In the couples applying for IVF, the male reproductive cell is examined by the andrology laboratory for examination, evaluation and treatment preparations for the sperm.
Taking a Sperm SampleFor routine andrology laboratory procedures, it is necessary to take a sample of semen (ejaculate) through masturbation. In cases where it is not possible for the patient to be given ejaculate;
- Through sexual intercourse using special condoms which do not contain spermicidal chemicals,
- By the use of devices that provide ejaculation by stimulation of the male genitalia with appropriate electrical signals, called electroejaculation,
- In the case of dry ejaculation (retrograde ejaculation), the semen empties into the bladder during ejaculation. In this case, by taking the sperm cells inside the urine sample taken immediately after discharge,
- In case of any obstruction in the sperm ducts, which prevents the semen specimen from going out, by sampling with the injector from the epididymis region where the sperms in the testicles are deposited,
- In cases where there is no sperm in the semen specimen or when sperm production is reduced or sperm cell production is reduced, sperm can be obtained by TESE or TESA methods or by taking part or sample from testis tissue.
The ideal timing for this procedure is concurrent applications when the eggs of the patient's partner are collected. Semen analysis is the first test used in infertile couples to evaluate male reproductive potential and the following parameters of ejaculate are evaluated:
- Evaluation of semen volume and pH and fluidity
- Sperm count, mobility and morphology (formal features)
The sperm sample to be used for semen analysis is taken after 2-8 days of sexual abstinence. This period is important in terms of obtaining the appropriate sperm number / vitality ratio. Less than two days of sexual abstinence leads to the appearance of a small number of sperm cells, more than 8 days of sexual abstinence causes a decrease in mobility.
The results of semen analysis are interpreted according to the standards set by the WHO (World Health Organization):
- Normal Values:
- Volume - 1.5 mL
- pH - <8.0
- Sperm Count –15 million sperm / mL
- Total sperm count - 39 million sperm / ejaculate
- Morphology - 4% normal shaped sperm, according to Kruger Strict criteria
- Vitalite - 58% live sperm
- Forward mobility - 32%
- Total mobility - 40%
- Leukocytes - <1 million / mL
- Immature germ cell - <1 million / mL
It is defined as the minimum threshold required for pregnancy to be achieved by normal way. Additional tests can be performed in cases where semen analysis is not sufficient.
Special Semen Analysis Tests:
- Semen biochemistry: Tests for measuring the level of fructose in semen are guiding for detecting blockages that may be present in seminal channels.
- Semen culture: It is used for the detection of a possible infection in the semen sample.
- Sperm function tests: Tests to measure sperm fertilization ability.
- Acrosome reaction test
- ROS (reactive oxygen species)
- HBA (Hyaluronan Binding Test)
- Peripheral karyotype analysis: Numerical chromosome analysis. It is especially applied for the detection of excess or missing chromosomes (47XXY Klinefelter syndrome etc.).
- Y chromosome microdeletions: The absence of the regions identified as AZFα and AZFb on the Y chromosome is performed for their diagnosis. It is especially used for the decision of patients who had previously undergone TESE / TESA to undergo this operation again.
Measurement of blood levels of testosterone, LH, FSH and AMH hormones regulating sperm production
Hormonal (Endocrine) Tests
In the Andrology laboratory, sperm preparation is performed to remove sperm from the ejaculate fluid and to isolate the cells..
Sperm Preparation Methods
Swim-up method: Swelling of sperm cells into culture fluids to increase fertilization ability.
Gradient method: Microscopic dimensions of the silicon gel particles containing ready-made solutions are filtered using the ejaculate.
PICSI / spermslow method: It is the method of selection of sperm without mature and DNA fractures.
Microchip method: It is a method in which sperms, which are popular in recent periods and which have not only the movement and normal form of the sperm, but also the DNA maturity, are also differentiated.