Chapter II -
Infertility Diagnosis Conventional Perspective
A. Overcome Male Infertility -Diagnosis or Test In Conventional
Perspective
I. Definition
Infertility is defined as inability of a couple to conceive after 12 months of unprotected sexual intercourse or can not carry the pregnancy to full term. It effects over 5 millions couple alone in the U. S. and many times more in the world, because of unawareness of treatments, only 10% seeks help from professional specialist. In fact, More than 40% of infertility of a couple is caused by male inability to fertilize. Diagnosis is a analytics approach, after initial consultation and medical history and personal information have been taken from a patient or couple. The main objective conventional diagnosis is to find the causes of infertility, but unfortunately, it has less than 1% successful rate. We will try to give you the definitions of type of diagnosis in alphabet order.
Recommended Reading
Increase Sperm Count Naturally
With Male Fertility Success, No Drugs,
Surgery Or Humiliating Medical Procedures
Pregnancy Miracle
Reverse Infertility And Get Pregnant Naturally
Using Holistic Ancient Chinese Medicine
I. Medical history and physical exams
Before reading the definition of types of diagnosis, you may want to know briefly what information is recorded on your personal file
I. General medical history
1. Any miscarriage, previous pregnancies and abortion.
2. Any ectopic pregnancy
3. Any previous surgery
4. Have you now on HRT.
5. Use of conceptive method, type of use
6. Any reproductive chronic pain including STD. urinary tract infection ad chronic diseases.
7. Medication you are taking now
8. Any medication of your mother during pregnancy to rule out infertility caused by birth defect
9. Your lifestyle.
II. Physical Exam
a) Testicle related including injure, childhood testicle illness and abnormal in birth
b) Age of puberty
c) Number of previous sexual partners
d) Question related to ejaculation and impotence e) Do you have child with other women
f) Have you ever contacted and treated with sexual transmitted diseases g) Hot bath
h) Smoking and drugs abuse i) Expose to radiation
j) workplace hazard
k) Medication may influence your sexual organs.
l) Other general exam depending to your specialist (herbalist or others)
III. Male Infertility Diagnosis
1. Acrosome reaction test
After the sample is taken your fertility specialist exam the acrosome reaction of your sperms to see how your sperm penetrate the female egg, how the enzymes (acrosome then acrosin released from the sperm head ) in sperm work through tough coating of the eggs and fgertilized it. The purpose of this test is to diagnosis the sperm acrosome then acrosin to see hoe these enzyme help to break tough surface of the egg. If not it may be the cause of infertility and specific treatment is required. It happens only 5% of infertility male population.
2. Antisperm antibody
An antisperm antibody test as defined as a test to look for abnormal function of immune system antibodies that fight against a male's sperm in blood, vaginal fluids, or semen. With a substance added to the sample sperm, the test will tell whether the sperm is affected by proteins of the immune system or not.
3. Biochemical analysis
The study of the chemical substances and vital processes occur in male testicle such as the concentration of white blood cells, the level of fructose in the semen, and the volume, pH, and liquefaction time of the ejaculate.
4. Computer-Assist semen analysis
The sample of sperm is scanned in to the computer pre store program to show how the sperm quality, quantity, shape and movement. Since any small change of the computer may produce a significant change in sperm calculation, therefore any abnormal sperm count should be confirmed by manual count.
5. Hemizona assay
Hemizona assay is the analysis to compare sample sperm of the male to the sperm of the fertilized male by splitting the mature and normal egg into 2 half. 1/2 is tested by sample sperm and the other half is tested by fertilized male sperm.
6. Hormone evaluation
Hormonal evaluation is a study to measure the levels of certain hormones produced by your body such as levels of FSH and testosterone which are involved directly in sperm production. The test will only be used if the semen of sperm analysis comes back with low density of sperm or your specialist suspects that hormone imbalance is the cause of infertility.
7. Human zona pellucida binding test
The testes help to exam how the sperm bind to outer layer of the egg including hemizona assay.
