Friday, January 16, 2009

Semen Analysis: What the results might mean...

We got our detailed diagnostic test results in the mail from SHER - very quickly I might add - 3 business days :) I love that clinic! I will say that there was one inconsistency in their notes regarding our situation. Dr. Ahlering referred twice to "pelvic discomfort" that I had "mentioned"... which I never did... maybe it was taken from the initial questionnaire I'd completed, maybe I mis-marked something? Who knows, because we never talked about that verbally. Anyway, not a big deal, but I do want to clear it up with them.

Semen Analysis Results
Our semen analysis didn't come back with complete flying colors afterall and it looks as though we might be dealing with slight male factor infertility. First, let's note what the job of sperm is. According to the Georgia Reproductive Specialists:

1) Sperm must be able to swim to the egg with a vigorous straight motion (motility, forward progression, revealed in the SA)
2) Sperm must be able to penetrate the egg to deliver your genes for fertilization (sperm penetration)

The only way you will know if it can penetrate an egg is to do a "sperm penetration assay (hamster test) or acrosin test". We haven't had this done, and at this point, I'm not sure if Dr. Ahlering would recommend that or not. The only reason we'd want to check this out is to see if we'd need to do assisted hatching with our IVF treatment to help encourage the egg to implant.

Also, his count was somewhat low (11.7 total concentration - they like to see 20 or above), however, according one site, "provided your sperm show adequate forward motility and good egg penetration, concentrations as low as 5 to 10 million can produce a pregnancy. It's interesting to note that only twenty-five years ago counts of 100 million sperm per ejaculate were the norm. With time, the effects of our toxic environment and/or lifestyle seem to be gradually degrading male sperm counts."

Kruger morphology, where they look at the shape and make-up of the sperm for abnormalities, results were 16% (they like to see 15% or moe), and comments noted were "Overall, good. Valcuoles and some head abnormalities". When doing research online, I came across a statement from a women who said, "If you have a Kruger between 10% and 15% your chances of conceiving with IUI are very very slim. If your Kruger is between 5% and 9% you will likely NOT have success with IUI, you should be directed to IVF and with Kruger below 5% you should be directed to IVF with ICSI. These are not hard and fast numbers. ICSI increases your chances with IVF so if you are doing IVF and you have Kruger morphology below normal, I would seriously consider ICSI." Another site, this time from the Georgia Reproductive Specialists, states "normal sperm function is predicted when more than 15% are normal".

The good thing is that motility(the percentage of sperm moving and the progression of the motile) was 77 (they like to at least see 50) and rapid cell count was 40 (normal is 25).

Honestly, we're still learning the ins and outs of male infertility factors. For now I'm trying to think positive about this; afterall, the doctor didn't seem to stress any male factor during our follow-up conversation, or on their internal notes they mailed to us, there was only a slight mention of the low count. For now, we're taking some initial steps to try and improve his sperm production... things like a multi-vitamin (especially focusing on zinc and vitamin A) and changing to boxers. In the coming weeks we are planning to ask Dr. Ahlering more about the male factor infertility we're dealing with, all the while keeping in mind that sperm takes approximately ninety days to form and mature. Whatever we do, if anything, in regards to this sperm issue, we need to make sure we're thinking proactively in time for the IVF cycle we eventually do. Live: Dr's Thoughts on Semen Analysis
In doing some research on reading semen analysis results, I came across another Live online radio show titled "Treating Male Factor Infertility", hosted by Kim Hahn, with the special guest being none other than my RE, Dr. Peter Ahlering of SIRM/SHER of St. Louis, from 12/04/08. To listen to this archived show, click here. As always, I like to take notes of what I find to be most helpful from the show and have summarized them below. As a disclaimer, these are in my own words and are in no way meant to represent verbadum the thoughts of either party mentioned above.

Who needs a semen analysis and what tests to run
If a couple has been trying for more than six months, don't just blame it on a female factor. Males who should be particuraly concerned are those exposed to chemicals over long periods of times (i.e. farmers), however, that certainly doesn't exclude all others, it just puts those type of individuals at a higher risk. All couples who have been trying and aren't seeing a positive pregnancy test should have a full semen analysis to insure you're not overlooking a possible male factor. Remember, it's not enough to just check count and motility. Typically, someone will call their OB or general practicitioner for a semen analysis. They then getting results from a lab that is suboptiomal because it's coming from a lesser quality lab and often is run through a generic, compter-generated screening process, rather than a human interpretation. DNA fragmentation is almost never suggested by most doctors, simply because they aren't educated enough. One sample looks for four things - count, motility, high resoultion morphology and DNA fragmentation. Currently, these four things tell us the most we'll know about sperm. SIRM's internal lab looks that the sample themselves, immediately. The DNA fragmentation will need to be sent away to a specialized lab (only three in the country).

A year can make a big difference
Age still plays a part in male factor - a year can make a big difference sometimes. One year you can have 500,000 or a million, which is great, but they may come back a year later and they have none. Dr. Ahlering says he suggests people consider Sperm Crown Preservation in many cases for anyone who is dealing with male infertility, for that exact reason. You never know what will happen. Low count, motility, etc. - you never know what you'll deal with in the future. Dr. Ahlering recommends men see a Reproductive Endocrinologist, not a urologist, if you're dealing with more severe male infertility cases, because they're not interested in knowing the cutting edge technology of male infertility. You will find some urologists who specialize in this, but that's not the majority.

Why your average lab often isn't good enough
When looking at count in a semen analysis, 20 million isn't the "cut-off" entirely. Sometimes you can have higher and it not result in a pregnancy. Sometimes it's lower and it still yields a pregnancy. One problem in using a lab where results are read by a reference laboratory, rather than using an infertility clinic's lab, machines can mistakenly read things that aren't sperm as sperm (white blood cells, debris) and it can over estimate the count. Also, the machine doesn't look at the entire picture. The cut-offs they give are generalities and people can, therefore, have a false assurance. With a clinic's lab you are getting personally assessed results for a more accurate set of results.

Which results are most important
DNA fragmentation has been available commercially about 6-7 years. If you rank influence on infertility potential - this is #1. To review...

In terms of importance:

#1 DNA fragmentation
#2 Morphology
#3 Motility
#4 Count

Qualitative results are most important. If there are abnormalities in this, non-IVF treatments have a very low probability of success, regardless of count and motility. What is the effect of this on pregnancy? When there is DNA fragmentation present, the probability of achieving pregnancy is lower and the probability of having a miscarriage is higher (most often earlier miscarriages). Usually implants, but never reaches the ultrasound stage of pregnancy.

For the record, morphology is the shape, size, and other microscopic qualities that can be evaluated. The majority have defects, and multiple defects, and ones can't be capable of fertilizing or creating a baby. But with ICSI they would select the ones with the highest quality.

UPDATE: Our DNA fragmentation test came back with flying colors, so nothing to worry about there. Thankfully!

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