What does semen analysis look like? Can a man deliver a sample to the laboratory? Or it needs to be done at the clinic? What’s the cost of the examinations? We will talk to Dariusz Mercik, MD, gynecologist, infertility specialist at Gyncentrum Infertility Clinic.

Doctor, what does the quality of male sperm depend on?

Daily choices made by men, habits, but also lifestyle have a huge impact on the quality of sperm and the condition of the sperm in it. In the multitude of daily obligations, absorbed with  work, we do not even remember about our testicles. Nobody teaches us about them practically, they do not familiarize us with the proper operating instructions. And it is this organ subjected to hormonal contro, whichl is of great importance for the quality of male reproductive cells, without which a new life cannot arise. Sperm production begins with the period of puberty of a young man and continues until his old age. One sperm is formed in> 70 days.

There are several factors that affect the quality of male sperm:

Firstly, overheating. Male testicles will not work properly unless they remain cooler than the rest of the body. Their excessive exposure to heat causes a significant decrease in the number of spermatozoa and negatively affects the very process of their formation. Overheating may result from spending too much time in a sauna or hot tub, wearing regular tight underwear that lifts the scrotal bag to a warm underbelly, using low-ventilated pants, and carrying a warm smartphone in your pocket. Longer bicycle rides also create a less friendly environment for sperm production. The temperature of the testicles can also be lowered using home-made techniques,  or special cooling methods for scrotal glued patches.

Secondly, obesity. Too much fat component in men’s body weight is a known source of female hormones that do not promote the proper functioning of the testicles and reduce sperm count. On the other hand, after 35 years of age, excessive physical exertion may be the cause of low semen parameters.

Thirdly, lifestyle. Any doses of alcohol always have a negative effect on very sensitive male gametes – sperm. The sperm is formed about 74 days, and if something poisons it along the way, then such an improper sperm escapes to the surface. Especially the abuse of alcoholic beverages is a serious factor that damages sperm and strongly affects spermatogenesis in men. Smoking cigarettes, (nicotine) damages sperm chromosomes (DNA) to a very large extent, slows down the sperm’s progressive movement (they do not flow forward) and increases erectile dysfunction. Marijuana is even worse because its smoking reduces the number of spermatozoa, weakens their functioning very much and significantly reduces overall male fertility.

Practice safe sex. Sexually transmitted diseases like gonorrhea, chlamydia, herpes can lead to infertility. You should always use protection or engage in a monogamous relationship with someone you trust while having sex.

Fourthly, stress. Stress increases the percentage of abnormal sperm and generally reduces their concentration in ejaculate. The right amount of sleep, healthy nutrition and relaxation help relieve tension and stress.

Fifth, diet. You should eat so as to reduce the body’s share of free radicals that damage sperm. Take huge doses of vitamin C 1g per day, which “sweep” free radicals out of the body – a lot of them are created after eating meat. Vit. C- use it from citrus fruits and their juices, sweet peppers, kiwi, strawberries, tomatoes, broccoli, brussels sprouts, cabbage, potatoes, dairy products. It is also recommended to take products with zinc – which is of great importance for semen and other dietary supplements to improve the quality of sperm. Zinc 30mg twice a day (oysters, poultry, crustaceans – crab and lobster, healthy breakfast cereals, nuts and beans, whole wheat grain products, dairy products, pumpkin seeds are full of zinc, which is lost with each ejaculation in the amount of a few mg !!!). It is good to eat vit. B (green, leafy vegetables such as spinach, cos lettuce, brussels sprouts and asparagus, fruit and fruit juices, especially oranges and orange juice, nuts, beans and peas, whole grains, healthy breakfast cereals, fortified flour products such as bread and pasta ), vit. B-12 1g per day – fish and seafood, especially mussels, meat and poultry, especially liver, dairy products such as eggs and milk, fortified breakfast cereals, food yeast, but not from beer. Do not forget about the vit. D – fatty fish such as salmon, mackerel and tuna, beef liver, cheese, yolks, fortified milk, yogurt and other dairy products, mushrooms, vit. E – vegetable oils such as sunflower and soybean oil, nuts and seeds, green vegetables such as broccoli and spinach. Remember about coenzyme Q10 10mg daily (meat = poultry, especially chicken, fish, such as herring and trout, vegetable oils, including soybean and rapeseed oil, nuts and seeds, in particular peanuts, sunflower seeds and pistachios), fatty acids omega-3 (fish and seafood, especially salmon, mackerel, tuna, herring and sardines, nuts and seeds, including chia seeds, linseed and walnuts, vegetable oils such as linseed, soybean and rapeseed oil), L -arginine 4g daily (meat and poultry such as turkey and chicken, nuts and seeds, especially pumpkin seeds and peanuts, almonds, beans and lentils, dairy products), fenugreek seeds (600 mg fenugreek seed extract per day for 12 weeks ), ginseng root, in any edible form, selenium 200mg daily (from bananas), L-carnitine 4g daily, linseed oil 1 tablespoon daily.

You can increase sperm ejaculation with diet and supplementation by always taking zinc in combination with folic acid. A pair of these supplements increases the sperm count (1 mg of folic acid and 15 mg of zinc sulfate consumed per day).

