Evaluation of the male partner is an important part of the infertility work-up. A complete male history is obtained, and a semen analysis ordered. The semen refers to the liquid that is expelled at the time of ejaculation. The sperm are the moving cells within the semen that have the ability to fertilize the egg. The semen specimen is then evaluated for the following:
- volume of the semen 2-5 ml
- concentration of sperm ³ 20 million/ml
- motility (percentage of moving sperm) ³ 50%
- strict morphology (sperm appearance) > 14%
At the Missouri Center for Reproductive Medicine and Fertility, we have a dedicated Andrology Laboratory which is staffed by an Andrologist and an Andrology technician. Our High Complexity Lab Director and our embryologist are specially trained in in vitro fertilization (IVF) procedures. We provide private rooms designed specifically for sperm collection, each with a private bathroom. In the event of an abnormal semen analysis, the male partner can be referred to a urologist who specializes in male infertility for a physical examination and further testing.
When a sperm problem exists that cannot be corrected, the basic principle of treatment involves getting the sperm closer to the egg. This can be done by a number of methods: 1) IUI (intrauterine insemination) involves injection of sperm into the woman's uterus 2) IVF (In Vitro Fertilization)involves mixing the sperm with the patient's eggs in the laboratory, where fertilization will take place 3) IVF + ICSI (intracytoplasmic sperm injection) involves injecting a single sperm individually into each egg in the laboratory to improve the chances for fertilization.
ICSI can be used in cases where there are very low sperm counts/motility/ and/or low percentages of normal appearing sperm (morphology). In some cases where the husband produces no ejaculated sperm, sperm can be directly removed from the testicle or epididymis by a urologist (Testicular or Epididymal sperm aspiration), and then frozen for a future IVF + ICSI cycle. Donor Sperm can be used in cases where there is not even enough sperm for ICSI or in conjunction with intrauterine insemination (IUI) in patients with open fallopian tubes.
Our Andrology Laboratory also offers sperm banking (cryopreservation or freezing of sperm for use at a later date) for males who are undergoing medical treatment which might make them sterile. This would include radiation or chemotherapy for cancer, surgery of the male reproductive tract, etc. This allows the patient to have a chance for future fertility following their medical/surgical treatment. As previously mentioned, patients who require removal of sperm directly from the testicle or epididymis also have sperm frozen prior to IVF + ICSI.
Our Andrology Laboratory also offers an anonymous donor sperm bank to allow our patients more flexibility and choice when donor sperm is required.
Causes of Infertility
Ovulation Disorder and PCOS