Specialised tests for the male partner
In case of fertility concerns, the first specialised test for the male partner is semen analysis. Afterwards, this can be followed by more advanced tests available at the Andrology lab at Nadezhda hospital, such as the SDI test, Halo test, sperm viability test, antisperm antibody test, semen WBC count, etc. Your fertility consultant may also advise for genetic tests or a consultation with an andrology specialist to diagnose and treat various diseases or conditions that affect the male reproductive system.
Male fertility testing
Semen analysis is usually the first test assigned to check for fertility issues with the male partner.
In more than one-third of infertile couples, male factor is the underlying cause for difficulty getting pregnant. For the fertility consultant to make a good decision about the individual treatment strategy for each couple, it is necessary to check and follow up on several tests.
SDI test (sperm DNA integrity)
Sperm DNA quality is essential to successful fertilisation and embryo development.
In its essence, the Halo test is similar to the SDI test. It reports the structural integrity of sperm chromatin in %.
Sperm viability test
This test uses sperm staining to determine the percentage of viable spermatozoa. It is necessary when no motile sperm are present or when the ratio of immotile sperm is > 72%.
Semen antioxidant test
Even with normal semen parameters, in cases of unexplained infertility, the underlying cause can turn out to be oxidative stress.
Antisperm antibody test
Approximately 5–7 % of infertile men have antibodies against their own sperm.
White blood cell count in semen
The presence of leukocytes, or white blood cells, in semen (over 1 mln) is an alarming finding signalling inflammation of the genital tract (inflammation of the epididymis, testis, or prostate, or varicocele), bacterial infection or other condition. Leukocytospermia, the unusually high number of white blood cells in semen, is linked to increased numbers of immature spermatozoa, increased DNA damage, and ultimately, fertilisation failure.
When semen analysis shows abnormal results, it is necessary to assign additional testing, like hormone blood tests, a testicular biopsy, etc.
Karyotyping is the gold standard in looking for genetic causes for infertility.
When is this test indicated:
In patients with fertility issues:
- No pregnancy after trying to conceive for a year;
- Unexplained infertility;
- Birth of a child with a malformation syndrome;
- Azoospermia, severe oligoasthenoteratozoospermia, amenorrhoea, early menopause;
- Chromosomal aberrations detected by prenatal diagnosis;
- Confirmed familial chromosomal rearrangements in family members.
In patients with developmental disorders:
- Multiple hereditary abnormalities;
- Clinical evidence for a chromosomal disease;
- Disorders of growth, sex differentiation and development;
- Intellectual deficit and behavioural abnormalities.
This test is recommended for men with non-obstructive azoospermia (NOA) and severe oligoasthenoteratozoospermia, regardless of the presence of other testicular pathologies. The analysis is indicated in men with sperm concentrations below 10 mln/mL.
Microdeletions (submicroscopic loss of genetic material) in the long arm of the Y chromosome are a common cause of male infertility. They are specifically related to impairments of spermatogenesis. Microdeletions of particular interest are those in the AZF-regions (azoospermia factor regions), which include genes of crucial importance to the development and maturation of spermatozoa.
When is the test indicated?
- DNA analysis for Y-chromosome microdeletions is recommended in cases of severe semen analysis abnormalities – microdeletions are found in 10–15% of men with azoospermia (absence of sperm in the ejaculate) when it is not caused by obstructive defects of the seminal ducts and in 5–10% of men with severe oligozoospermia.
- The Y-chromosome microdeletion test has additional value when assisted reproduction techniques are used:
- The presence of Y-chromosome microdeletions can render unsuccessful therapies for improving semen parameters.
- In azoospermic men, confirmed Y-chromosome microdeletions are essential for assessing the potential success of surgical sperm extraction techniques (ТЕSE, MESA, PESA).
- Y-chromosome microdeletions are always passed on to the male offspring, though not always with the exact extent of impairment of spermatogenesis, and semen parameters tend to deteriorate with age. In confirmed Y-chromosome microdeletions, the future sons could manage their reproduction plans more successfully by resorting to semen cryopreservation at an earlier age, when semen parameters are still good.
A venous blood sample is needed for DNA analysis for Y-chromosome microdeletions, preferably not fasting. Results are ready within 1–2 weeks.
CFTR gene mutations screening is highly recommended in infertile men with unilateral or bilateral congenital absence of the sperm ducts. If a CFTR mutation is confirmed in one of the partners, a DNA analysis of the other must be done to assess the risk of passing cystic fibrosis to the offspring.