For Doctors: Male infertility, IUI and Cryopreservation
Both Michael A. Werner and M.A.Z.E. Laboratories pride themselves on serving as a resource for physicians and their patients.
For more detailed information on the following subjects, please click below.
A M.A.Z.E. SEMEN ANALYSIS WILL TELL YOU WHAT A COMMERCIAL SEMEN ANALYSIS MAY NOT:
- Whether antibodies are present.
- Whether the forward progression is abnormal despite normal motility.
- Whether the patient has retrograde ejaculation.
- Whether the strict morphology of the sperm indicates conventional IVF or ICSI.
- Whether there is an increased number of white blood cells indicating an infection or inflammation.
- Whether the semen fructose is positive or negative.
M.A.Z.E. determines which of these follow-up tests are indicated based on the preliminary findings and performs them on the same specimen at the same time.
THE BENEFITS TO YOU
YOU CAN SAVE UP TO 6 MONTHS FOR YOUR PATIENTS
An inaccurate or incomplete semen analysis may fail to identify the presence of a male factor and valuable time will be lost. Since sperm take 3 months to produce and mature, there often is a 4-6 month delay between treatment of the man and resulting changes in the semen analysis. The man should therefore be evaluated and appropriately treated as soon as possible after the couple presents to you.
OUR SEMEN ANALYSIS WILL SAVE YOU TIME
M.A.Z.E. Fertility Laboratories will walk your patient through the process, from insurance referrals to specimen collection. If you choose, M.A.Z.E. will call the patient to discuss the results with him. You will receive a fax of the results within 48 hours, which includes our suggested plan of action for the male partner and any implications for your treatment of the couple.
YOUR PATIENTS WILL BE PLEASED WITH OUR SERVICE
In contrast to many commercial collection sites, M.A.Z.E. has private, comfortable and well equipped rooms for sample collection. The lab schedules semen analyses on Saturdays and weekday evenings in addition to weekdays.
WE CAN COORDINATE ALL YOUR MALE FERTILITY TESTING
In rare instances when tests may be indicated or requested by you that we cannot perform on site (sperm penetration assay, genetic screening) we can oversee and coordinate off-site testing.
Please keep in mind that M.A.Z.E. Laboratories:
- Guarantees that all semen analysis will be conducted within one hour of collection, insuring results that are significantly more accurate than most commercial labs.
- Provides the most up to date clinical interpretations and recommendations for all results.
- Combines both technical and clinical expertise. We are directed by a leading andrologist with 15 years experience and by a board certified urologist who is fellowship trained in male infertility.
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Sperm Processing for IUI
Sperm washing is the process which prepares a semen sample for an intrauterine insemination (IUI). For an IUI to be performed, the semen sample must be washed free of debris, white blood cells, and prostaglandins, which can cause the uterus to contract. The processing also removes dead sperm and concentrates the sperm into a small volume which can easily be handled by the uterus. There are three main methods of sperm washing; the swim-up, density gradient wash, and simple (centrifugation) wash. The type of wash used depends on the individual characteristics of each semen specimen.
The swim-up is most successful when performed on patients with normal semen analysis, and is not recommended for samples of high viscosity, with high numbers of round cells, or with a high content of debris. In this procedure the washing media is gently placed over the semen in a conical tube. The specimen is then placed in an incubator for approximately one hour. During this time the sperm are allowed to swim up into the media, with the purpose of collecting the most motile, normal sperm which are free of debris. The supernatant is collected and centrifuged twice with sperm washing media. The final pellet is then resuspended in approximately 0.5 mls of media. Modified sperm washing media must be used to process the sample. It is available from Irvine Scientific.
DISCONTINUOUS (DENSITY) GRADIENT
The discontinuous (density) gradient method should be used on samples containing round cells, debris, or those with increased viscosity, but with a relatively normal concentration and motility. The gradient is achieved by layering media of two different densities in a conical tube. The semen is then placed on top of the gradient and the tube is then spun to allow the specimen to proceed through the gradient. The resulting pellet should contain the motile, normal sperm, while the dead sperm and debris are caught up in the gradient media. The pellet is then resuspended in washing media and centrifuged twice. The final pellet is resuspended in a final volume of approximately 0.5 mls of media. There are several commercially available kits. Conception Technologies carries the Enhance-S Plus kits and Irvine Scientific carries the Isolate Sperm Separation Medium.
