A M.A.Z.E. semen analysis will tell you what a commercial semen analysis may not:
- Whether antibodies are present.
- Whether the forward progression is abnormal despite normal motility.
- Whether the patient has retrograde ejaculation.
- Whether the strict morphology of the sperm indicates conventional IVF or ICSI.
- Whether there is an increased number of white blood cells, in contrast to simply increased round cells, indicating an infection or inflammation.
- Whether the semen fructose is positive or negative.
M.A.Z.E. determines which of these follow-up tests are indicated based on the preliminary findings and performs them on the same specimen at the same time.
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Benefits of M.A.Z.E Laboratories Tests
M.A.Z.E. Laboratories saves you time:
- Michael A. Werner, M.D., FACS, the medical director of M.A.Z.E. Laboratories and a urologist with fellowship training in male infertility, will call your patients to discuss and explain their results.
- M.A.Z.E. Laboratories will provide you with an easy-to-read lab report that includes Dr. Werner's clinical interpretations, recommendations, and a suggested plan of action for the male partner. It will also include any implications for your treatment of the couple.
- M.A.Z.E. Laboratories will walk your patient through the entire process of the semen analysis from specimen collection to billing.
M.A.Z.E. Laboratories can coordinate all your male fertility testing. In rare instances when you have requested tests we cannot perform on site (sperm penetration, assay, genetic screening), we can oversee and coordinate off-site testing.
- M.A.Z.E. Laboratories offers sperm washing services convenient for you, as well as your patients. We are available 7 days a week.
M.A.Z.E. Laboratories provides superior service for your patients:
- M.A.Z.E. Laboratories determines which follow-up tests are indicated based on the preliminary findings and, whenever possible, performs them on the same specimen at the same time
- In contrast to many collection sites, M.A.Z.E. Laboratories has private, comfortable, and well-equipped rooms for sample collection.
- M.A.Z.E. Laboratories schedules semen analyses on Saturdays and evenings in addition to weekdays. In all, we have more than 50 appointment hours available weekly.
M.A.Z.E. Laboratories guarantees accuracy:
All basic semen analyses are conducted within one hour of collection and, unlike many other labs, our semen analyses are conducted on site, ensuring results that are significantly more accurate. Also, in contrast to other labs, we run daily assays for quality control and monitor intra-technician variability by running regular comparison tests on the same specimen.
Sperm Processing for IUI
Sperm washing is the process which prepares a semen sample for an intrauterine insemination (IUI). For an IUI to be performed, the semen sample must be washed free of debris, white blood cells, and prostaglandins, which can cause the uterus to contract. The processing also removes dead sperm and concentrates the sperm into a small volume that can easily be handled by the uterus. There are three main methods of sperm washing: the swim-up, density gradient wash, and simple (centrifugation) wash. The type of wash used depends on the individual characteristics of each semen specimen.
The swim-up is most successful when performed on patients with normal semen analysis, and is not recommended for samples of high viscosity, with high numbers of round cells, or with a high content of debris. In this procedure the washing media is gently placed over the semen in a conical tube. The specimen is then placed in an incubator for approximately one hour. During this time, sperm swim up into the media, so we collect the most motile, normal sperm, free of debris. The supernatant is collected and centrifuged twice with sperm washing media. The final pellet is then resuspended in approximately 0.5 mls of media. Modified sperm washing media must be used to process the sample. It is available from Irvine Scientific.
Discontinuous (Density) Gradient
The discontinuous (density) gradient method should be used on samples containing round cells or debris, or those with increased viscosity but a relatively normal concentration and motility. The gradient is achieved by layering media of two different densities in a conical tube. The semen is then placed on top of the gradient and the tube is then spun to allow the specimen to proceed through the gradient. The resulting pellet should contain the motile, normal sperm, while the dead sperm and debris are caught up in the gradient media. The pellet is then resuspended in washing media and centrifuged twice. The final pellet is resuspended in a final volume of approximately 0.5 mls of media. There are several commercially available kits. Conception Technologies carries the Enhance-S Plus kits and Irvine Scientific carries the Isolate Sperm Separation Medium.
The simple (centrifuge) wash should be performed on a sample that has a decreased concentration and/or motility. A sample containing round cells and debris should not be prepared by this method. Sperm washing media is added to the specimen and centrifuged. The pellet is recovered, resuspended, and again centrifuged. The final pellet is resuspended in approximately 0.5 mls of media.
