How can we analyze the quality of sperm?

Dr. Laura Blasco Gastón has extensive experience in Assisted Reproduction. She has several publications and conferences on the specialty, especially on stimulation protocols and oocyte and embryo quality. In addition, he has doctoral studies on screening for cytomegalovirus infection during gestation. In this article he explains how semen quality can be analyzed.

The spermiogram or seminogram is a diagnostic test that aims to evaluate semen quality. It analyzes macroscopic aspects, such as pH and volume, and microscopic aspects, such as sperm motility, morphology and concentration; data which, if normal, are related to the probability of achieving a natural pregnancy in less than 2 years.

This analysis can be completed with urethral and seminal cultures to rule out the presence of microorganisms that may alter fertility.

It should be kept in mind that the spermiogram provides limited information on the “male factor”. When the spermiogram results are below the reference values, the probability of spontaneous pregnancy will be decreased; and when the values are normal, there is no guarantee of fertility, since up to 15% of men with infertility present spermiograms with values within the limits of normality. This suggests that the spermiogram is the first step in analyzing the male factor, but it is the tip of the iceberg, and we must take into account other factors that can affect reproductive success.

Causes affecting sperm quality

There are a multitude of causes that can affect sperm quality. We must study from the most external, such as life habits, physiology and anatomy of the male, to the most internal, such as the genetics of the sperm.

The spermatozoa are responsible for transporting the genetic material to the interior of the egg, therefore, if this material is not correct there will be no pregnancy or there will be an increase in miscarriages.

DNA fragmentation in spermatozoa

The influence of lifestyle habits on spermatozoa, such as tobacco and alcohol consumption, obesity, type of work, intense sport…, can be investigated by studying the DNA fragmentation of spermatozoa.

DNA fragmentation makes it possible to evaluate what percentage of spermatozoa in an ejaculate have some damage to their DNA. It is a very simple test that can be performed on the same ejaculate in which the spermiogram is analyzed. When DNA fragmentation is altered, various strategies, such as reducing the number of days of sexual abstinence, treatment with vitamins and antioxidants, as well as reducing the consumption of tobacco, alcohol or weight, manage to lower the levels of DNA fragmentation and improve the result. This test is also indicated in cases of repeated miscarriages, age over 45 years, varicocele, cryptorchidism, diabetes, etc… Having a nutrition unit in assisted reproduction clinics helps patients to improve their lifestyle habits and improve their semen quality.

FISH in spermatozoa

At the genetic level, male factor diagnosis can be completed by performing a FISH study on spermatozoa. This test can be indicated in the case of abnormal seminograms, altered male karyotype, repeated miscarriages or implantation failures. It is performed on an ejaculate and allows us to know what percentage of spermatozoa have some of their chromosomes altered.

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During the formation of spermatozoa in the testicles, errors can occur that will result in spermatozoa with an extra copy of a chromosome (disomy), without a chromosome (monosomy) or with all chromosomes duplicated (diploidy). If any of these abnormal sperm fertilize the oocyte, it could result in non-implantation of the resulting embryo or miscarriage. The result of this test may lead the couple to be recommended to undergo an IVF cycle with Preimplantation Genetic Diagnosis (PGD).

Long Embryo Culture in IVF or Ovodonation

Sometimes the male factor is not diagnosed until we perform an in vitro fertilization cycle, with our own or donor eggs, in which we leave the embryos in long culture for 5 days, for the transfer of blastocysts. The evolution of the embryos during the first 3 days of development depends mainly on the oocyte quality, while from the 4th day of development the embryonic genome is put into action, reflecting from that moment on the sperm quality as well. Thus, when the embryos have a good progression until day 3 of culture and slow down or stop from day 4 onwards, it is possible that we are faced with a poor sperm quality that may not have been previously diagnosed. This is especially striking when we perform oocyte donation cycles, where the oocyte quality is normally optimal, due to the age of the donors, and where the male factor limits the proportion of blastocysts originally estimated.

Urological consultation

The study of the physiology and anatomy of the male is carried out by urologists. In this consultation, problems that influence male fertility such as varicocele, cryptorchidism, obstruction or absence of the vas deferens, hormonal disorders, prostatitis, erectile dysfunctions… can be ruled out in order to propose treatments that can improve the probability of spontaneous pregnancy or with Assisted Reproduction treatments. It is common to indicate this consultation in the presence of several altered spermiograms.

In conclusion, the study of the male factor is more complex than requesting a spermiogram. Being this test essential, it is necessary to investigate the clinical history of each patient and evaluate the need for other tests that help us to have a more complete diagnosis and a more effective action in each case, reducing treatment failures that generate physical, emotional and economic wear. URH Garcia del Real has a multidisciplinary team, highly qualified and committed to the proper diagnosis and treatment of their patients.