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Andrology Lab Booklet


Computerized Routine Semen Analysis


Comprehensive, expert semen analysis is an essential element of male infertility diagnosis and treatment planning for helping couples achieve pregnancy. The expert physicians and technicians in our Andrology Laboratory are among the most experienced in the country in conducting and analyzing the highly specialized tests related to semen analysis.

Our laboratory technologists are certified by the American Society of Clinical Pathologists. Our laboratory is CLIA certified by the Department of Health and Human Services and accredited by the College of American Pathologists in conjunction with the American Society for Reproductive Medicine. In addition to providing testing services for our own patients, the laboratory also offers referring physicians accurate, quantifiable results using the latest technology available.

Leukocytospermia Quantitation/Endtz Test

Endtz Test

The presence of high numbers of white blood cells (WBCs) in semen has been associated with male infertility. WBCs can be quantitatively estimated by Endtz test, a histochemical technique in which peroxidase-positive granulocytes (leukocytes and PMN cells) stain dark brown. The Endtz test allows clear differentiation of WBCs from other immature germ cells in semen.

Kruger's Strict Morphology Classification


Data indicates that normal sperm morphology is a significant predictor of pregnancy in in vitro fertilization. The Kruger strict morphology classification is a tool to assess sperm morphology. Performed by experienced laboratory personnel, it is a valuable aid in the evaluation of the infertile male.

Special Staining for Azoospermic Specimen


Nuclear fast red-picroindigocarmine stain is used to assess the presence or absence of sperm microscopically in azoospermic specimen, when no sperm were seen during a routine semen analysis. The sperm heads stain pink and tails stain green.

This test must be performed by an experienced laboratory technologist.

Post-vasectomy Screen


This test is performed to determine the success of a vasectomy.

Sperm Processing

Diagnostic Sperm Wash*

Tests marked with an * (asterisk) require an appointment, All others do not.

A diagnostic sperm wash can be ordered for a patient who has been selected for intrauterine insemination using the husband's washed spermatozoa. This procedure includes a pre-wash semen analysis and sperm washing. The ejaculate is divided into two equal aliquots and processed by swim-up and density gradient techniques, yielding more accurate results than previously possible. The results of this procedure can help decide the best possible sperm processing technique for each couple.

Swim-up Sperm Wash*

The swim-up method results in sperm fractions with improved motility and numbers adequate for conception, as well as a more nearly uniform morphology, free from seminal debris. The main advantage of a swim-up method is that high percentages of motile sperm can be recovered. However, the recovery rate of total motile sperm is low, especially if the initial motility is low.

Density-Gradient Sperm Wash*

The density-gradient separation method with PureCeptionTM concentrates highly motile, viable sperm in a small volume of fluid. Separated samples are free of seminal plasma, leukocytes and other debris. The density gradient method is especially useful in cases of asthenozoospermia and oligozoospermia, in which normal wash and swim-up procedures may yield an insufficient number of sperm for clinical use.

Sperm Antibody Immunological Analysis

This test is an important part of the evaluation of infertile couples. Indications for testing may be a poor postcoital test, sperm agglutination, poor sperm motility, or simply overall unexplained infertility.

Direct Immunobead Test*

A patient's semen specimen can be tested for the presence of antisperm antibodies by an immunobead binding test, which detects IgG, IgA or IgM classes of antibodies that may be present on the sperm surface.

Indirect Immunobead Test

The presence of antisperm antibodies also can be detected in the patient's serum or seminal plasma.

Semen Biochemistry

Fructose Test

Fructose is normally present in all semen specimens. The absence of fructose could indicate congenital bilateral absence of the vas deferens or bilateral ejaculatory duct obstruction. Both a qualitative and a quantitative measurement of fructose can be performed.

Sperm Function Tests

Hypo-osmotic Swelling Test

The ability of the human sperm tail to swell in the presence of a hypo-osmotic solution is a sign of membrane integrity and normal function activity. HOS is correlated to the in vitro fertilizing ability of the spermatozoa and is a useful addition to the standard semen analysis.

Reactive Oxygen Species (ROS)*

Free oxygen radicals such as .O2-, .H2O2, .OH, and .OHCL, are called reactive oxygen species (ROS). These substances are unstable and could cause damage to the spermatozoa. A small amount of ROS is needed for sperm-egg fertilization. Normally, antioxidants present in seminal fluid neutralize any increased production of ROS. However, in case of infection, or some other clinical conditions such as varicocele, significant amounts of ROS can be generated. This increased ROS can damage the normal spermatozoa in semen. Levels of ROS can be measured using a chemical probe that reacts with the free radicals. This test may be ordered in the presence of high numbers of round cells in semen due to infection, idiopathic infertility, or in the presence of a clinical varicocele.

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Last Update : December 12, 2008
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American Center for Reproductive Medicine
The Cleveland Clinic
10681 Carnegie Avenue, X11
Cleveland, OH 44195 USA
Tel: (216) 444-9485
Fax: (216) 445-6049
E-mail: CRM@ccf.org