Investigations for Men
Investigations for Men
The Regional Fertility Program provides complete services for the diagnosis of male fertility disorders. The investigation of male fertility always begins with a complete semen analysis. Specialized testing for abnormalities of the sperm parameters is ordered when indicated including genetic testing for abnormal male karyotypes, Y chromosome microdeletions and DNA fragmentation of sperm.
The Diagnostic Semen Laboratory (DSL) provides specialized services related to the evaluation and treatment of male fertility. The DSL is accredited and inspected by the College of Physicians and Surgeons of Alberta as well as by Health Canada. The DSL provides the following services:
- Complete semen analysis
- Immunological testing for antisperm antibodies
- Sperm washing for Intrauterine Insemination (IUI)
- Cryopreservation of sperm when required for:
- – surgically retrieved sperm samples (PESA, MESA, and microTESE)
- – vibrostimulation and electroejaculation sperm samples
- – fertility preservation for adolescents and men undergoing fertility damaging treatments for cancer and other medical conditions
- storage and processing of frozen Donor Sperm
- Male karyotype testing
- Y-chromosome microdeletions
- DNA sperm fragmentation analysis
For further information regarding semen analysis, please check out our frequently asked questions (FAQ’s).
To Schedule an Appointment
All requests for testing and treatments, including semen analysis, are by appointment only. Unfortunately, drop-in appointments cannot be accommodated. If you need to reschedule or cancel an appointment, please call the DSL at (403) 284-9410. We require 24 hours notice of cancellation, otherwise there will be a $50.00 missed appointment fee.
*Note: Due to the processing time for semen analysis, appointments are scheduled between 07:30 and 11:00 a.m. Monday – Friday excluding statutory holidays.
If you have been advised by your physician to have a semen analysis, please book your appointment by:
- calling the Diagnostic Semen Laboratory (DSL) at (403) 284-9410,
- making your appointment in person with the receptionist at the DSL, or
- using the online appointment booking window shown below.
Please Note: Currently, online booking is available only for existing RFP patients needing complete semen analysis. For all other specialized testing requests, please call the DSL directly.
ONLINE Appointment Booking
The Diagnostic Semen Laboratory is located on the third floor of the Cambrian Centre at Suite 301, 2000 Veteran’s Place NW. You are required to bring the requisition form from your referring physician as well as your provincial health care card to your appointment.
When you undergo treatment at the RFP your appointments will be pre-arranged by the nursing staff. IVF/ICSI and intrauterine insemination (IUI) samples are collected the day of the procedure. Please note that patients providing samples for treatment procedures must present government issued I.D. (with photo and signature) at the time of collection. The semen sample cannot be accepted without proper identification.
Please contact the Diagnostic Semen Laboratory for further information.
Semen Analysis General Information
A semen analysis is the primary laboratory test for assessment of male fertility. A period of 2-3 days of ejaculatory abstinence (either through sexual intercourse or masturbation) is required before producing a sample for analysis. If ejaculation has occurred more recently the sperm concentration may be artificially low. In contrast, if the abstinence period is greater than 5 days the quality of the sample may be affected. The sample that you produce in the special private collection rooms at the DSL is immediately placed in an incubator.
The Diagnostic Semen Laboratory performs this analysis using the 2010 World Health Organization (WHO) guidelines. From the WHO standards a series of “normal” parameters have been determined as below.
The semen analysis includes assessment of the following:
Ejaculated Volume – greater than or equal to 1.5 milliliters
Sperm Concentration – greater than or equal to 15 Million sperm/milliliter
Sperm Motility – the number and quality of the sperm movement graded as rapid progressive (RP), slow progressive (SP), non-progressive (NP) and immotile (IM). Normal motility is when Progressive Motility (rapid + slow progressive movement) is at least 32% and Total Mobility (Progressive Motility + Non-Progressive) is 40% or greater.
Sperm Vitality – determines the number of living sperm in a sample. At least 58% of the ejaculated sperm should be alive.