8. Hypoosmotic swelling test (HOST)
hypoosmotic swelling test (HOST) is the test used to identify sperm membrane for structure integrity by examining how the sperm tails react to special sugar and salt. Only healthy sperm can react in that circumstance.
9. Pene trak
Pene trak is the test for 90 minutes to check the movement of sperm through a normal and friendly mucus in the test tube.
10. Peroxidase staining
It is a test to check for infection by differentiating white blood cell from the immature sperm.
11.Post-coital/cervical mucus test
It is a test to see how friendly the mucus of the cervix toward the sperm invasion a few days before and after ovulation. The result can be determined after
a) Male partner sperm with female partner cervical mucus
b) Male partner sperm with healthy mucus
c) Known healthy sperm with female partner mucus d) Known healthy sperm with known healthy muscle
12. Sperm penetration assay (hamster test)
Sperm penetration test only is needed if the normal semen test can not determine the sperm penetration ability then hamster eggs with the ouster membrane has been stripped off are used in place of female eggs because of it's structural similarity to human eggs. After the sperm and hamster eggs have incubated for three hours, the eggs are checked for sperm penetration. Any percentage over 10 % is considered normal and potential for fertilization. Since it is used eggs other than human being, good sperm penetration rate in hamster test does not guarantee 100% of positive result in human.
13.Sperm-Ubiquitin tag immunoassay (SUTI)
Sperm-Ubiquitin tag immunoassay ignores other sperm attributes and focus solely on sperm's ubiquitin because ubiquitin is considered as a universal marker of any sperm abnormalities including sperm damage and sperm defective, thereby reducing some unnecessary treatments.
14. Semen analysis
A semen analysis is usually the first test for all infertility male , it helps to measure the amount of semen a man produces and determines the quantity and quality of sperm such as size, shape. movement and PH level in the sample.
a) Normal form sperm
Ovary head, single tail with intact midsection and an uncoiled.
b) Abnormal heads
Head of sperm if too big or too small and other than ovary head.
c) Abnormal tails
Coil, broken, bent tail and other than single tail.
d) Immature gen cells
Since white blood cells and white gen cells have a very similar apprance and structure, it is up to the specialist to make sure that the present is immature gen cells and not white blood cells.
e) Vital staining
It is the analysis to see the percentage of dead sperm compare to lice one.
f) Urinalysis
It is to make sure the infertility is not caused by retrograde rejaculation and the urinary tract is not infected.
15. Scrotal sonography
Scotal sonography is used to evaluate the testicle disorder and surrounding organs including prostate gland, epididymis, an absent or undescended testicle and any testicle abnormality.
16. Testicle biopsy
A small sample is taken and tested for the ability of sperm producing cellsl in normal cells production. This test is necessary if the infertility male is found to have no sperm in semen, normal sex levels of hormone and abnormal sperm with unknown cause. The risk of the test may cause testicle damage.
17. Vasography
Vasography is a Radiographic study of the vas deferens. It helps to determine if the vas deferens is blocked or not and the reason of such blockage. In this study, if there is large amount of sperm containing fluid presented when the vas deferens is open, it indicates there is a block appeared in the vesicle end of the vas deferens. If there is no fluid presented, the procedure continue until the cause of blockage is found, if there is one.
AA. What Is Acrosome Reaction Test
I. Definition
An Acrosome reaction test is a sperm analysis. The sample is taken through masturbation to see how the sperm performs during the fertilizing process. It may be necessary if the fertilization specialist suspects that the causes of infertility may be a sperm related problem.
II. Diagnosis
After the sample is taken, your fertility specialist exammines the acrosome reaction of your sperm to see how your sperm penetrates the female egg, how the enzymes (acrosome, then acrosin released from the sperm head) in sperm work through tough coating of the eggs to fertilize it. If not, it may be other causes of infertility and specific treatment is required.
III. Analysis
If the diagnosis finds that the sperm is unable to penetrate the egg because of a lack of acrosome or acrosin, then intracytoplasmic sperm injection (ICSI) may be suggested by your specialist so that the fertilization process can be by-passed by the natural penetration of sperm as ICSI is the direct injection of a sperm cell into the egg. If the ICSI is decided, then the fertilization process is either through intrauterine insemination (IUI) or in vitro fertilisation (IVF).
