The dr. Laura Blasco Gastón has extensive experience in Assisted Reproduction. It has diverse publications and conferences on the specialty, especially on protocols of stimulation and oocyte and embryonic quality. In addition, it tries doctorate studies on screening of cytomegalovirus infection during gestation. This article explains how you can analyze semen quality.
The spermiogram or seminogram is a diagnostic test that aims to evaluate semen quality. Macroscopic aspects, such as pH and volume, and microscopic aspects such as the mobility, morphology and concentration of spermatozoa are analyzed; data that, if normal, are related to the probability of getting a natural pregnancy in less than 2 years.
This analysis can be completed with urethral and seminal cultures to rule out the presence of microorganisms that may alter fertility.
It should be noted that the spermiogram gives us limited information about the "male factor". When the spermiogram results are below the reference values, the probability of spontaneous pregnancy will be decreased; and when the values are normal, there is no guarantee of fertility, since up to 15% of men with infertility present spermiograms with values within the limits of normality. This suggests that the spermiogram is the first step in analyzing the male factor, but it is the tip of the iceberg, and we must take into account other factors that can affect reproductive success.
Causes that affect sperm quality
There are many causes that can affect sperm quality. We must study from the most external, like the habits of life, the physiology and the anatomy of the male, to the most internal, as is the genetics of spermatozoa.
Sperm are responsible for transporting the genetic material into the egg, so if this material is not correct there will be no pregnancy or there will be an increase in abortions.
DNA fragmentation in spermatozoa
The influence of lifestyle habits on sperm, such as tobacco and alcohol consumption, obesity, type of work, intense sports ... can be investigated by studying the DNA fragmentation of spermatozoa .
The DNA fragmentation allows to evaluate what percentage of spermatozoa of an ejaculate has some damage in its DNA. It is a very simple test that can be performed on the same ejaculate in which the spermiogram is analyzed. When DNA fragmentation is altered, various strategies, such as reducing days of sexual abstinence , treatment with vitamins and antioxidants, as well as reducing the consumption of tobacco, alcohol or weight, reduce the levels of DNA fragmentation and improve the result. This test is also indicated in cases of repetitive abortions, age over 45 years, varicocele, cryptorchidism, diabetes, etc.. Having a nutrition unit in assisted reproduction clinics helps patients improve their living habits and improve their seminal quality.
FISH in spermatozoids
At the genetic level, the diagnosis of male factor can be completed by performing a FISH study on spermatozoa. This test may be indicated against abnormal seminograms, altered male karyotype, repeat abortions or implantation failures. It is done in an ejaculate and allows us to know what percentage of sperm have some of their chromosomes altered.
During the formation of the spermatozoa in the testes, errors can occur that will give rise to spermatozoa with an extra copy of some chromosome (disomy), without a chromosome (monosomy) or with all duplicated chromosomes (diploidy). If any of these anomalous spermatozoa fertilize the oocyte could result in non-implantation of the resulting embryo or abortions. The result of this test may cause the couple to be recommended to perform an IVF cycle with Preimplantation Genetic Diagnosis (PGD).
Embryonic long culture in IVF or ovodonation
Sometimes the male factor is not diagnosed until a cycle of in vitro fertilization, with own or donor eggs, in which we leave the embryos in long culture for 5 days, for the transfer of blastocysts. The evolution of the embryos during the first 3 days of development depends mainly on oocyte quality, whereas from day 4 of development the embryonic genome is started, reflecting from that moment also the sperm quality. Thus, when the embryos have a good progression until day 3 of culture and slow down or stop after day 4, it is possible that we face a poor sperm quality that may not have been previously diagnosed. This is especially striking when ovodonating cycles occur, where oocyte quality is normally optimal, due to donor age, and where the male factor limits the proportion of originally estimated evolutionary blastocysts.
The study of the physiology and anatomy of the male is carried out by urologists. In this consultation, problems that affect male fertility such as varicocele, cryptorchidism, obstruction or absence of vas deferens, hormonal disorders, prostatitis, erectile dysfunctions ... can be ruled out to propose treatments that may improve the probability of spontaneous pregnancy or with Assisted Reproduction. It is frequent to indicate this consultation in the presence of several altered spermiograms.
In conclusion, the study of the male factor is more complex than asking for a spermiogram. Being this essential test, it is necessary to investigate the clinical history of each patient and to evaluate the need to perform other tests that help us to have a more complete diagnosis and a more effective action in each case, reducing failures in the treatments that generate physical, emotional and economic. URH Garcia del Real has a multidisciplinary team, highly qualified and committed to the good diagnosis and treatment of their patients.