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800.223.2273 Ext. 49485
Andrology Lab appointments:
800.223.2273 Ext 48182 or 216.444.8182

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Male Infertility

Investigations

CRSA

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.


Endtz Test

Leukocytospermia Quantitation/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.


Classification

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.


Staining

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.


Screen

Post-vasectomy Screen

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

Sperm Processing

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

Diagnostic Sperm Wash*

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 PureCeption 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 classes of antibodies that may be present on the sperm surface.

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.


 

Total antioxidant capacity (TAC assay) *

Oxidative stress occur when there is an imbalance between the formation of highly reactive free radicals called reactive oxygen species (ROS) and the ability of compounds known as antioxidants to neutralize these free radicals. These antioxidants include enzymes such as superoxide dismutase, catalase and glutathione peroxidase, macromolecules such as albumin, ceruloplasmin and ferritin and other small molecules, including ascorbic acid, a-tocopherol, ß-carotene, reduced glutathione and bilirubin. The sum of endogenous and food derived antioxidants represent the total antioxidant activity of the system. The overall antioxidant capacity provides more relevant biological information compared to that obtained by the individual components as it is considered to represent the cumulative effect of all antioxidants present in the seminal plasma. Poor antioxidant levels in seminal plasma are indicative of oxidative stress in patients with various clinical diagnoses.


 

Sperm DNA fragmentation (by TUNEL test) *

Sperm DNA fragmentation is a genomic anomaly which leads to male infertility. DNA fragmentation in sperm may be the result of many factors including, but not limited to oxidative stress, disease, diet, drug use, high fever, elevated testicular temperature, air pollution, cigarette smoking and age (upper 40's and beyond). Assessment of sperm DNA damage can be done through direct methods (direct detection of breaks in the DNA), or indirect methods. TUNEL assay is considered a reliable direct method for assessment of DNA damage in the sperm. The research has shown that sperm DNA fragmentation measured by TUNEL assay can differentiate between fertile and infertile men. Sperm DNA fragmentation can be treated by elimination of its cause and by oral antioxidants or assisted reproductive technology. Several studies have documented the role of TUNEL assay as a useful predictor for success of assisted reproductive technology.


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