Sperm Morphology – an assessment of the “appearance” of individual sperm. The physical appearance of sperm is assessed with respect to the head and tail characteristics using the Kruger Strict Criteria method. A morphology of 4% or greater is considered normal.
Leucocyte (white blood cell) count – the number of white blood cells in a specimen. High numbers of white blood cells may indicate infection.
Microbiological testing – the semen may be cultured to identify infections of the semen.
Immunologic Testing (Antisperm Antibody Test)
Assessment for the presence of antisperm antibodies that may impair the movement and/or fertilizing ability of the sperm. Under normal circumstances sperm develops in the testes and are completely isolated from the circulatory system (via a blood/testes barrier). If there is a break in this barrier for any reason surface antigens on the sperm can cause the immune system to develop antibodies against the sperm. Antibodies are common following vasectomy or vasectomy reversal and may impair fertility.
Sperm Evaluation for IUI
Not all semen samples are suitable for IUI treatments. Samples with reduced sperm concentration, decreased motility or the presence of antisperm antibodies may not yield adequate numbers for the “sperm wash”. An IUI evaluation may be advised prior to starting treatment to determine the suitability of a man’s sample for IUI.
Sperm Wash/Intrauterine Insemination
Intrauterine insemination (IUI) involves the placement of “washed” sperm (partner or donor sperm) into the uterine cavity prior to ovulation. The chance of conception is increased by placing a large number of motile sperm high in the uterus. The sample for IUI is collected by masturbation at the DSL the morning of the insemination procedure. Approximately 2 hours are needed to perform the “sperm wash” procedure. Sperm washing is also required for Clomiphene Citrate / IUI and Superovulation / IUI cycles.
Preparation of Sperm Samples from PESA, MESA, TESE, Vibrostimulation, and Electroejaculation/Cryopreservation
This option is available for patients wishing to store sperm for future use include those men having radiation, chemotherapy or other treatments that may render them infertile. Sperm samples obtained through masturbation, PESA, MESA, TESE, as well as vibrostimulation and electroejaculation can be processed and cryopreserved (frozen) and stored indefinitely for future use. Service members serving in war zones may wish to store sperm samples prior to their deployment for future use. Cryopreservation and storage of sperm is not paid for by the provincial health care plans and patients using this service will incur initial and annual charges.
Samples are assessed for motility and concentration prior to freezing. The sample is mixed with a biocompatible cryoprotectant and frozen in small straws. The straws are frozen in liquid nitrogen. A portion of the frozen sample may be thawed and examined to assess the post-freeze viability and mobility of the sample.
Due to the nature of the sperm freezing it is usual for motility and concentration to be less after freezing and thawing than in the original fresh sample. Therefore there can be no guarantee that the frozen sperm will be suitable for future use. Once frozen the sample may be kept indefinitely. The majority of degradation of the sperm quality occurs at the time of the freeze, not during storage.
Male Karyotype Testing
Approximately 10 percent of men with a very low sperm count will be found to have an abnormality of their chromosomes. Since chromosome abnormalities may rarely cause miscarriages or birth defects all men with a very low sperm count will have this test performed prior to proceeding with treatment. Karyotyping is done using a blood sample from the male partner.
Deletions of small amounts of genetic information from the long arm of the Y chromosome may be found in 10 -15 percent of men with no or very low sperm counts. The deletion of these genes from the Y chromosome significantly affects the production of sperm. Microdeletion testing results are used to predict the likelihood of finding sperm in testicular biopsies. If a child is born as a result of an IVF/ICSI cycle from a man with a Y chromosome microdeletion it is very likely his sons will be born with the same abnormality. This assay is performed on a blood sample from the male partner.
DNA Sperm Fragmentation Analysis
It is thought that sperm with a high proportion of fragmented DNA have a reduced capability to fertilize an egg and also may result in poor embryo development. Patients that have had failed fertilization or had excessive fragmentation of their embryos in a previous IVF cycle may consider utilizing sperm DNA testing to detect this potential problem. Semen samples are required for this test and are flash frozen in liquid nitrogen and sent to a specialized laboratory in Toronto for analysis.