You should drink more fluids (but not sparkling water, soda) – water is the base of the semen. Alcohol dehydrates and reduces sperm count and reduces sperm quality.

If you want to have more sperm in the ejaculated semen, you should refrain from orgasm for one or two or three days because typical sperm production is about 1,500 units per second (130 – 200 million sperm per day).

Men should avoid bisphenol (it highly poisons sperm) contained in plastic bottles, PET packaging.

Men should also avoid eating phytoestrogens, there are a lot of them in soy products and beer.

Is there a correlation between the quality of male sperm and age? Is it similar to the case with women, that the older a man is, the lower his fertility can be?

A man’s “biological clock” is not as obvious as in women, and the age-related decrease in male fertility is more gradua. The statistical dependencies we have obtained, based on several thousand sperm samples tested, clearly show that the age of the man who’s trying for a child begins to be significant after 35 years of age. Then, the quality of sperm, described by several parameters, including: sperm concentration, ejaculate volume, sperm motility and vitality, the presence of correct forms (one correct head with an acrosome, strong insertion, long, single and strongly working switch) naturally decreases. Generally speaking, the later you start trying for children, the harder it is (worse semen quality, lower potency, lower reproductive potential, more chromosomal defects). In addition, apart from age, everything mentioned above is significant, including type of diet, lifestyle, occurrence of fever, inflammation (teeth, joints), infection, taking anabolic steroids, deficiencies required for the production of sperm supplements and the type of work performed (especially for steel worker, welder, railwayman, miner).

However, just lowering sperm parameters in older men does not exclude the possibility of having children.

While for women, potential fertility problems can often be seen, e.g. ovulation does not occur. And how is it with men? When can you suspect that something might be wrong? When is it worth carrying out diagnostic tests for male infertility?

When, despite strenuous attempts of conceiving naturally, pregnancy doesn’t occur (after trying for over a year, without contraception, among young people). When the penile erection is weak or sperm donation does not occur despite of stimulation, it may not occur in practice. When the presence of varicose veins is suspected, which impeding the flow of blood through the testicles increases their temperature and significantly reduces sperm production. When the mammary glands grow – this may be a clue to run the hormonal profile (prolactin, testosterone, etc.). When orgasm occurs, but there is no sperm ejaculation (suspected retrograde ejaculation due to, among others, anatomical defects in the paths leading to semen from the testicles). When you know that the testicles did not descend into the scrotum before 3 years of age (risk of complete infertility).

If only sperm production in the testes takes place, then the chance of having your own offspring obtained from own germ cells exists; in the absence of sperm in ejaculation, they can be microsurgically taken directly from the testicles.

Every man should examine his semen at least once in a while. Finding out whether they have sperm, whether they are alive or flowing straigh. It’s something that you should be interested in, you cannot be ignorant in this aspect.

Is a semen test sufficient or should a man receive a referral for other tests too?

General basic semen examination can be extended with more in-depth sperm analysis, including full examination, with sperm morphology, or MSOME examination looking for high magnification of undesirable vacuoles in sperm heads, or fragmentation of DNA contained in sperm heads:

Lack of erection – sexologist.

Painful ejaculation – urologist.

Suspected malfunction of the endocrine system – endocrinologist.

Malfunction of the genitourinary system – urologist, andrologist.

Varicose veins of the spermatic cord – urologist, surgeon.

Bacteria in a sperm smear – urologist.

What does semen analysis look like? Can a man deliver a sample to the laboratory? Or it needs to be done at the clinic?

Each month, hundreds of men from a group of patients or donors donate semen for testing at Gyncentrum. Routinely, sperm is donated in a specially adapted intimate room of the Clinic. ‘Sperm donation’ is nothing more than normal ejaculation (after masturbation) of the sperm produced in the testicles and associated glands:

– seminal vesicles (of which fructose feeding the sperm + substances increasing viscosity and gelatinization to keep the sperm in the vagina after ejaculation),

– Cowper’s glands and urethral glands (lubricant, as a specific “smear” + anti-sperm antibody that can have a negative effect on fertility,

– prostate (several chemical compounds, including the PSA enzyme – prostate antigen, sperm liquefaction catalyst = sperm release),

– the epididymis (where the spermatozoa matures for 14 days and the sperms do not move yet), through the vas deferens and the penis outside the body.

The semen donation room is equipped with a comfortable couch, armchair, audio video set, lubricants, personal hygiene products, etc. You can stay there for any length of time alone or with a partner. You can donate semen in a dedicated container or a special condom (without spermicides). Semen can also be delivered to the Clinic within 1-2 hours, keeping the container with the sperm sample at +/- body temperature.

How long does it take to get the result?

The test result can be released very quickly. 30 minutes after donation, the sperm liquefies, which allows you to perform basic sperm analysis.

Basic, general examination whether we can see live or mobile sperm cells and the concentration: the result is ready after several dozen minutes.

Detailed examination, with morphology, sperm structure: usually the result is ready the next day after donation.

DNA fragmentation determining the degree of “shredding” of chromosomes: one day after donation.

