Today, March 19, Father’s Day is celebrated in several countries around the world, where the father figure and the father’s influence on family life is commemorated. One way of paying tribute to fatherhood is through this collaboration with URH García del Real, a member center of Top Doctors, which has extensive experience in Assisted Reproduction. The article explains how to analyze semen quality for men seeking to become fathers and the factors to take into account when looking for a natural pregnancy.
The spermiogram or seminogram is a diagnostic test that aims to evaluate the quality of semen. For this, macroscopic aspects are analyzed, such as pH and volume, and microscopic aspects, such as mobility, morphology and concentration of spermatozoa; data which, under normal conditions, are related to the probability of achieving a natural pregnancy in a period of less than 2 years.
This analysis can be completed with urethral and seminal cultures to rule out the presence of microorganisms that can alter fertility.
It should be kept in mind that the spermiogram provides limited information on the “male factor”. When the spermiogram results are lower than the reference values, the possibility of spontaneous pregnancy will decrease; and when the values are normal, there is no guarantee of fertility, since up to 15% of men with infertility show spermiograms with values within the limits of normality. This points out that the spermiogram is the first phase in analyzing the male factor, but it is only the tip of the iceberg, since other factors that can influence reproductive success must also be taken into account.
Causes affecting sperm quality
There are several reasons that can affect sperm quality. We must explore from the most external ones, such as life habits, physiology and anatomy of the male, to the most internal ones, such as the genetics of the spermatozoa.
The spermatozoa are responsible for transferring the genetic material to the interior of the egg, for this reason, if this material is not correct, there will be no pregnancy or 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, etc., can be analyzed by studying the DNA fragmentation of spermatozoa.
DNA fragmentation analyzes 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 the 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 failure. It is performed on an ejaculate and allows to know what percentage of spermatozoa have some of their chromosomes altered.
During the creation of spermatozoa in the testes, 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 for some reason any of these abnormal sperm fertilize the oocyte, it could result in the non-implantation of the resulting embryo or miscarriage. The result of this test may lead to the couple being recommended to undergo an IVF cycle with Preimplantation Genetic Diagnosis (PGD).
Long Embryo Culture in IVF or Ovodonation
On some occasions the male factor is not diagnosed until an IVF cycle is performed, with the couple’s own or donor eggs, in which the embryos are left in long culture for 5 days, for the transfer of blastocysts. The development 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 activated, reflecting from that moment on the sperm quality as well. Thus, when the embryos have a prosperous progression up to day 3 of culture and slow down or stop after day 4, it is possible that we are dealing with a poor sperm quality that may not have been diagnosed previously. This is quite striking when we perform oocyte donation cycles, where the oocyte quality is usually optimal, due to the age of the donors, and where the male factor limits the proportion of blastocysts initially estimated.
Urological consultation
The study of the physiology and anatomy of the male is carried out by urologists. This consultation can rule out problems that influence male fertility such as varicocele, cryptorchidism, obstruction or absence of the vas deferens, hormonal disorders, prostatitis, erectile dysfunction … to propose methods that can improve the likelihood of spontaneous pregnancy or assisted reproduction treatments. It is usual to indicate this consultation in the presence of several altered spermiograms.
To conclude, the study of the male factor is more complex than requesting a spermiogram. Since this test is essential, it is necessary to investigate the clinical history of each patient and assess the need to perform other tests that help us to have a more complete diagnosis and a more effective action in each case, reducing treatment failures that can generate physical, emotional and economic wear and tear. URH Garcia del Real has a multidisciplinary team, highly qualified and committed to the proper diagnosis and treatment of their patients.