Since the test only provides a limited amount of information about how sperm penetrate the egg, some doctor may choose to forgo it because of very low percentage of males who have such problem, unless it is absolutely necessary.
AB. What is Antisperm Antibody Test ?
I. Definition
An antisperm antibody test is defined as a test to look for any abnormal functioning of the immune system's antibodies that fight against a male's sperm in blood, vaginal fluids, or semen. With a substance added to the sample sperm, the test will tell whether the sperm is affected by proteins of the immune system or not. If you would like to know the immunity causes of infertility, please refer back to previous articles.
II. Procedure
a) Reason for this test
If you cannot find the cause for infertility from other tests such as the postcoital test.
b) A medical information form is required so you can understand the risk, how to prepare, how it is done, and what are the possible results.
c) For women: blood, vaginal fluid and uterus mucus samples are required.
d) For men, semen sample is collected by masturbation. It is important that you should not ejaculate for 2 days before the test and go longer than 5 days before the test without ejaculating. Semen samples should be collected within 48 hours of ejaculating or after not ejaculating for longer than 5 days may alter the test result.
III. Analysis
The purpose of this analysis is to find the possible causes of infertility due to immunity malfunction. Here are the possible outcomes:
1. If antisperm antibody is found on the head of sperm, causing the inability of the sperm to efficiently make its way through a woman's cervical mucus, then medication is required
2. If antisperm antibody is found on the tail of sperm, it may cause the sperm to risk becoming immobilized or clumping together, you are required to take some medication.
3. If antisperm antibodies are found in the cervical mucus, then medication is given or other treatments may be required.
4. If no antisperm antibody is found, other test may be required.
AC. What is Biochemical Analysis ??
I. Definition
The study of the chemical substances and vital processes occurring in male testicle such as the concentration of white blood cells, the level of fructose in the semen, and the volume, pH, and liquefaction time of the ejaculate.
II. Procedure
The semen sample of sperm is taken at the clinic laboratory through masturbation, the the semen is sent for analysis for chemical substances and vital processes as mentioned in the definition.
III. Diagnosis
This test a semen analysis typically for
1. Volume
The semen sample required for this test is no less than 2.0 ml or more It measures the number of sperm per millilitre ( ml ) of ejaculate
2. pH
pH is a measure of the acidity or basicity of a solution ( PH of 07 is considered as neutral). In this test, it is requires in the range of 7.2-8.0 to be considered as normal.
3. Sperm concentration
It measures the number of sperm per millilitre of ejaculate, for a normal sperm concentration it requires 20,000,000 per ml or more.
4. Motility
Motility is a measure of sperm for movement, the normal sperm motility is 50% or more with forward progression. It can be classified in 4 grade
a) Sperm with progressive motility:
These are the strongest and swim fast in a straight line
b) Non-linear motility: These also move forward but tend to travel in a curved or crooked motion.
c) Non-progressive motility:
Sperm not move forward despite the fact that they move their tails.
d) Non motility:
Fail to move at all.
5. Rapid forward progressive motility
Sample sperm requires to have at least 25% or more of this types of sperm to be considered as normal.
6. Morphology
It is the study of normal and abnormal form of the sperm. It considered normal if it is
a) 30% or more normal forms (WHO criteria)
b) 11% or more normal forms (Tygerberg strict criteria developed by Dr. Roelof Menkveld, Tygerberg Hospital, South Africa, and disseminated by Dr. Thinus Kruger )
7. Vitality
The sample should have least 75% live sperm in a semen sample
8. White blood cells
The sample must have a white blood cells of less than 1,000,000 per ml. Otherwise, it may be an indication of immunity causes of infertility and more testes are required.
AD. What is Computer-Assist Semen Analysis ??
I. Definition
The sample of sperm is scanned in to the computer pre store program to show how the sperm quality, quantity, shape and movement. Since any small change of the computer may produce a significant change in sperm calculation, therefore any abnormal sperm count should be confirmed by manual count.