What’s the cost of the examinations?

Below are the sperm test costs according to the current Gyncentrum price list:

• Sperm Analysis (Computer Assisted Sperm Analysis – CASA) – €25
• Complete sperm analysis – €60
• DNA sperm fragmentation – €70
• Bacteriology assessment of sperm – €10
• MSOME examination – €70

Is it worth to repeat the test? When?

The quality of semen changes over time and under the influence of various external factors (stress, diseases, diet, stimulants, low physical activity, harmful factors related to work, etc.). Therefore, the diagnosis should be based on several results. A single sperm test result (even indicating azoospermia = no sperm at all) does not yet qualify the patient as infertile. Also, the result of a study ordered during an earlier visit to a specialist (which took place e.g. a year ago) does not entitle the doctor to make the final diagnosis.

The semen test should always be repeated from time to time. If the cause of the reduced fertility lies deeper, the semen tests should be repeated at least several times at longer intervals, after the doctor’s recommendations. One-time semen analysis, although recommended for everyone, will never give a picture of a certain biological whole work and functioning of the testicles.

If abnormalities are found as a result of sperm testing, they should be repeated within the next 3 months (which includes the time of subsequent sperm maturation).

And what are the norms of male sperm today? Is it true that norms are lowered every year because the quality of semen of modern men is much lower than a dozen / dozen years ago?

The semen is usually white or gray, occasionally yellowish. Pink or red semen suggests the presence of blood.

It solidifies almost immediately after ejaculation, forming a viscous, gelatinous liquid. It takes 5 to 40 minutes to liquefy again.

The World Health Organization (WHO) defines “normal” sperm parameters:

Ejaculate volume ≥;; 1.5 ml.

Total sperm count in ejaculate ≥;; 39 million.

Sperm concentration (number of spermatozoa in 1 ml of semen) ≥;; 15 million.

Overall percentage of motile sperm (progressive and non-progressive motion) ≥;; 40%.

Percentage of spermatozoa with progressive movement ≥;; 32%.

Sperm viability (percentage of live sperm) ≥;; 58%.

Sperm pH ≥;; 7.2.

Sperm morphology (percentage of completely normal sperm) ≥;; 4%.

Leukocytes (test) with preoxidase <1 million may also be tested in semen (if the semen contains a large number of white blood cells, this may indicate an existing infection or inflammation).

Immunobead test (its purpose is to detect sperm antibodies in an amount that disrupts sperm function) <50%.

Fructose (energy resource for sperm) ≥;;13 mmol / ejaculate.

It should be noted that these are not reference values ​​(based on statistics). These values ​​do not set a threshold below which a man is infertile and cannot have children – his reproductive chances may simply be lower.

Similarly, a correct semen test result does not mean that a man can become a father 100%. It is estimated that 40% of male infertility cases are caused by reduced sperm production or poorer semen quality. Other causes of male infertility may include, for example, damage to the testicles or vas deferens as a result of infection (e.g. gonorrhea) or mechanical or thermal trauma or other types of radiation, or even heart, lung or kidney disease. In turn, the results of the semen test, in which the parameters are significantly below normal, do not mean male infertility. A patient with significant sperm parameters, e.g. sperm count below normal, has a chance of becoming a father.

Modernity and civilization have clearly left its mark on the quality of men’s sperm, regardless of the country of origin. Currently, among typical representatives of the male population, the quality of semen is particularly low, compared to the semen of our even close ancestors (those from 50 years ago). Only some of them manage to obtain satisfactory semen parameters, contained in the cited “standards”.

Finally, could you please name a few ways to improve the quality of male sperm?

As already mentioned above.

When all fertility treatments seem to have been exhausted, the chance of having children is in vitro with an anonymous donors egg. However, the issue of adopting oocytes raises many questions and doubts. Is that right? We will talk to Dariusz Mercik, MD, gynecologist, infertility specialist at Gyncentrum Infertility Clinic.

When all fertility treatments seem to have been exhausted, the chance of having children is in vitro with an anonymous donor’s egg. However, the issue of adopting oocytes raises many questions and doubts. Is that right?

We will talk to Dariusz Mercik, MD, gynecologist, infertility specialist at Gyncentrum Infertility Clinic about the adoption of oocytes and in vitro with the donor’s cell.

1. Doctor, you have been helping infertile couples to fulfill their child’s dreams for many years. Sometimes a little help for the nature is enough for patients to enjoy the birth of a new life after a few months. However, it is quite often the case that many years of treatment and traditional in vitro treatment do not bring the expected results. Then the only way a woman can give birth is by adopting an egg. Please tell me what is the adoption of an egg and how is it different from traditional in vitro?

Adoption of oocytes is a procedure in which the patient receives another woman’s oocytes. In the process of adopting oocytes, we obtain oocytes from a donor and fertilize them in laboratory conditions (in vitro) with the semen of the recipient partner (or donor semen). The resulting embryo, after prior preparation of the endometrium, is transferred to the recipient’s uterus. In Gyncentrum we have just introduced the only program in Poland with a 4-embryo guarantee.

