BLOOD TESTING

All men with fertility problems should undergo hormonal evaluation (male infertility testing by a male reproductive urologist), similar to that obtained in the female partner. This consists of a single blood test to determine the level of three pituitary hormones (FSH, LH and Prolactin) and one testicular hormone (Testosterone). Sperm production and function depends on the proper interrelationship between these hormones.

SEMEN TESTING

Semen testing is not like blood testing in that it must be done by a trained lab technician and not by a computer. Therefore, the experience of the lab is critical in obtaining accurate semen testing. Most men evaluated for infertility will need two separate semen analyses due to day-to-day variations in semen quality. Many men who have had one or more tests done at a large commercial lab such as Quest or LabCorp may still need two more tests done at a more specialized lab with experience doing semen testing. This, of course, depends on what the initial semen testing has shown if it has already been obtained before seeing me.

There are several tests of semen quality available, but the “basic” semen analysis should include the following:

1. Semen volume
2. Sperm density (‘count’)
3. Motility (% ‘swimming’)
4. Forward progression (determination of the forward movement)
5. Morphology (see below)

Morphology is a determination of the shape of the sperm as seen under a light microscope. It is NOT a genetic test and has nothing to do with DNA problems or birth defects. Morphology testing originated in the 1970’s when doctors wanted to know why some sperm did not fertilize eggs well during standard in vitro fertilization. It has now been expanded to looking into sperm function during intercourse and with some forms of assisted reproduction such as intrauterine insemination (IUI). There are only two acceptable measures of morphology: one by the World Health Organization and the other by Kruger, et al. Both of these are called “strict morphology” and are the ONLY standardized means of determining morphology.

There are several additional tests of semen function available. These include the following:

1. Presence of reactive oxygen species (oxidants)
2. Presence of antisperm antibodies
3. Presence of white blood cells (WBC’s)
4. Determination of sperm penetrating ability (through the egg membrane) – This test, called sperm penetration assay (SPA) is used when all other parts of the semen analysis are normal but pregnancy is still not occurring. The sperm from a single semen sample are allowed to penetrate the surface of hamster eggs stripped of some of their outer membrane components. This simulates some of the processes sperm must undergo during fertilization with the human female egg. This test is one of the only tests used to determine sperm functional ability. Decreased sperm penetrating ability may be caused by several conditions including varicocele, infection, inflammation, and the presence of semen oxidants.

If these tests become necessary, Dr. Nudell will give you further detailed information about each one.