II. Procedure
Since 25% of all infertility is caused by a sperm defect and 40-50% of infertility cases have a sperm defect as the main cause, or a contributing cause. The second test that your doctor order usually is the computer assist semen analysis if the normal semen analysis fail to given a conclusive result. A sample semen sperm is collected through masturbation in the clinic laboratory.
III. Diagnosis
It said that CASA provides more accurate reading than normal semen analysis, because 25% of all samples shown as infertility in normal semen analysis even with the normal fertility male. The computer will study chemical substances and sperm quality, quantity as in normal semen analysis, including
1. Volume
The semen sample required for this test is than 2.0 ml or more
It measures the number of sperm per millilitre ( ml ) in the semen.
2. pH
It is requires in the range of 7.2-8.0 to be considered as normal.
3. Sperm concentration
For a normal sperm concentration it requires 20,000,000 per ml or more.
4. Motility
The normal sperm motility is 50% or more with forward progression. It can be classified in 4 grade
a) Sperm with progressive motility:
b) Non-linear motility
c) Non-progressive motility:
d) Non motility:
5. Rapid forward progressive motility
The sample semen must have 25% or more of sperm with rapid forward progressive motility.
6. Morphology
It is the study of normal and abnormal form of the sperm. It considered normal if it has 30% or more normal forms (WHO criteria)
7. Vitality
The sample should have least 75% live sperm in a semen sample
8. White blood cells
The sample must have a white blood cells concentration of less than 1,000,000 per ml.
IV. Risk
Since any small change of the computer may produce a significant change in sperm calculation, therefore any abnormal sperm count should be confirmed again by manual count.
AE. What is Hemizona Assay??
I. Definition
Hemizona assay is an analysis to compare the binding capacity of sample sperm of the unfertilized male to the sperm of the fertilized male through manual hand cutting versus micro manipulation in IVF and IUI fertilization.
II. Diagnosis
After splitting the mature and normal egg in half. 1/2 is tested by sample sperm of the infertile male and the other half is tested by the fertilized male sperm through manual hand cutting or micro manipulation. Then the number of sperm bounds to each half and is calculated, and the infertile male's sperm is divided by that from the fertile male's sperm. A figure of less than 0.60 indicates abnormal infertile male's sperm.
Although the success rate of this test is not 100%, the HZA has been found to be predictive of IVF and IUI outcome with positive and negative values of 83% and 95% respectively, according to one study. Therefore, if an infertile couple decides to go through IUI or IVF for conception then the hemizoma test is necessary.
III. Risk
There is no guarantee that a couple who scores high in the hemizoma test will be successful to conceive via IVF or IUI, because there are other factors that may interfere with the process after the fertilized egg or embryo was implanted into the uterus.
AF. What Is Hormone Evaluation ??
I. Definition
Hormonal evaluation is a study to measure the levels of certain hormones produced by your body such as levels of FSH and testosterone which are involved directly in sperm production. The test will only be used is the semen of sperm analysis come back with low density of sperm or your specialist suspects that hormone imbalance is the cause of infertility.
II. Procedure
Your fertilized special may order saliva test or blood spot test overall hormone assessment.
III. Analysis
Primary hormone imbalance effecting fertility happens only about 3% of infertile male, therefore if your doctor suspects that you have some symptom such as loss of muscle, enlarged breasts, low sexual desire, softer erections, weigh gain or loss, erectile dysfunction, low sperm density, etc., he or she may ask for male hormone imbalance test.
1. Testosterone
Testosterone decrease with age, testosterone deficiency is common in men over the age of 50. If the levels of testosterone is too low, it may causes sexual dysfunction ( most of the time he also has deficiency of kidney yang according to traditional Chinese herbalist) and symptoms of low density of sperm and sperm count and interferes with reproductive system in process of fertility.
2. Excess estrogen (estradiol)
Excess estrogen in male is rare, but it may happens. It causes symptoms such as hair loss, decreased libido, Increased urinary urge, prostate enlargement, weight gain and low sperm production and low sperm count that increases the risk of infertility.