What is the difference between procedures? In traditional in vitro the patient is hormonally stimulated to cause multiple ovulation. Obtained oocytes are collected, fertilized with partner / donor sperm. The resulting embryos are transferred to the uterine cavity. In the in vitro case with a donor cell, the recipient is not subjected to ovulation stimulation, ovarian puncture is not performed, and no egg cells are collected. In both procedures, the recipient is prepared in the same way for the transfer and the embryo is transferred to the uterus.

2. What are the indications for in vitro with a donor egg?

Indication for in vitro with donor’s egg cells is the patient’s inability to obtain oocytes. Most often these are women with very low ovarian reserve and patients whose ovarian function has expired as a result of premature menopause. Another indication is the condition after surgery of ovaries removal and other surgeries of reproductive organs after chemotherapy. All situations in which we are unable to obtain fertilized eggs can be a premise for in vitro fertilization with an egg.

If the patient’s AMH is very low, but the Couple still wants to try to get pregnant with their own eggs, we attempt to stimulate the patient. Normal FSH and estradiol values on day 2 and 3 of the cycle, with low AMH, give you the chance to get eggs. If oocytes cannot be collected in a few cycles, I suggest Patients to consider adopting oocytes. In patients in premature menopause whose AMH is undetectable (practically 0), we do not start stimulating our own eggs.

Patients are aware that this is a cell of a foreign person. Therefore, the use of donor’s eggs is always the last resort. I suggest such a solution only if I am absolutely convinced that all other options for infertility treatment have been exhausted and the only chance for pregnancy may be in vitro with the donor’s cell.

3. What is the reaction of patients when they hear from you that the only chance for them to become parents is in vitro with the donor’s cell?

Most of my patients are aware of the treatment options offered by modern medicine. They are also aware of the moment when traditional in vitro will not solve their problem and knowing that it is possible to use the donor’s egg, they ask if it is possible in their case. As I said, I suggest this solution when I am convinced that there are no other options for infertility treatment in a given couple. I then consider using another woman’s eggs for the procedure. This is an open proposition. I realize that this is not an easy decision. So I don’t expect them to take it right away. If the patients agree and there are no medical contraindications, then we begin the procedure of adopting the egg.

4. In vitro with fresh eggs or in vitro with frozen eggs – what’s the difference?

We have an ideal situation when the donor and recipient are at the same time prepared in parallel for the procedure. The donor is hormonally stimulated to induce multiple ovulation and the recipient prepares the uterus endometrium. On the day of the puncture of the donor’s ovaries, the recipient’s partner gives semen to which the fertilized eggs are fertilized. On the same day, the recipient begins to take progesterone to transfer fresh embryos after 3-5 days. However, it is quite difficult to synchronize. Therefore, other variants of the procedure are also used in which oocytes obtained from the donor or embryos created from them are vitrified. In the first case, after donor’s stimulation, ovarian puncture takes place and the oocytes obtained are frozen. In the next cycle, the recipient prepares the endometrium.

When it reaches the right thickness, the oocytes are thawed and fertilized with the partner / donor sperm. Embryos are transferred within 3-5 days. In the second case, during ovarian puncture, the recipient’s partner gives sperm to fertilize the eggs. The resulting embryos are frozen. In the next cycle, the recipient prepares the endometrium. When it reaches the appropriate thickness, the embryo is thawed and transferred to the patient’s uterus. In the era of modern methods of freezing – vitrification, the effectiveness of these procedures is comparable.

5. How is the recipient prepared for the in vitro procedure? What are the challenges for the doctor and patients?

The biggest challenge is to prepare the endometrium and the entire female body so that the embryo has the right conditions for implantation and development. Preparation for the procedure therefore requires tests to check the patient’s overall health. They are made, among others tests for thyroid hormone balance, vitamin D3 levels and many other tests based on the patient’s health. In the cycle in which the transfer is performed, the patient also takes estrogens to get the right endometrium after 10-14 days. Then, progesterone substitution is activated to recreate the cycle of the woman’s preparation for embryo implantation. Normal menstrual patients can be prepared on natural cycles without drugs that promote endometrial growth, using only progesterone substitution.

6. How does the in vitro with egg donation looks like in women, who cannot have children because of underwent cancer disease?

Patients who have lost fertility as a result of disease and cancer therapy can use a donor cell and undergo in vitro fertilization. Of course, if embryo transfer is possible and there are no medical contraindications for the patient to become pregnant. Women who are affected by this problem are usually very well versed in the subject and want to take advantage of this opportunity. In these cases, we usually don’t try other treatments. If a woman has high FSH, low estradiol and very low AMH, and she is aware that the adoption of eggs is the only way for her to have a child, we immediately proceed to the oocyte adoption procedure.

7. Can every woman undergo in vitro donor egg donation? What are the contraindications?

The contraindications for the in vitro procedure with the donor cell are the same as for traditional in vitro. These include cases in which we are unable to carry out the embryo transfer, i.e. uterine defects preventing the embryo from entering and the proper development of pregnancy, as well as serious diseases that are contraindications to pregnancy itself.

8. What does the selection of an egg donor look like? Can a couple who decide to adopt an egg cell decide to choose the cell of a specific donor, e.g. a friend?

