Infertile man diagnostics

//Infertile man diagnostics
Infertile man diagnostics2016-11-10T12:49:28+00:00

Infertile man diagnostics

The basic information about a man’s fertility is provided by the general semen evaluation. It consists in analysing a sample of semen for key parameters, including sperm count and quality, ejaculate liquefaction and volume, and many others.

The most up-to-date semen analyses allow to determine a man’s procreative potential and the accurate diagnosis of the background of his potential fertility problems.

Based on the obtained results it is possible to:

  • evaluate the sperm count and quality
  • determine a patient’s chances for having a child through natural conception
  • diagnose the cause of the problems with conceiving a child
  • in the case of any sperm abnormalities, determining the most effective path of medical proceedings


The general semen analysis allows to determine its basic parameters (sperm count, quality and motility, volume of ejaculate, etc.) and to eliminate potential abnormalities in this scope.

Abstinence from all sexual activity is required for 2-7 days before the test. The material for testing is obtained by masturbation. It can be provided in the Clinic in a special intimate room booked earlier before the test, or delivered to the Clinic within 45 minutes after collection. The material is provided for analysis in a special sterile container (similar to the urine specimen container).

Abstinence from all sexual activity is required for 2-7 days before the test.

Computer Assisted Sperm Analysis

Computer Assisted Sperm Analysis (CASA) allows to obtain objective data on sperm motility. The microscopic image is processed by a computer and subjected to a detailed analysis. The sequentially obtained images record the location of the spermatozoon’s head and its movement trajectory. This allows to assess in detail the parameters of the sperm cell movements: average path velocity, average velocity of forward progression, average amplitude of lateral head displacement, straightness and many others used to divide spermatozoa into subpopulations with different movement rate and velocity of progression. CASA ensures objective results and standardisation of the procedure and of obtained parameters thus allowing diagnostic comparability among laboratories.

Semen analysis is the basic marker of fertility; its aim is to diagnose the causes of inability to have offspring. The most up-to-date semen tests allow to determine a man’s procreative potential and the accurate diagnosis of the root cause of his potential fertility problems. Abnormalities relate to the sperm cell count, motility, structure, function and other disorders or anomalies.

It's worth knowing

Semen reference values according to WHO
In 2010 the World Health Organization (WHO) updated its reference values for the Semen Analysis Parameters. They are presented in the table below.

ParameterWHO until 2010 r.WHO since 2010 r.
Abstinence2-7 days2-7 days
Liquefaction time30-60 minutes30-60 minutes
Volume2 mL1,5 mL
Sperm count in ejaculate40 milions39 milions
Sperm count in 1mL20 millions15 millions
Progressive motility (A+B)50%32%


If the general semen analysis reveals any abnormalities, or a physician after conducting a detailed interview with the Patient considers it necessary, additional tests may be required.

INVICTA Medical Laboratories, as the first in Poland, introduced modern tests allowing the comprehensive and scientifically advanced semen diagnosis. In addition to standard testing procedures, the offer of INVICTA includes, among others:

  • sperm DNA fragmentation test,
  • motile sperm organelle morphology examination (MSOME),
  • hypo-osmotic swelling (HOS) test,
  • extended test SOME+HOS,
  • hyaluronan binding assay (HBA),
  • diagnostic sperm separation,
  • diagnostic testicular biopsy.
The Sperm DNA Fragmentation Test allows the detailed examination of the genetic material as the prognostic parameter of the fertilisation efficacy, pregnancy development and birth of a healthy baby. A standard semen analysis does not always provide all necessary information allowing the determination of a patient’s fertility.

Embryos obtained in result of fertilising an egg with the spermatozoon with abnormal (high) level of DNA fragmentation have poor prognosis already at the development stage of blastocyst (5-day old embryo). After their administration to the uterus, they often fail to implant and the pregnancies obtained with them more often can end with miscarriages, abnormalities and increased vulnerability of the offspring to cancer diseases.

The increased level of sperm DNA fragmentation is associated, among others, with infections, fever, increased body temperature in the testicle area, smoking, improper diet, stimulants, exposure to environmental contaminants, and advanced age. The treatment, or more precisely minimising the level of fragmentation, depends on a causative factor. If the sperm chromatin damage was caused by oxidative stress, changing the lifestyle and balanced diet may contribute to reducing the extent of DNA damage. Antibiotic therapy in case of infections should also result in reducing the fragmentation level. The verification of the accuracy of the introduced measures should take place on the basis of repeated evaluation of the genetic material quality after 2-3 months from the first analysis.

Motile Sperm Organelle Morphology Examination (MSOME) is the examination of the sperm morphology under high magnification. The diagnosis using MSOME method allows to take into account the intracellular structures of spermatozoa, including the presence of vacuoles and their size. There is a relationship between the presence of vacuoles and the sperm nuclear chromatin damage. Large vacuoles may be suggestive of abnormalities in semen (among others, chromosomal aberrations) or DNA damage.

This test is performed, among others, to qualify the patient to the IMSI-MSOME procedure of assisted reproduction.

The Hypo-osmotic Swelling (HOS) Test is an extended semen analysis which allows to evaluate the sperm cell viability (vitality) and to analyse the regularity of the structure of their cell membrane. In live spermatozoa, in hypo-osmotic environment, water passes through the semi-permeable cell membrane to the inside of a spermatozoon causing the swelling of the sperm tail. Such reaction takes place only in live semen where the sperm cells have integral cell membrane.