3. Levels of FSH
FSH levels are important in production of sperm, if the levels of FSH is too high as resulting of primary testicular failure, it may interfere with sperm production and decrease sperm density and count.
AG. What is Human Zona Pellucida Binding Test ??
I. Definition
The testes help to exam how the sperm bind to outer layer of the egg, including hemizona assay.
II. Procedure
The test is necessary if the men is found to be infertile with either reduced sperm count, motility and morphology alone, or in combination and is classified with unexplained causes. The sperm and egg are collected from a couple and is used to see the sperm penetration in IVF.
III. Diagnosis
The process of human fertilization, sperm must bind to the zona pellucida, undergo the acrosome reaction, penetrate the the out layer of the egg and then fuse with the oolemma. The process is observed and recorded. If the sperm can not penetrate the egg then other testes may be needed or conception may be required more technical support. If the sperm has no problem in egg penetrating, then IUI or IVF is the best choice in assisting the fertilization for a unfertilized couple.
IV. Risk
Although the successful rate to conceive is very high, if a couple pass the humanzona pellucida binding test, but it is not 100% guaranteed, since for a couple to get conceive, it takes more than human zona pellucida test.
AH. What is Hypoosmotic swelling test (HOST)??
I. Definition
Hypoosmotic swelling test (HOST) is the test used to identify sperm membrane for structure integrity by examining how the sperm tail reacts to special sugar and salt. Only healthy sperm can react in this circumstance.
II. Procedure
The HOS test was performed by mixing special sugar and salt in distilled water. The mixture was incubated and immediately examined under a microscope. The percentage of reacted sperm (curled tails) and non-reacted sperm (non-curled tails) were assessed.
III. Diagnosis
1. A sample sperm is considered normal if more than 60% response to the swollen spermatozoa. otherwise the tested sample is considered to have poor sperm membrane structure integrity. It is said the hypoosmotic swelling test result is predictive of the sperm penetration test. If the tested sample fail, it may need some other technical support to by-pass the sperm penetration process.
IV. Risk
Although the hypoosmotic swelling test is less time consuming and can help to determine the the sperm fertilization capacity, the result is not 100% guaranteed. For the couple to conceive, it take more than the hypoosmotic swelling test for a successful pregnancy, please make sure that other health problems have been taking care of.
AI. What is Pene Trak ??
I. Definition
Pene trak is a test for 90 minutes for checking the movement of sperm through a normal and friendly mucus in the test tube.
II. Procedure
Tested sperm is taken in the clinic laboratory through masturbation then the mixer of sperm and friendly mucus is examined through microscope.
III. Diagnosis
After a 90 minutes, the sample is observed through the microscope and the distance of the sperm have penetrated the mucus also is recorded. Failure of sperm to move a minimum distance is considered to have a poor chance for egg fertilizing and suggested a infertility problem for the testes sample couple. The inability of sperm to move a minimum distance through cervical mucus may be caused by immune antibody leading to the risk of infertilization.
IV. Risk
Ff the test is successful, it only increases the chance of fertility but does not guarantee the sperm will be free to fertilize the egg when it reach the Fallopian tube. Please make sure that other reproductive organs are already taking care for a healthy conceive.
AJ. What is Peroxidase Staining test ??
I. Definition
Peroxidase Staining is a test of infection by differentiating white blood cells produced by the immune system from immature sperm.
II. Procedure
If a man is suspected to have producing abnormal sperm caused by infection of the reproductive system including high levels of white blood cells in other sperm test, then his doctor may require a peroxidase staining test. A semen sample is taken in the clinic laboratory with masturbation.
III. Analysis
1. Levels of white blood cells
Since high levels of white blood cells or leukocytes cause cells oxidation to leading to changing the makeup of sperm cells, affecting motility and morphology and damaging their ability to fertilize an egg.
2. Infection other in the reproductive system
If the infection of the body is the cause of increasing of the white blood cells in the semen, than
of antibiotics may be given. If the infection is caused by testicle damage then same medication may be given but you may also be advised to ejaculate frequently, to move those excessive white blood cells out of the seminal tract.
IV. Risk
Infection of testicle if not t