Men have an important role as well but are all too often overlooked and not involved in the IVF process as much as they could be, or indeed should be. Sperm quality influences the outcome of IVF through its effects on fertilisation of the egg and the quality of the embryos that result. At Nurture Fertility we try and do everything we can to maximise sperm quality. Our ‘Men’s Corner’ provides you with some information on this and the male side of treatment. We hope you find it useful.
How is Sperm Produced?
Sperm are produced in the testes. Sperm develop within very small tubules in testicular tissue (seminiferous tubules) and then move along a network of tubes to a holding point (the epididymis) before being released at the time of ejaculation. In the average man with a normal sperm count, the testes produce thousands of sperm every second but it takes three months for these to become mature and be ready to be ejaculated. If you want to optimise your fertility and improve sperm quality you should start to look at lifestyle and other factors sooner rather than later and allow a good few weeks for these to take effect!
How can you Optimise or Improve Sperm Quality?
Whilst there are no proven ways to guarantee an increase in the number of sperm or their motility there are a number of measures men can take to try and optimise and/or improve semen quality:
- Maintain a normal BMI (18.5 – 25)
- Have a healthy balanced diet
- Avoid foods containing transfats like hydrogenated vegetable oils, margarine etc
- Regularly eat foods containing unsaturated fats such as oily fish, nuts and olive oil which are a good source of Omega-3
- Increase your intake of anti-oxidants such as vitamin C and E through your ‘5 a day’ and so-called ‘superfoods’ like blueberries, broccoli and 100% cocoa chocolate
- Take supplements containing Zinc, Selenium, Anti-oxidants and Omega 3 such as Well Man or Proxeed Plus
- Do not smoke (seek help and support if you do – it is available)
- Limit alcohol intake to less than 5 units per week
- Avoid exposure to excessive heat i.e. avoid hot baths, saunas, tight underwear and high intensity exercise
- Do not take anabolic steroids or smoke Marijuana
- Avoid any medication which is contraindicated when trying to achieve a pregnancy
Can we have sex during treatment or before a sperm sample?
Many couples remain intimate during treatment and this is perfectly fine in most cases. There are times when unprotected intercourse is best avoided and this will be clarified during treatment as it is different for different couples.
One occasion when we can give general advice is before a sperm sample is provided for analysis or treatment. It is important to avoid ejaculation for a few days as this affects the result and both the number of sperm and their motility. The highest number of sperm and best motility are typically seen after a man has abstained for between 2 to 7 days. Abstaining for longer than this may increase the number of sperm but the proportion of sperm still ‘swimming’
falls. In contrast, ejaculating every day may increase sperm motility but the numbers will be lower. The 2 to7 rule is the best compromise therefore between concentration and motility.
What tests are there for men?
There are several tests we do for men but these depend on the semen analysis. For men with normal numbers of sperm with good motility we typically do not offer further tests as these do not influence how we treat you or the outcome of that treatment. For men with abnormal sperm results we follow a pathway of tests dependent on the degree of abnormality which may involve blood tests, genetic studies and testicular exploration. The semen analysis is the most important test therefore and the place to start.
What does a Semen Analysis involve?
If you have been requested to provide a semen sample, this can be for any of the following reasons:
- Assessing the likelihood of achieving a pregnancy with your partner.
- Diagnosing a sperm problem that means you may need medical help to achieve a pregnancy.
- Determining which treatment is the most appropriate for you and your partner.
- For freezing a semen sample, whether as a back-up for treatment, for preservation of fertility, or prior to vasectomy.
At Nurture, all our semen analyses are performed by trained Clinical Scientists and Technicians using World Health Organisation (2010) Guidelines. We assess:
- The volume and pH of the semen sample.
- The concentration of sperm in the sample (how many sperm are present).
- The motility of the sperm (how well the sperm are moving)
- The morphology (the number of sperm that are of normal size & shape)
- The presence of anti-sperm antibodies (most common after vasectomy reversal and trauma to the testes)
- The test may also provide investigations into the vitality (number of live sperm) and retrograde analysis where appropriate.
How do I Book an appointment?
Nurture patients or private patients requiring a semen analysis should contact Nurture reception. Appointments are:
|Monday||12:30 - 14:30||12:00|
|Tuesday||13:00 - 14:30||12:30|
|Wednesday||12:30 - 14:30||12:00|
|Thursday||13:00 - 14:30||12:30|
Where and How do I Produce a sample?
It is preferable to produce the semen sample on site at Nurture by masturbation. A discreet & quiet room is provided and ’embryo friendly’ lubricant is available. You may wish to have your partner with you but this may not be possible during treatment. If this method is unsuitable or unsuccessful or if you are concerned that you may have difficulties producing a sample on site, please speak to a member of staff about alternative arrangements. It may be possible to produce a sample at home. You will be provided with an appropriately labelled sterile pot and a sealable plastic specimen bag for transport. You must ensure that the sample can be transported at a temperature between 20oC – 37oC (we suggest close to your body/ inside jacket pocket) and within 1 hour of production.Where and how do I produce the sample?
What preparation do I need?
You must abstain from sexual activity/ masturbation for a minimum of 2 and a maximum of 7 days. This will mean you produce a sample of optimal quality as outlined above.
Wash your hands and genitals prior to producing the semen sample.
You must tell the clinic about any illness or medication taken in the last three months – this might have some bearing on your semen quality and affect the advice given.
You must inform a member of staff if the whole sample was not collected. Spillage of the sample can affect the results and subsequent treatment plans.
How do I get my results?
