Abnormalities on a semen analysis may prompt your doctor to order more tests to determine underlying causes of fertility issues or to determine whether there really is a fertility issue. Here are a list of some of the most common follow-on tests that specialists use to diagnose and treat male fertility.
Hormone levels are as important for fertility in men as they are in women. A hormonal imbalance can affect sperm production. (See our biology lesson on hormones to learn more) Doctors will often order a blood test looking at a number of hormones to determine if they are a contributing factor to semen abnormalities.The key hormones that doctors look are are: Testosterone (T), Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). They may also want to look at Prolactin (PRL), Thyroid Stimulating Hormone (TSH) and Sex Hormone Binding Globulin (SHBG) to better understand underlying causes of hormonal imbalances.
Chromosomal analysis is performed in men with low (less than 5 million) or no sperm in the ejaculate. For more information, please read about genetic infertility.
Y Chromosome Analysis
It has become apparent that up to 8% of men with low sperm counts and 15% of men with no sperm counts may be missing small portions of the Y chromosome, termed Y-microdeletions. For more information, please read about genetic infertility.
FISH – Fluorescence in situ hybridization
Developed in the 1980s, the Flourescence in Situ Hybridization or FISH test helps to diagnose genetic abnormalities such as Downs Syndrome. It is also used to help develop a prognosis in cancer patients. Recently, it has become an increasingly popular way to screen sperm for aneuploidy, or extra chromosomes, prior to IVF. This helps to eliminate genetic disorders such as Downs Syndrome, Turner Syndrome and Edwards Syndrome.
Extended Semen Analysis
Seminal Fructose and Post Ejaculate Urinalysis
Fructose is normally present in the ejaculate. If absent, or the pH in the ejaculate is low, then the seminal vesicles may be missing or obstructed. A post ejaculate urinalysis (PEU) is a microscopic inspection of the first voided urine after ejaculation for sperm. Retrograde ejaculation is diagnosed in this manner.
Semen Leukocyte Analysis
Leukocyte is the scientific term for white blood cell. There are naturally a few white blood cells floating around in semen but if there are more than a few, it can mean that there is an infection somewhere in the male reproductive system. At first glance, baby sperm cells (ones that haven’t grown a tail yet) look very similar to white blood cells. So, if doctors see a large number of round cells in the semen they will often perform this test to find out if they are sperm cells that haven’t developed yet or white blood cells. Identifying the type of round cells in semen can help doctors get to the root of a fertility issue.
Quantification of Reactive Oxygen Species (ROS)
Have you ever poured hydrogen-peroxide (brown bottle, white cap) on a cut and had it bubble up? The reason we clean cuts with peroxide is because it kills cells and we use it to try to kill off bacteria so they don’t infect a wound. Hydrogen-peroxide (and other similar things collectively known as Reactive Oxygen Species or ROS) is a byproduct of natural processes in the body that use oxygen. These leftover molecules can get into semen and start killing off sperm cells. ROS levels are elevated in up to 40% of subfertile men. Doctors might check ROS level in semen if they suspect that it is contributing to low motility.
Sperm DNA Fragmentation Assay
Sperm DNA can get damaged while they are being created or during the process of maturation. DNA fragmentation has been found to contribute to early miscarriages as it can affect implantation and embryo development. ROS (see above) and varicoceles are known offenders for DNA damage and can be corrected. The most common form of DNA fragmentation test done these days is called Sperm Chromatin Structure Assay (SCSA) This can be a useful test in cases of unexplained early miscarriages and for predicting success with ICSI.
Yes. This is exactly what it sounds like. Get your busy on, then go straight to the docs. A sample of cervical mucus is taken 30 minutes after intercourse during mid-cycle to see how many swimmers got there and how well they are swimming. This test has become less popular with the increasing use of ISCI (direct injection of sperm into egg during IVF) but for people who would like to pursue natural conception, this test can provide good information about compatibility issues.
Detection of Anti-sperm Antibodies
Antibodies are proteins that circulate in the blood. The immune system develops antibodies as a way to identify infections. Antibodies stick to the germs and signal your white blood cells to kill them. In rare occasions, the immune system gets confused and develops antibodies against sperm which could signal an attack on your swimmers. The role of anti-sperm antibodies in fertility has been controversial and medicine has been working to figure out exactly how they impact fertility. They have been found in around 13% of subfertile couples and may be a contributing factor to unexplained fertility. Doctors will most commonly recommend the test when the semen analysis reveals clumping of sperm cells.
This test checks to see if immotile sperm are dead or just bad swimmers. This is useful to know if there are factors that killing sperm or if they are not developing correctly. It is also useful in severe cases of poor semen quality for selecting sperm for ISCI.
Acrosome Reaction Assay
The acrosome is a protein “hat” on the sperm’s head that enables it to penetrate the egg. Sometimes sperm with abnormal morphology will develop without the acrosome, called globozoospermia, causing them to be unable to penetrate the outer layer of the egg. This test checks sperm to see if they are equipped with an acrosome.
Hemizona Binding Assay (HZA)
A little like sperm Olympics, this test pits your sperm against a donor sperm to see how well each are able to fertilize an egg. The outer layer of a non-fertiliizable egg is placed in a petri dish and your sperm go head to head, gladiator style against a donors to see how many of each are able to penetrate in a 4hr period. With the increased use of ISCI and the high expense and expertise required to do this test, this test is becoming more rare.
Sperm Penetration Assay (SPA)
This test seems a little crazy, and isn’t done all that often anymore with the advent of ISCI but had to include it in the list. This is a complete test to find out if sperm are able to complete all the steps necessary to fertilize an egg. A semen sample is collected and allowed to incubate with a hamster egg that allows multiple sperm to penetrate it. After a set amount of time doctors will check to see how many sperm have been able to penetrate the egg. As you can imagine, its a time consuming and expensive test to run, but it rare cases where ISCI isn’t an option it allows patients to find out ahead of time how successful classic IVF is likely to be from a fertilization stand-point.
Scrotal Doppler Ultrasound
Urologists often order scrotal ultrasounds to confirm suspicions about abnormalities that they discover during a physical exam or to discover abnormalities that may be too small to detect by other means. Ultrasounds are painless windows into the inner workings of the testicle that do not present any risk to the patient which is why they are a popular diagnostic tool for docs. Read on to learn what you can expect from a scrotal ultrasound appointment.
Transrectal Ultrasound (TRUS)
Like the scrotal ultrasound, TRUS employs ultrasound technology to image the plumbing of the male reproductive tract. Similar to submarine SONARs, ultrasounds use high frequency sound waves to build an image of internal tissue structures. In the case of the transrectal ultrasound, the doctor is looking to see the structure of the various tubes that transport sperm and the prostate gland. Sometimes, if there is a suspicion of prostate cancer, they may also take a small sample of tissue to biopsy. Read More….
X-Ray of the vas deferens.
CT Scan/MRI Pelvis
Since the advent of TRUS, these studies are only rarely indicated. One reason to order this study is to further evaluate a patient with an isolated right varicocele.
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