FERTILITY TESTING

• Fertility testing


  Used to know whether an individual is capable of conceiving
• Infertile couple's chance of conception


  • 20% conceive in a month
  • 50% in 3 months
  • 75% in 6 months
  • 90% in a year
• Infertility


  If a woman gets pregnant and ALWAYS experiences a miscarriage or stillbirths
• Terms used for couples

  • Gravidity / gravida (G) – no. of pregnancies
  • Parity / para (P) – no. of births of viable offspring
  • Abortus(Ab/A)–no.ofabortions
  • Nulligravida gravida 0 – no pregnancy at all
  • Primigravida gravida 1 (G1) – one pregnancy
• Primary infertility (G0P0)


  Has never gotten pregnant, couples unable to conceive even after 1 month of trying
• Secondary infertility


  Has been pregnant previously but currently cannot get pregnant or unable now
• Secondary infertility examples


  • G2P0- 2 pregnancies but 0 successful delivery
  • gravida 2, para 0, abortus 2 - two pregnancies, no babies since there are 2 abortions
• Semen analysis

  Purpose: for FERTILITY TESTING, for POST VASECTOMY, for forensic analysis
• Method of semen collection

  1. Masturbation or self-production

  2. Coitus Interruptus

  3. Condom Method

  4. Vaginal Vault Aspiration
• Prior to semen collection

  ABSTINENCE 2-3 days, NOT >5 days causing an increase in volume but decrease in motility, diff. color
• Post-ejaculate urine sample


  Used if the patient has retrograde ejaculation, it is when semen entered the bladder instead of emerging thru the penis during the orgasm but it is still possible to reach the sexual climax but in little or no amount of semen at all termed as dry orgasm
• Semen analysis procedure

  1. The semen/sample must be transported in lab within 30-60 mins after the collection at temperature 37C → because liquefaction will be performed

  2. Performed after liquefaction
• Semen analysis parameters


  • Viscosity
  • Volume: >2ml (2-5ml) and it depends on the abstinence
  • Semen pH: slightly ALKALINE (7.2-7.8)
• Sperm concentration


  Normal: 20-160 million/ml
• Sperm concentration calculation


  1. # of cells counted x dilution (20) x 1000 / # of squares (2) x 0.1

  2. # of cells counted x dilution (200) x 1000 / # of squares (5) x 0.004
• Sperm count


  Normal count: at least 40 million/ejaculate
• Sperm count calculation


  sperm concentration x volume of semen
• Fructose test


  To confirm the presence of fluid from the seminal vesicle and to rule out retrograde ejaculation in post-ejaculate urine
• Sperm motility


  50% shows moderate to strong forward motion or movement
• Sperm motility grading


  • Grade 4: rapid straight
  • Grade 3: slower speed, some lateral
  • Grade 2: slow, noticeable lateral
  • Grade 1: no forward
  • Grade 0: no movement at all
• Sperm viability


  Eosin Y & Nigrosin stains are used, they will stain the sperm whether the sperm is still alive or dead
• Sperm morphology


  • Routine: >50% normal
  • Strict: >30% normal forms
• Teratozoospermic index (TZI)


  Measurement of average # of defects per sperm → could be used to improve the correlation between sperm morphology and fertility
• Sperm agglutination


  When sperms are motile, they tend to STICK to each other either head-to-head, tail to tail, midpiece to midpiece or mix ways (head to tail, midtail to head, etc.)
• Mixed agglutination reaction (MAR)


  Direct or indirect screening test to detect IgG or IgA
• Immunobead assay


  Detect all three Ig classes (IgG, IgM, IgA) and when beads are coated with monospecific antisera to each class
• Oligospermia


  Abnormality/LOW sperm concentration
• Asthenospermia


  LOW sperm motility, DYSMOTILITY
• Teratospermia


  ABNORMALITY in sperm MORPHOLOGY
• Ultrasound/ultrasonography

  Locate DAMAGE or BLOCKAGE in male reproductive tract, COST EFFECTIVE & NON-INVASIVE, MORE ACCURATE to help in performing successful treatment
• Andrology specialist


  Reproductive urologist for mixed-sex couples to know the options for the fertility testing
• General rule for fertility testing: MALE patient to UROLOGIST, FEMALE patient to GYNECOLOGIST
• Testicular biopsy


  Taking tissue sample from 2 testicles which produces sperm and male sex hormone (testosterone) for lab analysis, used to determine whether sperm production problem is caused by blockages, use sperm for IVF, used to diagnose testicular cancer or determine cause of lump in the testes
• Vasography


  Evaluate condition of vas deferens and ejaculatory ducts, some doctors use radiologic dye for easy visualization injected to vas deferens and ejaculatory ducts, X-ray is taken as the dye flows through ejaculatory ducts
• Panleukocyte (CD45) immunocytochemical staining


  Detects peroxidase negative polymorphonuclear WBC which can only be detected thru immunocytochemical, helps in differentiating leukocytes and germ cells
• Prostatic dysfunction


  Alters the pH of semen, FROM 7.2-7.8 to 8. It also reduces acid phosphatase.
• Low semen volume

  Can be due to EJACULARTORY DUCT DYSFUNCTION, agenesis of vas deferens or seminal vesicles
• Low fructose


  Can be due to DYSGENESIS of seminal vesicles
• Management of male infertility

  • Take medications to increase sperm production
  • Take antibiotics to heal infections affecting fertility
  • Taking clinically proven supplements or anything that can increase sperm production (anything that increases the number o
• CD45


  Helps in differentiating leukocytes and germ cells