For patients of Nurture the results are usually provided at the consultation appointment, by the doctor who will give you appropriate advice. If you do not have a further appointment scheduled it can be arranged that you receive your results via a telephone consultation with an embryologist.
Private patients will receive results via a telephone consultation with an embryologist and a copy of the report will be sent to the registered address. The turnaround time for results is usually three working days.
Hormone & Genetic Tests
If the semen analysis reveals that you have very low numbers of sperm or no sperm at all in the ejaculate, a blood test to assess the levels of the hormones involved in sperm production (testosterone, LH and FSH) may be recommended. A second blood test to determine that you have the correct genetic make up (sex chromosomes) may also be requested. Such tests may help provide further information about the cause of the problem and assist in determining the best treatment option for you.
Genetic Sperm Testing
A number of genetic tests have been developed for men who may be at greater risk of having genetically abnormal sperm. Such tests are performed directly on the sperm sample and results are usually available within 14 days.
These tests may be applicable if you have experienced recurrent miscarriage, repeated unsuccessful attempts at IVF or following chemotherapy to assess the recovery of the sperm. They may also be recommended before Egg Donation cycles to rule out any problems with the sperm sample. Both tests can be arranged via our Embryology Team. We do recommend implications counselling prior to any form of genetic testing which can be arranged via the Reception team.
There are two tests we can do:
Test 1: Sperm Chromosomal Analysis
During this test, approximately 2000 sperm within the sperm sample are examined for the following five key chromosomes: X, Y, 13, 15 & 18. This test can provide important information about the risk of your embryos having sperm-derived chromosomal abnormalities. The results of such tests can be used to help decide whether or not to use the sperm or to consider donor sperm. They can also be used to inform decisions about Pre-implantation Genetic Screening (PGS) of embryos. The test may also be useful before embarking upon egg donation to ensure that the male gametes are normal and that the problem truly lies with the oocyte.
Test 2: DNA Fragmentation Testing
This test is also performed directly on the sperm sample. A sperm sample is produced and the percentage of DNA fragmentation calculated. If the level of fragmentation exceeds 30% there is an increased chance that the embryos produced will not result in a viable pregnancy. If the result is above 30%, we would recommend following all the guidance above regarding ‘optimising sperm quality’ as well as other investigations such as a full STD screen.
What Treatment Options are there?
There are several treatment options available.
Intra-Uterine Insemination (IUI)
IUI is the treatment whereby a prepared and washed sperm sample is inseminated into the uterus of your partner. Average success rates with this form of treatment are around 10-15% in female patients under the age of 40. This form of treatment is only recommended for patients with normal semen parameters.
In Vitro Fertilisation (IVF)
IVF is the treatment whereby eggs are harvested from the female and then mixed with prepared sperm in a petri-dish. The sperm must swim to the eggs independently and attempt to fertilise them. This form of treatment is recommended for patients with either normal or slightly suboptimal semen parameters.
Intra Cytoplasmic Sperm Injection (ICSI)
ICSI Is the treatment whereby a single sperm is selected by an embryologist and it is injected into the centre of the egg. This form of treatment is generally recommended for patients with moderately or severely sub optimal semen parameters.
Surgical Sperm Retrieval (SSR)
SSR is the removal of sperm directly from the testes via a surgical procedure. This procedure is performed under anaesthetic and can either involve aspirating sperm from the epididymis, which is the least invasive method, or via direct biopsy of the testicular tissue. SSR may be required if there is no sperm in the ejaculate or if the patient is unable to produce an ejaculated sample on the day of treatment. Sperm can successfully be retrieved using this method in 25-75% of patients. Prior to performing an SSR, a blood test can be performed for those patients with no sperm in the ejaculate to help predict the chance of obtaining sperm during surgery, this is called the Y-microdeletion test.
Sperm can be cryopreserved and stored in liquid nitrogen for several years and then subsequently used in treatment. Sperm cryopreservation may be recommended if the numbers of sperm in the sample are low or declining, you are anxious you may not be able to produce a sample on the day of treatment or if you are about to undergo a form of treatment which may inhibit sperm production e.g. chemotherapy, radiotherapy or methotrexate treatment.
The use of sperm from an altruistic sperm donor may be recommended if there are no sperm in the semen sample or in the event of multiple failed attempts at IVF/ICSI treatment. Sperm donors are vigorously screened to ensure they do not carry any sexually transmitted infections, have a normal chromosomal complement and have good quality sperm. We aim to try and find donors which match the male partner’s physical characteristics as closely as possible, though it is worth being aware that all sperm donors can be ‘identifiable’, once a donor conceived child reaches the age of 16. Should you require donor sperm, our experienced donor sperm co-ordinator can help explain the process fully. It is important that you are aware that there may be a delay in starting treatment until a suitable donor has been identified. The cost and current waiting times will be discussed in detail with you by our donor sperm co-ordinated. You can help speed the process up by having your CMV blood test done as soon as possible, this can be booked in with the nursing team and by completing and returning the characteristics form.
Counselling & Support Services
Nurture has two independent counsellors who are available either to individuals or couples undergoing treatment. The counselling appointments are for 45 minutes on site at Nurture and are conducted by counsellors specialising in fertility. The content of these sessions is completely confidential and is not documented in your patient notes. There are two types of counselling:
- Implications counselling, for patients considering using donor sperm or having tests such as genetic sperm testing
- Support counselling, for patients who are undergoing treatment and may wish to speak to someone other than a fertility specialist about the treatment process or for patients who would like support through the treatment process and help in coming to terms with some of the emotional issues of treatment.
If you have any further questions or concerns about male fertility, please contact one of the embryology team and they will try to assist you. You can reach us via the main Nurture Fertility telephone number or email address.