The doctor, when choosing the donor, takes into account the similarity of phenotypic and morphological features. Polish law guarantees the full anonymity of both the recipient and donor of oocytes. The legislator has foreseen only anonymous donation and reproduction of reproductive cells. Donation with indication and intra-family donation is also not allowed. Therefore, patients cannot identify a particular woman as a donor.

9. What criteria must a donor candidate meet? What does the preparation and stimulation of an egg donor look like?

A candidate for a donor must meet certain criteria and undergo a multi-stage qualification procedure in our clinic. Ladies who want to join the oocyte donation program must be at least 20 and no more than 32 years old, be in good health and have no addictions. The candidate must also perform a number of genetic and viral tests (HIV, hepatitis B and C, syphilis, HTLV). Only positive verification, no genetic load and negative results of viral tests qualify her for the program. The donor is then subjected to hormonal stimulation to induce multiple ovulation. Stimulation involves taking hormonal drugs in the form of injections. After about 10 days, ovarian puncture is performed, followed by the collection of eggs.

10. Over the years, have you noticed any change in the approach of Polish patients to in vitro and the adoption of eggs? Do foreign patients show less concern about it?

I have to admit that I have noticed a big change in the Poles’ approach to this type of procedure in recent years. Patients currently have unlimited access to information. They are more aware and more willing to use the opportunities offered by medicine. Patients who come to me usually know what procedures are performed and what they consist of. They also know the opinions of others on the subject. I usually meet my patients at the very beginning of their journey, i.e. at the stage of infertility diagnosis. Then we go through the next stages of treatment until we reach the moment when we have to decide what to do next. Often, the only chance for a child is the adoption of eggs. There are fears and doubts that are most justified.

For most couples, however, they are not an obstacle to continuing treatment and deciding to adopt a donor’s cell. Another group of patients are people from abroad who are treated in the Gyncentrum clinic. These patients are usually at a different stage and already have a history of infertility treatment, including unsuccessful in vitro trials. When they come to our clinic, they are usually 99% decided to adopt eggs and hence their fears are not as big.

Throughout my professional career I don’t remember a single couple who would undergo in vitro with a donor’s cell, get pregnant in this way and come back unsatisfied with me. Patients, like couples who manage to conceive a child naturally, feel 100% parents and have no doubt about it. Parenting gives them a lot of joy. Because of the way they travelled, they enjoy it even more. Often, after a successful procedure, they visit our clinic to show off their comfort and share their happiness. They are also happy to send pictures of toddlers who are developing properly, to everyone’s joy. It’s uplifting! Not only for the entire Gyncentrum team, but also for couples who are undergoing treatment and waiting for the desired child.

The semen test is the basic test for assessing male fertility and necessary in case of problems with getting pregnant. Doctors recommend taking a seminogram usually after about 1 year of trying to conceive. In the so-called seminological examination semen quality is assessed according to criteria proposed by the WHO.

Although the sperm is almost 20 times smaller than an egg, because it measures about 0.006mm long with a tail, it plays an extremely important role. It is impossible to conceive a child without its participation. However, before the inconspicuous sperm meets the egg, flowing towards it at a speed of 0.1mm / s (and tail waving 800 times  at the distance of each centimeter swam) to rise a new life, it must pass a real test of endurance and overcome many obstacles on its way and millions of competitors.

That is why it is so important that the spermatozoa, when starting the race for the egg, is in the best condition. Fortunately, you can check the quality of spermatozoa with a simple and painless examination – of course, we are talking about a seminogram.

The semen test is the basic test for assessing male fertility…

…and necessary in case of problems with getting pregnant. Doctors recommend taking a seminogram usually after about 1 year of trying to conceive. In the so-called seminological examination semen quality is assessed according to criteria proposed by the World Health Organization (WHO).

Sperm – the most important component of sperm

Continuous production of male reproductive cells begins at the time of puberty of a young man, around 12-13 years of age. It runs under the control of the endocrine system in the even testicles located in the scrotum (at a temperature 1.5 °C lower than in the center of the body). More precisely, the process of spermatogenesis occurs in sperm-forming tubules at a release rate of approx. 3,000 spermatozoa per 1s. Finally, sperm during ejaculation (ejaculation) are suspended in the nutritious and protective semen plasma – liquid secretion produced by the testicles and epididymis (5%), seminal vesicles (46-80%), prostate (13-33%) and bulbous-tubular glands and urethral glands (2-5% volume). Plasma abounds, among others in testosterone (the basic male sex hormone), fructose (sugar, energy), the enzyme PSA (liquefies sperm and releases sperm from the plasma in the vagina), lubricants and antibodies.

However, before one sperm can fertilize an egg, it must (like millions of others) reach the required maturity within 74 days. It is preceded by a series of divisions of primary germ cells and a number of changes that lead to the formation of actively floating spermatozoa with a head (containing 23 chromosomes with genes) and an acrosome (dissolving oocyte covers), the neck, midpiece (in which mitochondria responsible for providing energy) and tail (providing sperm drive).

Sperm test – what exactly is checked?

