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Male Infertility Services
Available andrology (male fertility)
services include:
1 - Referral to urologists
with training in male infertility
2 - Specialized sperm function
testing (Trial Wash)
What is a Trial Wash?
The reasons for a couple's
infertility are as individual as the couple. Therefore,
both partners need to be tested before treatment can
be planned. This is true even if one cause of infertility,
such as blocked fallopian tubes, has already been found.
For the man, these tests include a semen analysis (the
"sperm count"). A sperm count tells the doctor
whether there are sperm in the semen, whether they are
moving and how many of them are normally shaped. The
sperm count can’t give information about the particular
processes involved in fertilization, such as whether
the sperm can swim well enough to reach an egg and then
penetrate it. This needs a series of specialized tests
like Trial Wash that give your doctors the information
they need to tailor your infertility treatment to you
as a couple.
What are
the processes that the sperm has to go through?
For the sperm to reach the egg after intercourse, they
have to leave the vagina and swim through the mucus
in the cervix, which is the entrance to the uterus.
Then they have to swim through the uterus to the fallopian
tubes where they meet the egg. Before sperm can fertilize
eggs, they have to change their swimming pattern and
undergo various other changes. Whether a man’s
sperm can meet these challenges can now be tested in
the laboratory. With a Trial Wash, we can identify which
(if any) of the processes that the sperm will not be
able to accomplish. Your doctor can use this information
to develop a treatment plan for you which bypasses the
identified problems. This can range from intrauterine
insemination (IUI) to the
high-tech assisted conception procedures of in-vitro
fertilization (IVF) and
intracytoplasmic sperm injection (ICSI).
While a trial wash cannot identify a treatment that
is guaranteed to work, it means that treatments that
will probably not work can be bypassed. In the long
run, this can save couples both time and expense.
What are
the tests in a Trial Wash?
There are four tests in a trial wash that can usually
be done using a single semen sample.
- Full sample
analysis: This is a structured analysis that meets
World Health Organization standards. The Andrology
laboratory at the Genesis Fertility Centre was developed
to conform to, and even exceed, international standards
in the methods used and in quality control. The results
give your doctor information about the sperm concentration,
% of moving sperm, movement quality, % with ideal
shapes, a description of the abnormally shaped sperm
and signs of possible infection.
- Antisperm antibody screen: It
is possible for a man to make antibodies to his own
sperm. There are a number of causes of antibody formation,
such as trauma to the testes, vasectomy or a cross-reaction
with particular bacteria. These antibodies can bind
onto the surface of the sperm, but not kill them.
Depending on what part of the sperm cell the antibodies
are bound to, they can interfere with sperm movement
through the woman’s reproductive tract, or they
can stop the sperm and egg from uniting. While there
is no effective treatment to stop antisperm antibodies
from forming, there are treatments that can bypass
the fertility problems they can cause.
- Sperm swimming patterns in semen:
For sperm to swim through the mucus in the woman’s
cervix, they must have a particular swimming pattern. If the sperm are unlikely to penetrate
cervical mucus, then the chance of pregnancy with
timed intercourse would be low. In this case we would
recommend doing IUI.
- Trial wash with PureSperm: Not
all of the sperm in semen are of good quality, and
if assisted conception treatments are going to be
used, the “best” sperm have to be separated
from the rest of the semen. The best method available
for this is a PureSperm wash, where the best sperm
make it through the PureSperm solution, and the rest
get left behind. The selected sperm are the ones used
for IUI, IVF
or ICSI. The Trial Wash is like a practice run
so that the lab knows how to process the man’s
sperm on the day of the assisted conception procedure.
How does
my doctor use a Trial Wash?
After a Trial Wash is completed, your doctor can use
the results to predict which types of infertility treatment
would not be likely to help you. Your doctor can use
this information, along with the results of the other
infertility investigations to plan the best course(s)
of treatment for you as a couple. Of course, no treatment
option is guaranteed to result in pregnancy –
there are too many other factors involved in the establishment
of a pregnancy to be able to promise a successful outcome.
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3 - Sperm freezing
What is
sperm freezing?
There are many situations that may interfere with a
man’s future fertility. Some are planned,
some are accidental and others are due to complications
of illnesses or their treatment. These may include the
following:
- Chemotherapy or radiation therapy
- Vasectomy
- Occupations with high risk of (pelvic)
injury
- Illnesses (such as diabetes or
multiple sclerosis) that may
cause erectile difficulty
- Spinal cord disease or injury
- Certain types of pelvic surgery
Regardless of their current situation,
many men decide to freeze extra sperm as a safeguard
against unforeseen future circumstances.