In each of the above cases, the laboratory performs an analysis on both the fresh specimen and washed specimen. This will include an assessment of the count, motility, volume, and viscosity.
M.A.Z.E. Laboratories offers state-of-the-art sperm banking. Please visit our page that provides information on cryobanking.
Common Patient Concerns Reguarding Male Infertility
The following outlines the most current information on several topics likely to be of concern to patients in the area of male infertility:
Cigarette smoking has been shown to significantly affect semen quality.
- Causes a 23% decrease in sperm density (concentration) and 13% decrease in motility (when averages are taken from nine separate studies).
To a lesser extent, causes an increased number of morphologically abnormal sperm.
- Causes toxicity to the seminal plasma: sperm from nonsmokers had significantly decreased viability when placed in the seminal plasma of smokers.
- Affects the hypothalamic-pituitary-gonadtropin (HPG) axis, most commonly affecting levels of estradiol and estrone. The Leydig Cells, which are in the testes and produce testosterone, may have secretory dysfunction.
- Most worrisome is that there is evidence that suggests that paternal smoking may also be associated with congenital abnormalities and childhood cancer, though the relative risk in most studies is less than two.
- Often causes a decreased average sperm count, motility, and normal morphology.
- Affects HPG axis, causing decreased plasma testosterone.
- May have a direct negative effect on the Leydig Cells.
Even infrequent cocaine use:
- Causes decreased sperm counts, motility, and normal morphology. These effects can be found in men who have used cocaine in the two years preceding their initial semen analysis.
- Decreases the ability of sperm to penetrate cervical mucous.
The use of anabolic androgenic steroids has reached almost epidemic proportions. Nearly 7% of 12th grade males use or have used them to build muscle mass and improve athletic performance. These exogenous androgens:
- Depress testicular production of testosterone and thus, intra-testicular testosterone levels. This may cause severely diminished spermatogenesis or complete azoospermia.
- Cause a persistent depression of the hypothalamus and pituitary, which may be irreversible even when the steroids are stopped.
Moderate alcohol use does not affect male fertility. Excessive alcohol use:
- Affects the HPG axis and is a direct gonadotoxin.
- May cause associated liver dysfunction and nutritional deficiencies, which are also detrimental for sperm production.
Most vaginal lubricants, including K-Y Jelly, Surgilube, and Lubifax, are toxic to sperm. Couples should avoid their use during the fertile time of a woman's cycle.
Elevated testicular temperature is known to have a negative effect on sperm production and ultimately on semen quality and fertility. Varicoceles and undescended testes are two important causes of male fertility. At least part of their negative effect is considered due to the increase in testicular temperature. Hot baths and saunas should be avoided, as they increase the core temperature of the testes. Hot showers are not a problem.
Many men are counseled to change from briefs to boxers under the assumption that the briefs do not allow the testes to regulate temperature. There is no evidence for this and, in fact, a recent article in The Journal of Urology showed that there was no difference in either the semen analysis or the core testicular temperature between groups of men who wore boxers or briefs.
Moderate amounts of exercise can only be helpful. However, long distance runners (men who run greater than 100 miles per week) and distance cyclers (men who ride greater than 50 miles per week) have decreased spermatogenesis. These activities should be moderated when a sub-fertile man is attempting conception.
About 5% of couples with infertility have factors relating to intercourse. This includes the inability to obtain or maintain an erection, premature ejaculation, lack of ejaculation, retrograde (backwards) ejaculation, lack of appropriate timing of intercourse, and excessive masturbation. Interestingly, the most common problem is infrequency of intercourse. Studies have shown that 5 out of 6 previously fertile couples who have intercourse four times per week will conceive during a six month period, while only 1 out of 6 with intercourse once per week will conceive during the same period.
Dr. Werner received his specialized fellowship training in male infertility and male sexual dysfunction at Boston University Medical Center and has written extensively on these topics in medical journals and books. He completed his residency in Urology at Mount Sinai Medical Center in Manhattan and received his medical school training at the University of California at San Francisco. He holds an honors undergraduate degree in Biology from Harvard College.
Michael A. Werner, M.D., FACS, is on the faculty of The New York Medical College in the Department of Urology. His private offices are in White Plains, New York, and in Norwalk, Connecticut.t.