The semen analysis consists of two stages. In the first, the male ejaculate is subject to andrological macroscopic evaluation. It includes such parameters of the donated sperm sample as: volume of ejaculate, liquefaction time, color and smell, viscosity and pH. The second stage, i.e. microscopic evaluation, determines the total number of sperm in the semen, in 1mm, motility, viability and structure (morphology).

How much semen must be donated to make the sample suitable for analysis?

To be able to perform a complete semen analysis, the analyzed sperm sample deposited by the patient in a comfortable cup must have a certain minimum volume. Usually, the norm is 2-5 ml, or at least 1.5 ml after ejaculation (1/3 teaspoon), which is affected by the condition of the man and the period of sexual abstinence. The preferred period for sperm sexual abstinence is 2-7 days, optimally 3. If the period of sexual abstinence is too short, the number of spermatozoa may be lower, if the period of sexual abstinence is too long, the number of spermatozoa may be higher, but motility, vitality and morphology will be significantly impaired. Despite the recommendations, too small volume of ejaculate may suggest retrograde ejaculation or the presence of anatomical defects within the reproductive organs of a man. Too much ejaculate volume and possible sperm thinning are also not desirable.
How much sperm should there be in the semen?

According to WHO recommendations, “normal” semen parameters are assumed (lower limit, 5th centile):

Volume of ejaculate (sperm) ≥ 1.5 ml
Total sperm count in ejaculate ≥ 39 million
Sperm concentration (sperm count in 1 ml of semen) -+0+15 million / ml
Mobility (progressive – fast, progressive / non-progressive) 40%
D-type sperm motility (stationary) <60%
Progressive spermatozoa (A + B) ≥ 32%
Viability – (% live sperm) ≥ 58%
pH ≥ 7.2
Sperm morphology (structure test) – ≥ 4% of normal forms
Leukocytes test with preoxidase <1 million (if the semen contains a large number of white blood cells, this may indicate an existing infection or inflammation)
Immunobead test (its purpose is to detect sperm antibodies in an amount that disrupts sperm function) <50%
Fructose (energy resource for sperm) ≥ 13 mmol / ejaculate

It should be noted that these are not reference values (based on statistics). These values do not set a threshold below which a man is infertile and cannot have children – his chances may simply be lower.

If abnormalities are found as a result of semen analysis, they should be repeated within one to three months (this is the time of sperm maturation).

What is the liquefaction time?

Semen coagulates almost immediately after ejaculation, forming a viscous, gelatinous liquid. It liquefies again after 5 – 40 minutes. A semen sample can be delivered from home to the laboratory. In order for the test result to be reliable, the semen should be analyzed at the latest within 1 hour of ejaculation, i.e. immediately after liquefaction. Sometimes the semen does not liquefy, which prevents its further analysis. Then the employee of the andrological laboratory may subject the ejaculate to additional processing.

How much sperm color and smell says about a man’s health?

It turns out that quite a lot! The semen is usually milky white or grayish, occasionally yellowish (too yellow may indicate jaundice or come from medication). Pink or red semen suggests the presence of blood. Greenish sperm color, in turn, can occur with bacterial infections.

Sperm, cadaverine, putrescine and spermidine, which is part of the semen, give it a characteristic taste and smell (edible chestnuts), while their physiological task is to protect the sperm DNA against the acidic environment of the vagina. The unpleasant smell of sperm can be caused by an infection of the male reproductive system, therefore medical advice is always required sperm crystallizes after drying out (spermine phosphate crystals).

When the semen is too sticky…

The correct semen flows from the diagnostician’s pipette with sticky drops. However, if it’s  too sticky to create threads that extend over 2 cm it can indicate a disease state, e.g. cystic fibrosis. It may also be associated with prostate disease or inflammation in the male reproductive system, or indicate dehydration.

Sperm do not like acid environment

Male sperm should have a slightly alkaline pH (7.2 and 7.6). Such conditions ensure adequate sperm motility, which they acquire during puberty in the epididymis (14 days). For comparison, a woman’s vagina has a strongly acid pH (3-5). And that’s why a large proportion of spermatozoa die in the acidic environment of the vagina just after ejaculation. The cause of too low semen pH may be a disease state located within the seminal vesicles. In turn, alkaline semen (above pH 8) may indicate prostate problems.

How fast should the sperm move?

It might seem that the sperm moving at a speed of about 0.1 mm / sec. doesn’t make it some outstanding sprinter. However, taking into account its truly microscopic dimensions and the path of a few centimeters that it has to cover through the vagina, the uterus towards the oocyte deposited at the end of the fallopian tube (through the specifically formed mucus), the sperm moves really fast. The quality of the male cell’s movement is definitely important. When assessing sperm motility, three states of movement are taken into account – progressive (flows forward), non-progressive (sperm moves in place), and no movement.

At least 40% of spermatozoa should be in normal sperm, while according to the criteria of the World Health Organization, 32% of spermatozoa should move in a progressive motion. Sperm can move abnormally for many reasons. The cause may be an “unhealthy” lifestyle, including nicotinism and inhalants, alcohol, prostate disease, inflammation, the presence of anti-sperm antibodies, varicocele, dehydration, genetic diseases (including cystic fibrosis – thick mucus, Kartagener Syndrome).