How do
I arrange to freeze sperm?
First, contact your family doctor or urologist to arrange
testing for Hepatitis B, Hepatitis C and HIV. We routinely
screen for these infectious diseases because they may
be transmitted through the semen to a female partner
or an unborn child. These blood tests results are usually
available in 2 to 3 weeks. Once we have copies of the
blood tests results, you or your doctor’s office
can call to arrange an appointment to provide your first
specimen. Be prepared to sign consent forms for the
freezing and storage of sperm.
How many
samples should I freeze?
As no one knows what the future holds, there is no exact
answer to this question. Most men freeze between two
and five samples, but some men choose to freeze many
more samples, especially if they are young and have
not yet had children. In many cases, the time interval
prior to surgery, chemotherapy or radiation treatment
will be the deciding factor. It is best to abstain from
intercourse and ejaculation for two days before the
first sample and for about two days between semen samples.
However, exceptions can be made, especially if cancer
treatment is to be started soon.
How long
can the sperm stay frozen?
We will continue to store the sperm for one-year periods
as long as you continue to pay the storage fee and update
us about any address changes. If we cannot reach you
to confirm that you want to maintain the frozen samples,
we will thaw and destroy them.
What happens
if I want to thaw and use the samples?
After we receive a doctor's referral, you and your partner
will see one of our physicians here at Genesis to discuss
the different possibilities. The female will undergo
some basic fertility investigations. If the sperm samples
are of good quality, they can be used for intrauterine
inseminations at the time of ovulation. Because the
sperm has been frozen and thawed, pregnancy rates are
usually lower than in the general fertile population,
at about 10 to 20% per cycle. However, many men who
freeze sperm have been ill, and their sperm counts may
be already reduced. Those samples may only be suitable
for use in the more complex forms of assisted reproduction.
Could there
be a problem with the quality of sperm?
Yes, there may be a problem with the number and quality
of the sperm, especially in men who are about to undergo
cancer treatment. Their underlying illness may have
caused a drop in the sperm count or in the motility
(movement) of the sperm. Time permitting; it may be
advisable to freeze even more specimens in such situations.
If the sperm count or motility is low, the thawed samples
may not be suitable for standard inseminations. However,
we can still use them for In Vitro Fertilization (IVF)
and Intracytoplasmic Sperm Injection (ICSI),
where individual sperm are injected directly into the
eggs. These procedures are much more complex and costly,
but can result in pregnancies even in cases where the
sperm count is very low or the sperm are functionally
impaired..
Are there
any problems with the children arising from the use
of frozen/thawed sperm?
There do not appear to be any differences in the rates
of abnormalities or birth defects among children conceived
with fresh versus frozen sperm. However, there are some
theoretical concerns that chemotherapy drugs may have
unknown effects on the sperm or the offspring. If possible,
it is best to freeze the specimens before chemotherapy
begins.
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4 - Sperm retrieval (PESA, MESA,
TESE)
Specialized sperm retrieval
techniques (in conjunction with the Vancouver Sperm
Retrieval Clinic):
- Vibrostimulation and electroejaculation
for men with spinal cord injuries, retrograde ejaculation
or failure or absence of ejaculation.
- Microepididymal sperm aspiration
(MESA) and percutaneous epididymal sperm aspiration
(PESA) for men with obstructed or absent ejaculatory
ducts (i.e. unsuccessful vasectomy reversal, congenital
absence of the vas deferens). Sperm are aspirated
directly from the epididymis (the tiny collecting
tubules next to the testes) for use in the ICSI
procedure. The few drops of fluid may contain sufficient
sperm to be frozen for several ICSI
procedures.
- Testicular sperm extraction
(TESE) for men with obstructions or ejaculatory problems
that cannot be treated by any other methods. Small
samples of testicular tissue are obtained by needle
biopsy and a few sperm are painstakingly dissected
out of the tissue for use in the ICSI
procedure.
- Screening tests and other diagnostic tests for severe male infertility:
- Genetic testing (chromosomal)
-
Microdeletion
-
Nuclear chromation fragmentation
-
Hormonal screens
-
Cystic Fibrosis screening
5 - Cost of Andrology procedures
Please refer to our fee
guide.
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