The simple (centrifuge) wash should be performed on a sample that has a decreased concentration and/or motility. A sample containing round cells and debris should not be prepared by this method. Sperm washing media is added to the specimen and centrifuged. The pellet is recovered, resuspended and again centrifuged. The final pellet is resuspended in approximately 0.5 mls of media.In each of the above cases the laboratory performs an analysis on both the fresh specimen and washed specimen. This will include an assessment of the count, motility, volume and viscosity.
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Please visit our page which provides information on cryobanking.
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Common Patient Concerns Regarding Male Infertility
The following outlines the most current information on several topics likely to be of concern to patients in the area of male infertility.
Cigarette smoking has been shown to significantly effect semen quality.
- Causes a 23% decrease in sperm density (concentration) and 13% decrease in motility (when averages are taken from nine separate studies).
- To a lesser extent, causes an increased number of morphologically abnormal sperm.
- Causes toxicity to the seminal plasma: sperm from non-smokers had significantly decreased viability when placed in the seminal plasma of smokers.
- Effects the hypothalamic-pituitary-gonadtropin (HPG) axis, most commonly affecting levels of estradiol and estrone. The Leydig Cells, which are in the testes and produce testosterone, may have secretory dysfunction.
- Most worrisome is that there is evidence which suggests that paternal smoking may also be associated with congenital abnormalities and childhood cancer, though the relative risk in most studies is less than two.
- Often causes a decreased average sperm count, motility, and normal morphology.
- Effects HPG axis, causing decreased plasma testosterone.
- May have a direct negative effect on the Leydig Cells.
Even infrequent cocaine use:
- Causes decreased sperm counts, motility and normal morphology. These effects can be found in men who have used cocaine in the two years proceeding their initial semen analysis.
- Decreases the ability of sperm to penetrate cervical mucous.
The use of anabolic androgenic steroids has reached almost epidemic proportions. 6.6% of 12th grade male use or have used them to build muscle mass and improve athletic performance. These exogenous androgens:
- Depress testicular production of testosterone and, thus, intra-testicular testosterone levels. This may cause severely diminished spermatogenesis or complete azoospermia.
- Cause a persistent depression of the hypothalamus and pituitary which may be irreversible, even when the steroids are stopped.
Moderate alcohol use does not affect male fertility. Excessive alcohol use:
- Effects the HPG axis and is a direct gonadotoxin.
- May cause associated liver dysfunction and nutritional deficiencies which are also detrimental for sperm production.
Most vaginal lubricants, including K-Y Jelly, Surgilube, and Lubifax are toxic to sperm. Couples should avoid their use during the fertile time of a woman's cycle.
Elevated testicular temperature is known to have a negative effect on sperm production and ultimately on semen quality and fertility. Varicoceles and undescended testes are two important causes of male fertility. At least part of their negative effect is considered due to the increase in testicular temperature. Hot baths and saunas should be avoided, as they increase the core temperature of the testes (hot showers are not a problem).Many men are counseled to change from briefs to boxers under the assumption that the briefs do not allow the testes to regulate its temperature. There is no evidence for this and, in fact, a recent article in The Journal of Urology showed that there was no difference in either the semen analysis or the core testicular temperature between groups of men who wear boxers or briefs.
Moderate amounts of exercise can only be helpful. However, long distance runners (men who run greater than 100 miles per week) and distance cyclers (men who ride greater than 50 miles per week) have decreased spermatogenesis. These activities should be moderated when a sub-fertile man is attempting conception.
About 5% of couples with infertility have factors relating to intercourse. This includes the inability to obtain or maintain an erection, premature ejaculation, lack of ejaculation, retrograde (backwards) ejaculation, lack of appropriate timing of intercourse and excessive masturbation. Interestingly, the most common problem is infrequency of intercourse. Studies have shown that 5 out of 6 previously fertile couples who have intercourse four times per week will conceive over six months, while only 1 out of 6 with intercourse once per week will conceive during the same period.
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Information on our Directors
Dr. Werner received his specialized fellowship training in male infertility and male sexual dysfunction at Boston University Medical Center and has written extensively on these topics in medical journals and books. He completed his residency in Urology at Mount Sinai Medical Center in Manhattan and received his medical school training at the University of California at San Francisco. He holds an honors undergraduate degree in Biology from Harvard College.
Michael A. Werner, M.D., FACS
Michael A. Werner, M.D., FACS is on the faculty of The New York Medical College in the Department of Urology. His private offices are in White Plains, New York, and in Norwalk, Connecticut. He is also the Regional Medical Advisor for New York and Connecticut for the Impotence World Association, a non-profit educational organization.
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