is critical that the specimen be collected in a sterile container (which can be provided upon request), that there be no inadvertent loss of the specimen, and that the analysis be performed within 1 hour of collection. To attain the most accurate results possible, it is recommended that the sample be produced on site via masturbation.  If it is necessary that you collect in a condom, you may request a collection condom, which will be provided with specific instructions on collection protocol.

Reproductive Medicine Associates of New York is equipped with a state-of-the-art Andrology Laboratory located in their Manhattan office under the supervision of Andrology Laboratory Director Jason Barritt, PhD, ELD, HCLD. Westchester patients, with the proper and specific instructions, may drop off samples at the White Plains office, which will then be transported to the Manhattan laboratory.

A semen analysis reveals the volume of ejaculate, the concentration or density of sperm, their motility and the morphology (shape). For each parameter there is a range considered to be normal or adequate.  Results outside of this range are considered abnormal. Be aware that an abnormal finding is only an indicator that infertility may be a problem, not a declaration of sterility. In fact, with the recent technological and surgical advances coupled with the expertise of the Male Reproductive Health team at RMA of New York, this finding can lead the way to finding the proper treatment and subsequent pregnancy for couples with severe male-factor infertility.

Standards for a normal semen analysis include:

  1. Ejaculate volume between 2.0 and 5.0 ml
  2. Sperm concentration of at least 20 million per ml or a total count of greater than 40 million.
  3. Motility (moving sperm) of greater than or equal to 50%
  4. Normal Kruger Strict Morphology (the shape of each sperm) of greater than or equal to 4%

Ultimately, it is up to your doctor to determine what tests are necessary.  The sperm tests of the male fertility panel generally also include, but are not limited to, the following tests:

Antisperm Antibiody (ASA): These are proteins that can be found in blood, semen, or vaginal fluids and are associated with low pregnancy rates.  They attach to sperm, damaging or killing them as an immune response.  The test is usually done on a small sample of semen, to which microscopic beads are added.  The beads bind to sperm that are affected by antibodies and can thereby be detected.  A sample is considered clinically significant for ASA if greater than 20% of the sperm have ASA binding.  Generally, such samples also have decreased sperm motility and excessive clumping.

Bacterial Culture: A test performed with a small portion of a semen sample in order to determine whether there is an infection of the prostate.  It is possible to have such an infection and not even be aware of it, so this test is often part of a routine work-up.  The most common general infections are staphylococcus, streptococcus, and enterococcus, which are usually easily treated with a course of antibiotics.

Chlamydia: A common sexually transmitted infection that can affect fertility, especially for a female.  It is caused by the bacteria Chlamydia trachomatis.  Chlamydia is often called a “silent” disease because symptoms may not always be present, which is why it is part of the Male Fertility Panel.

Mycoplasma: Small, bacteria-like organisms that are suspected to be related to urethritis, pregnancy loss, pelvic inflammatory disease, and other urological problems.  A simple semen culture can determine whether mycoplasma is present, and generally a course of antibiotics is all that is needed.

Ureaplasma: A bacterial infection that is transmitted between partners.  Like chlamydia, it is often asymptomatic, but has been correlated with an increased likelihood of miscarriage.  It is usually tested for in conjunction with mycoplasma via a semen culture.  If detected, usually a course of antibiotics is sufficient treatment.

SDD/SDFA: Sperm DNA Decondensation/Sperm DNA Fragmentation Assay. These state-of-the-art tests provide information about the efficacy of the sperm after it is inside the egg.   SDD evaluates the sperm function after egg penetration.  It can help predict whether IVF or other forms of ART will be successful.  The SDFA assesses the level of DNA fragmentation, which provides insight as to the potential of the sperm to achieve pregnancy.

Please note that an abnormal SDD/SDFA result does not indicate that there are genetic problems that will be transferred to your child.

Blood Tests

The blood tests performed may include FSH, LH, testosterone total, and estradiol.  As you may have anticipated, testosterone level is quite important.  A low testosterone level not only may indicate low levels of sperm production, it also may have significant implications for a man' s health such as sexual dysfunction, depression, fatigue, bone density and muscle integrity.  The other hormone levels that will be tested will ensure that the entire hypothalamic-pituitary-gonadal axis is functioning properly.  Other blood tests performed will evaluate genetic causes for infertility.

Genetic problems have attributed for 30% and 40% of the patients with low or no sperm in the ejaculate. For example, an extra X chromosome indicates a condition called Kleinfelter' s Syndrome, which cause infertility in most males affected with it due to the precipitously low sperm count they generate. In other cases of genetically linked male-factor infertility, pieces of the Y chromosome may be missing, or there may be mutations associated with cystic fibrosis.  These factors are generally tested for in the male fertility panel.

For information on insurance coverage of ordered tests, please click here.

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