Washington Center for Reproductive Medicine

Male Infertility- The Semen Analysis

Mycoplasma Culture

Mycoplasma are small bacteria like organisms that are suspected to cause several urologic, obstetric and gynecologic disorders, such as pelvic inflammatory disease, urethritis and pregnancy loss. Women whose reproductive tracts are colonized with Mycoplasma have higher rates of miscarriage. The organism is quite commonly cultured and easily treated with antibiotic therapy, with excellent results.

If any abnormal parameters are noted in the initial semen workup, further sperm testing may be indicated. The more advanced workup can include antisperm antibody testing (in either or both the male and female) and the hamster egg sperm penetration assay (SPA).

Antisperm Antibodies

Antisperm antibodies are immune-reactive particles produced by the body in response to the proteins contained in sperm. The immune system seeks to inactivate the sperm when antibodies are present. The formation of antibodies can happen as a result of contact between blood cells and sperm, as through testicular trauma, varicocele, vasectomy, intercourse, or sometimes for unknown reasons.

Antisperm antibodies can have a harmful effect on sperm function. These antibodies are of two main types, those preventing motion and those leading to cell death.

The likelihood of a proven fertile male having antibodies is approximately 4%. The probability tends to increase significantly in males with defined infertility and in men who have had a vasectomy followed by reversal some years later.

The presence of such antibodies is first suspected when routine semen analysis reveals clumping of sperm with poor forward progression. Repeated poor Post Coital tests may indicate the presence of antisperm antibodies in the female. Clumping of sperm may also be noted, although clumping of sperm by itself does not always indicate the presence of antibodies.

Sperm DNA Fragmentation Test

Sperm DNA Integrity Test- The integrity of DNA in a single sperm cell that fertilizes a female oocyte is important for the development of a healthy embryo and fetus.  Testing for sperm DNA integrity is another test of sperm function and is indicated in couples with a history of unexplained infertility or failed IVF including recurrent pregnancy loss.  This is a new test but it appears that if the semen sample contains more than 30% of sperm with denatured DNA the function is adversely affected.

Oocyte Fertilization in the IVF lab

In an IVF procedure the fertilization is directly observed and this is the ultimate test of sperm function.  Obviously this applies to couples having IVF and cannot be routinely used for all patients.


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