In 85 to 90 percent of infertility cases, treatment focuses on basic medical therapies, most of which require an evaluation of the man's reproductive potential. About 90 percent of male infertility cases are due to low sperm counts, poor sperm quality (movement/shape) or both. Beyond basic sperm studies, our Reproductive Studies Lab also provides services such as antibody testing and sperm washing to maximize reproductive potential of the couple.
Approximately 40 percent of couples having difficulty conceiving experiences some degree of male infertility. Most men produce millions of sperm each day; however, many of these may be abnormal either in count, shape (morphology), movement (motility) and function. The semen analysis is a primary diagnostic tool for determining both urological and infertility issues. Included in the semen analysis report are semen volume and viscosity, liquefaction time, sperm count, viability, motility and grade, white cell count, pH, and morphological assessment with classification of abnormal forms present.
When and Where Should a Man Have a Semen Analysis?
A semen analysis should be done very early in the evaluation of a couple seeking fertility treatment, preferably as one of the very first tests and clearly before any invasive or uncomfortable tests are performed on the woman (HSG or surgery). The best place to have a semen analysis performed is at a laboratory associated with reproductive endocrinologists who perform sophisticated, high-tech procedures. These laboratories are board certified and report their results in a manner that is understood by anyone who works with infertility patients. Insurance coverage also will direct you to a service on your provider list.
Sperm count, or sperm concentration, measures the concentration of sperm in a man's ejaculate, distinguished from total sperm count, which is the sperm count multiplied with volume.
Most men produce an average of between 20 and 40 million sperm per milliliter. Over 15 million sperm per milliliter is considered normal, according to the World Health Organization (WHO) per 2010 data. Older definitions state 20 million. Quantifying sperm count is an important first step to understanding a man's fertility potential.
Sperm motility (movement) is important in the sperm's ability to fertilize. A common layman's reference for sperm motility is how well sperm can “swim.” Sperm must be motile enough to penetrate through cervical mucus and to migrate through the female genital tract to the fallopian tubes for fertilization. Men with poor sperm motility can be helped with intracytoplasmic sperm injection.
This involves injecting slow-moving sperm directly inside a mature egg to achieve fertilization. Sperm motility generally is divided into four grades.
- Grade A (or motility I) –Progressive motility. These are the strongest sperm and swim fast in a straight line.
- Grade B (or motility II) – Non-linear motility. Sperm move forward but tend to travel in a curved or crooked motion.
- Grade C (or motility III) – Non-progressive motility. Sperm do not move forward despite the fact they move their tails.
- Grade D (or motility IV) – Sperm are immotile and fail to move at all.
The proportion of sperm with normal morphology (shape and size of the sperm head, mid-piece and tail) has been considered to be the most significant factor related to fertilization rates when using in vitro fertilization. Assessment of sperm morphology is reported in a few different ways. The most common assessment of sperm morphology is based on the WHO definition (World Health Organization, third edition) and/or the Kruger strict criteria method.
WHO definition of sperm morphology
- Oval and smooth (normal)
- Round, pyriform, pin, double and amorphous heads (abnormal)
- Straight, slightly thicker than the tail (normal)
- Single, unbroken, straight, without kinks or coils (normal)
Krueger strict criteria
- Smooth, oval configuration
- Length of 5 to 6 microns
- Diameter of 2.5 to 3.5 microns
- Acrosome: must comprise 40 to 70 percent of the sperm head
- Slender, axially attached
- Less than 1 micron in width and approximately 1.5x head length
- No cytoplasmic droplet larger than 50 percent of the size of the sperm head
- Single, unbroken, straight without kinks or coils
- Approximately 45 microns in length
Sperm Antibody Testing
(Immunobead Binding Test)
Both men and women can develop antibodies against sperm or sperm antigen (protein). Extreme cases of such male autoimmunity can result in infertility. Antisperm antibodies can be detected both in blood serum and on the sperm surface. Presence of antibodies can lead to sperm agglutination (clumps of sperm sticking together) or sperm immobilization (cytotoxic antibodies). Because of these antibodies, there is a reduced number of freely motile sperm, which adversely affects male fertility potential.
The Immunobead Binding Test (IBT) is a diagnostic tool to assess the presence of antisperm antibodies in semen, serum of either partner, or cervical mucus. The IBT determines both the location of the antibodies on the sperm cell (direct assay) and identifies the isotypes present (IgG, IgA or IgM).
Separation of sperm from seminal plasma is important for intrauterine insemination (IUI) or other advanced procedures since the process identifies and isolates the most highly motile sperm. A two-step washing procedure separates the sperm from the seminal plasma while maintaining high sperm recovery. For infertility patients with an increased number of abnormal sperm, white blood cells or ejaculate debris, the two-step wash often results in a higher quality sperm sample that offers a higher degree of fertilization potential.
Included in the sperm washing report are ejaculate volume, sperm count, motility and grade, post-wash (post-swim-up if applicable) and final re-suspension volume.
Men choose sperm cryopreservation (preservation of tissue or cells via freezing) for a variety of reasons, including fertility preservation prior to cancer treatment. Cryopreservation is achieved by adding a cryoprotectant to the liquefied semen sample and then storing it in liquid nitrogen. Samples can be frozen indefinitely when kept at a temperature of -196°C. Sperm can be thawed at a later date and combined with a wife's or partner's egg for fertilization either via intrauterine insemination or in vitro fertilization.
We recommend cryopreservation for the following situations:
- Male cancer patients facing chemotherapy or radiation therapy to the pelvis
- Patients with collection anxiety when undergoing infertility treatments
- Couples contemplating vasectomy as their birth control option
Please see our storage policy for more information.
The Reproductive Studies Lab shall freeze (cryopreserve) and store egg and sperm specimens until they are used, destroyed, released or transferred to a long-term facility. The patient will be required to sign a Storage Agreement acknowledging their desire to freeze and store their eggs or sperm. The Reproductive Studies Lab will charge the patient a semi-annual storage fee for continued storage.
In addition, the applicable consent or Agreement will need to be signed and/or notarized by the patient or guarantor to use, destroy, donate or transfer the stored egg or sperm specimens.
This service is offered for patients/couples wishing to achieve a pregnancy by means of in vitro fertilization (IVF) under the guidance and care of the staff of Bethesda Fertility Center. Freezing (cryopreservation) of embryos is a common procedure. Since multiple eggs (oocytes) are often produced during ovarian stimulation, on occasion there are more embryos available than are considered appropriate for transfer to the uterus. These embryos, if viable, can be frozen for future use.
Cryopreservation of embryos is a process of freezing embryos, generally after an IVF cycle. The patient/couple will be required to sign a Cryopreservation Agreement prior to their IVF cycle indicating their intention in regard to frozen embryo(s) in case of death of one or both partners, separation or divorce. The patient/couple can continue to store their embryo(s) and pay the semi-annual storage fee. They can use the embryo(s) to add to their family, donate embryo(s) to another couple or destroy their embryo(s).
In addition, the intentions of the patient/couple will not be acted upon until an applicable consent or Agreement is signed and or notarized by the patient/couple regarding their embryo(s). This Agreement provides several choices for disposition of embryos in these circumstances – death of the patient or the patient's spouse or partner; separation or divorce of the patient and the patient's spouse/partner; successful completion of IVF treatment; decision to discontinue IVF treatment; or failure to pay fees for frozen storage.