At least 4% of spermatozoa should have normal structure…

to meet the lower limits of the norm (5th centile) currently recommended by WHO to fulfill its biological role – DNA transfer. Morphological abnormalities can affect any part of the sperm – head, neck, midpiece or tail – and have very different nature and origin. For example, the head may be too small, too large, have the wrong shape, improperly shaped acrosome, it may not be present (“spermatozoon”), there may be two heads. A correctly developed sperm head is of cardinal importance for the transmission of genetic information, because the sperm head has a cell nucleus with 23 chromosomes, which when combined with an egg (with 23 chromosomes) recreates the correct composition of the first cell of the future child (46 chromosomes) and all subsequent ones. If the head is improperly formed or subsequent parts of the sperm associated with its drive, then the natural conception of a child can be very difficult or even impossible.

Basic semen analysis

Basic semen testing is done using CASA (Computer Assisted Semen Analysis) technology. Semen is analyzed in cooperation with an automatic computer system SCA (Sperm Class Analyzer). The microscopic image, recorded by a video camera, is processed and subjected to digital computer analysis “under the watchful eye of an andrologist”. The result panel obtained in this way allows to correctly and very accurately assess the most important sperm parameters (concentration, motility and morphology of spermatozoa), which is of great diagnostic importance (healthy / sick).

To assess oxidative stress in semen, a very accurate and fast MIOXSYS test is used. Oxidative stress is currently one of the most important factors of male infertility. It is based on an imbalance between the amount of free radicals (harmful products of metabolism) and the body’s ability to remove them. MIOXSYS allows to evaluate this ability.

MSOME examination and sperm DNA fragmentation

Further analysis for semen evaluation is enabled by the MSOME test, which tests sperm at an magnification of 6000-8000 times and the SCD test. The last of these, i.e. the study of DNA fragmentation of sperm, allows you to assess damage to their genetic material. This is a very important parameter because the presence of any abnormalities in the germ cell DNA significantly reduces the chance of fertilization, and also increases the risk of pregnancy loss and the birth of a child with a genetic defect.

Sperm quality and infertility

The correct semen test result does not mean that a man can become a father 100%. It is estimated that 40% of male infertility cases are caused by reduced sperm production or “worse” sperm quality. Other causes of male infertility may include, for example, damage to the testicles or vas deferens as a result of infection (e.g. gonorrhea) or trauma, and even heart, lung and kidney disease. In turn, the results of the semen test, in which the parameters are significantly below normal, do not mean male infertility. A patient with significant sperm parameters, e.g. sperm count below normal, has a chance of becoming a father.

The quality of the semen changes over time and under the influence of various external factors (stress, diseases, diet, stimulants, low physical activity, harmful factors related to work, etc.). Therefore, sperm diagnosis should be based on several results obtained. A single semen test result does not entitle the patient to be classified as sterile.

So what should a man do to get his partner pregnant?

Many causes of infertility can now be avoided. For example, surgery for varicocele or repair of obstructed vas deferens contributes to the return of chances for natural fertilization of the partner. Intrauterine insemination, sperm conditioning and increasing sperm concentration are proposed for men with lower than normal sperm counts. A whole range of ART and IVF treatments is also available.

And it happened! After a series of specialized tests, you were qualified for in vitro surgery. You are waiting for embryo transfer. Remember that it is really the most important element of the whole procedure. The embryos are transferred to the uterus 3-5 days after the collection of the eggs. The procedure itself is painless and usually lasts only a moment.

And it happened! After a series of specialized tests, you were qualified for in vitro surgery. You are waiting for embryo transfer. Remember that it is really the most important element of the whole procedure. The embryos are transferred to the uterus 3-5 days after the collection of the eggs. The procedure itself is painless and usually lasts only a moment.

However, you should prepare well for it – both physically and mentally. In this article, we suggest how you can do it!

Remember about medicines

Before the embryos enter the uterus, your doctor will prescribe hormonal drugs that will prepare your body for transfer. They are intended to facilitate implantation of embryos and prevent their rejection. The type of medication and their dosage determined by the doctor depends on whether you are preparing for the transfer immediately after ovarian puncture, or whether it will be the transfer of frozen embryos.

Take care of proper hydration and a healthy diet

By drinking about 2 liters of water a day, you flush out toxins from your body. You must know that toxic substances are found in air, food, cigarette smoke and other stimulants. So if you want to support your fertility before embryo transfer, remember to give up all addictions, drink the right amount of water, daily exercise and a healthy diet.

If you are preparing for a transfer, you should pay close attention to what you eat. It is best that your daily menu consists of 4-5 small, but varied meals a day. Before in vitro, it is best to completely exclude fast food and highly processed foods from your diet. Your diet should be rich in vegetables, fruit, meat and dairy products.

Remember! You should start to follow healthy lifestyle recommendations when you decide to expand your family, even before starting to try for a baby naturally.

You don’t have to come on an empty stomach for embryo transfer. Unless it takes place under anesthesia, which can sometimes occur. It is good, however, that on the day of the transfer you bet on easily digestible meals and avoid bloating products.