The test is performed in order to identify alive sperm cells.

SOME+HOS extended semen analysis is performed under very high magnification. It consists in the assessment of the morphology of the sperm cells’ head and its internal structures, and in the evaluation of the sperm tail reactions in hypo-osmotic environment.

The SOME+HOS extended semen analysis is performed, among others, to qualify the patient to the procedures of assisted reproduction.

The sperm-hyaluronan binding assay allows to assess the sperm cell quality and the degree of their maturity. Hyaluronan (hyaluronic acid) is present in large amounts in the area surrounding the egg cell, therefore the sperm’s ability to bind hyaluronan is significant from the fertilisation’s perspective. This ability appears at the advanced stage of sperm development, therefore the test allows o draw conclusions about the normal or abnormal function and the degree of maturity of the spermatozoa. Furthermore, the analyses demonstrate that there is a relationship between the hyaluronan-binding ability of the sperm cells and the sperm morphology and the quality of its genetic material.

The test can be performed in the presence of the adequate number of motile sperm cells in semen. It is recommended if the idiopathic infertility is suspected, and if there is the need to extend the diagnosis before further medical measures are taken.

Sperm cells used in IVF techniques require the adequate preparation. With the use of techniques of sperm cell isolation from semen, spermatozoa are separated from the semen plasma, substances inhibiting the ability to fertilise egg cells are removed, processes facilitating the egg cell fertilisation are initiated, sperm cells with proper morphology and motility are selected, bacteria and viruses are eliminated and the sperm cells with female or male chromosome are selected.

In the sperm cell isolation, the following techniques are applied:

  • semen flushing,
  • sperm separation in discontinuous gradient medium,
  • swim up.

The most commonly used method of sperm separation is density gradient centrifugation (DGC), or the Percoll method, which allows to obtain the homogeneous population of normal sperm cells, separate the sperm cells from other morphotic elements of semen, and poses negligible risk of losing some small amount of spermatozoa when their cumber in the ejaculate is small.

Sperm separation before the intracytoplasmic sperm injection of the egg allows to obtain a higher percentage of pregnancies and to reduce the number of childbirths occurring with the application of IVF techniques. The test is performed with the use of hyaluronan which is the component of culture media and selection dishes. Hyaluronan is a polysaccharide which is naturally present in the space surrounding the egg. At the time of physiological fertilisation, sites able to bind hyaluronan form on the sperm cell’s head; they are indispensable in the process of binding the sperm cells head to the egg. The sperm cell which is devoid of the hyaluronic acid binding sites in unable to fertilise the oocyte. This phenomenon has been used in the sperm cell evaluation also in assisted reproductive technologies. A diagnostic test with hyaluronan performed in vitro allows to select mature, viable spermatozoa with the lower percentage of DNA damage and normal rate of genetic disorders. Selection performed with the use of hyaluronan results in obtaining spermatozoa which in physiological conditions participate successfully in the fertilisation process.

Diagnostic testicular biopsy is a procedure consisting in collecting the tissue specimen for histopathological verification. The examination is performed by percutaneous fine needle aspiration biopsy or using an open surgical protocol. The biopsy is performed under general or local anaesthesia. The collected material is evaluated for the presence or absence of the germ cells and spermatozoa.

The isolated sperm cells are used in the fertilisation process using the procedure of sperm microinjection into egg cells. The testicular biopsy is performed most often in the case of diagnosed azoospermia (absence of the sperm cells in semen) in order to perform differential diagnosis of obstructive azoospermia and azoospermia without the obstruction of ejaculatory ducts.

From the 7th week of pregnancy the Sertoli cells of the foetal testicles produce the Anti-Müllerian Hormone (AMH); the presence of this hormone inhibits the development of paramesonephric ducts (or Müllerian ducts) thus preventing the development of female reproductive organs. The atrophy of Müllerian ducts ensures the development of male reproductive organs: epididymides, vasa deferentia, seminal vesicles, and testosterone produced by the Leydig cells of testicles supports their further development and maturation.

AMH is present in the blood serum at every stage of life in boys and men – from babyhood to adulthood, contrary to female sex where AMH is detected only after menopause. From the moment of achieving sexual maturity, AMH in men is present at low levels in the blood serum due to its inhibition by testosterone. In addition, the AMH secretion is regulated not only by testosterone, but also by the germinal cells and FSH. The serum AMH level is the marker of the Sertoli cells’ activity in boys. Its drop in the blood serum after the puberty period can be interpreted as the early sign of the local testosterone activity and activation of spermatogenesis in testicles. After achieving sexual maturation, AMH in men is present mainly in semen and is considered a marker of the functional maturity of the Sertoli cells and the development of spermatogenesis. In men with hypogonadotropic hypogonadism the lack of gonadotropin secretion leads to the underdevelopment of testicles – AMH levels are high due to the lack of inhibition caused by low levels of gonadotropins and testosterone. In the case of men with hypogonadotropic hypogonadism the exogenous supply of gonadotropins induces testicle development, sexual maturation and spermatogenesis, thus inhibiting high AMH levels.