What is Infertility – Where does the problem lie?

If a couple is infertile, this means that they have been unable to conceive a child after 12 months of regular sexual intercourse without birth control.
Primary infertility means they have never had a child.
Secondary infertility means that the infertile person has had one or more children in the past, but a medical problem is impairing fertility
  • 40% are related to the woman
  • 40% are related to the man
  • 10% are due to problems in both
  • 10% are unknown causes.




What is the need for Semen Analysis?

The semen analysis will help to determine whether there is a male factor involved in the couple's infertility. A comprehensive semen analysis is one of the appropriate first steps if a couple is having trouble conceiving. A thorough evaluation helps determine the cause of an abnormal semen analysis and rules out medical problems.

What are the parameters recorded in Hope Fertility Lab during Semen Analysis?

In Semen Analysis, we record the following parameters as per WHO standards:

Appearance:

A normal sample has a homogenous, grey – opalescent appearance. It may appear less opaque if the sperm concentration is very low, red – brown when red blood cells are present or yellow in a patient with jaundice or taking some vitamins.

Volume

Normal volume of ejaculate in healthy men is about 2 to 6 ml. A low volume (less than 1 ml) is often due to incomplete ejaculation or spillage. The volume may be low if a man is anxious when producing a specimen, if the specimen is not caught in the collection container, or if there are hormonal abnormalities or ductal blockages. However, a very high volume of ejaculate can also be a problem because this dilutes the total sperm present

Liquefaction

A normal semen sample liquefies within 60 minutes at room temperature, although usually this occurs within 15 minutes. In some cases complete liquefaction does not occur within 60 minutes.

Viscosity (Consistency)

Usually after ejaculation the semen should liquefy again in about 30 minutes. This allows the sperm free motility. If the semen does not liquefy or if it is very thick in consistency even after liquefaction, this suggests an infection of the seminal vesicles and prostate.

Semen pH

Normally the pH of semen is alkaline because of the seminal vesicle secretion. An alkaline pH protects the sperm from the acidity of the vaginal fluid. An acidic pH suggests problems with seminal vesicle function. It is usually found in association with a low volume of the ejaculate and the absence of fructose.

White blood cells

The semen may contain white blood cells. While a few white blood cells in the semen are normal, many pus cells suggest the presence of infection or inflammation. This also can affect the viability of the sperm.

Agglutination

Sperm clumping or agglutination means that many sperm stick together in groups or clusters. This impairs sperm motility and prevents the sperm from swimming up to through the cervix towards the egg.

Fructose

Fructose is a sugar produced by the seminal vesicles and provides energy for sperm motility. Its absence suggests a block in the male reproductive tract in ejaculatory duct. In men with no sperm or very low numbers of sperm in the ejaculate, it is important to determine whether the sperm are not being produced at all, or whether they are being produced but are blocked from getting into the semen. A fructose test can help differentiate between these two problems


Concentration (Count)

Sperm count means the number of sperm present per ml of semen. If the sample has less than 20 million sperm per ml, this is considered to be a low sperm count. Less than 10 million is very low. Some men who have no sperm at all and in their semen are said to be azoospermic.







Motility

This describes the percentage of sperm that are moving. Fifty percent or more of the sperm should be moving. Remember that only those sperm that move forward fast are able to swim up to the egg and fertilize it. Motility is graded from a to d, according to the World Health Organization (WHO) Manual criteria, as follows -

a. rapid progressive motility
b. Slow or sluggish progressive motility
c. non progressive motility
d. immotility





Morphology

The heads of stained human spermatozoa are slightly smaller than the heads of living spermatozoa in the original semen, although their shapes are not appreciably different. For a spermatozoon to be considered normal, the sperm head, neck, midpiece, and tail must be normal

Ideally, a good sperm should have a regular oval head, with a connecting mid-piece and a long straight tail. An abnormal sperm is distorted in its shape. If too many sperm are abnormally shaped (round heads; pin heads; very large heads; double heads; absent tails) this may mean the sperm are abnormal and will not be able to fertilize the egg. A normal sample should have at least 15% normal forms.

What is Intra Uterine Insemination (IUI)?

fertility
An intrauterine insemination (IUI) is a procedure in which the sperm is “washed” and prepared then deposited into the upper portion of the uterus to help achieve a pregnancy. It is often an excellent option for couples prior to considering more complicated and very expensive procedures, such as in vitro fertilization(IVF).

The wash and IUI can be very helpful to couples seeking to have a child when the man has low sperm counts, low motility, hyperviscosity (very thick semen), motile sperm that are clumped together (antibodies), sperm that “ backs up” into the bladder (retrograde ejaculation) or other abnormal sperm test such a poor sperm shape (morphology). Many couples use IUI to accelerate the chances of pregnancy, such as after vasectomy reversal or if the woman is older.
It is also useful when the woman’s mucus is hostile or incompatible with man’s sperm, or if she has problems with her cervical positioning or opening, as well as unexplained causes of infertility.
The chance for achieving pregnancy with an IUI is around 20% to 25% per cycle when at least 5 million sperm are used for insemination, and the sperm wash is performed by a competent and highly trained technologist. Several factors can affect these “odds” such as the woman’s age, correct timing of the cycle, and whether one or two IUI’s are performed each cycle. However, the single most consistently predictive factor in determining the success of an IUI is the number of motile sperm inseminated into the uterus from the wash procedure.
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