Your fertility can be supported by supplementation and herbal medicine

It has long been known about the beneficial effects of herbs and vitamins on fertility. For this reason, women preparing for in vitro fertilization are recommended to use them. Of course, always inform your doctor about the preparations you take. Herbs can also not be taken at the same time as taking preparations for in vitro preparation. So when to take them? Preferably 3 months before the procedure. It’s best to talk to your doctor about nutrients and vitamins important in the pre-in vitro period.

Drink water right before the transfer

It is best to drink from 0.5-1 liter of still water. This is to make the uterus more visible, which will facilitate the whole procedure. If it turns out that your bladder is not sufficiently filled, you will be asked to drink more water, but the transfer time may then change.

Try not to stress

In vitro may be a significant psychological burden to many women. You may feel uncertainty and fear for procedure failure. In this kind of situation, instead of suppressing the emotions &ndash release them. How? You can share them with your partner or a psychologist.

What exactly is embryo transfer?

Embryo transfer is about inserting the embryos through the vagina into the uterine cavity using a special catheter. The embryologist decides which embryos will be used. Usually, 1-2 embryos are placed in the uterus. The whole procedure takes place in a gynecological chair, it takes a few minutes and is usually not painful.

And after the transfer?

Immediately after the transfer, a short rest – lasting approx. 10-15 minutes – is recommended. Only after this time will you be able to empty your bladder and go home. 12 days after the transfer, you will do a blood pregnancy test (beta hCG test) to confirm or exclude pregnancy. Until then, you should also spare yourself if possible – avoid increased physical activity and refrain from sexual intercourse. Hot baths, sauna and solarium are also not recommended. Remember that you should inform your doctor about the result of the pregnancy test, whether it will be positive or negative.

Do you want the transfer to be successful? First of all, listen to the doctor

To sum up, whether an embryo transfer will be successful, it depends on many factors, such as the patient’s age or health. No matter what, the patient should work with a doctor and strictly follow his/her recommendations, especially when it comes to taking drugs that prepare for the transfer.

A woman after a miscarriage is most often referred for hormonal, anatomical or immunological tests. Genetic diagnosis is usually left at the very end when the other tests show nothing worrying. Statistics show, however, that approximately 70% of all miscarriages in early pregnancy are due to genetic disorders.

A woman after a miscarriage is most often referred for hormonal, anatomical or immunological tests. Genetic diagnosis is usually left at the very end when the other tests show nothing worrying. Statistics show, however, that approximately 70% of all miscarriages in early pregnancy are due to genetic disorders.

Therefore, it is more and more often said that the first step on the way to finding out the cause of miscarriage should be DNA tests – performed on the fetus and both parents. The results of the genetic tests should be discussed with your geneticist or reproductive medicine doctor.

Random changes in genetic material are usually responsible for miscarriage. It is nature that determines that the fetus is burdened with them. These changes are usually not inherited, but they can stop the child’s development and cause fetal death. Although the risk that the baby will be burdened with them in the next pregnancy is small, it is worth doing genetic tests of the miscarried fetus and finding out about the presence of possible disorders in the DNA.

The sample for genetic testing after miscarriage is usually a chorionic villus fragment. The doctor places it in saline immediately after cthe curettement. If the chorion is unsuccessful, a paraffin block can be used for analysis.

Analysis of the number and structure of chromosomes

Genetic testing of miscarriage allows us to find out the causes of pregnancy loss. The most common are: the presence of an additional chromosome 21 (Down syndrome), the presence of an additional chromosome 18 (Edwards’ syndrome), an additional chromosome 13 (Patau), or the absence of one X chromosome (Turner syndrome).

In this study, the individual chromosomes of the child are analyzed – their number and structure are checked. In this way the child’s karyotype is examined. However, this is not all. When examining material from a miscarriage, it can also be determined whether the child was male or female. With the help of ultrasound, the doctor is able to determine the sex of the baby only about 16 weeks of pregnancy. However, for genetic testing, pregnancy age is not of the slightest importance, since sex is a characteristic given at the time the egg connects with the sperm.

Parent, check your chromosomes!

Statistically, even 2 – 6% of parents are carriers of chromosome aberrations. The presence of abnormalities in the structure or number of chromosomes is associated with a greater risk of pregnancy failure, including habitual miscarriages. Such a parent has no visible symptoms that would suggest that their genetic material has errors. The only thing that can disturb them is repeated miscarriages.

If one of the parents is a carrier of chromosomal aberration, there is a danger that the next pregnancy will also result in miscarriage (changes of this type are hereditary). The risk of re-miscarriage, having information about the type of genetic change, will only be determined by a geneticist. If necessary, he may propose to a couple prenatal tests or preimplantation diagnostics (PGD).

Karyotype test

It is worth adding that the presence of aberrations in chromosomes does not always have to lead to pregnancy loss. The fact that the couple already has healthy offspring does not mean that the genetic defect did not contribute to the miscarriage. In the case of a chromosomal aberration in one of the parents, the karyotype of healthy children should also be examined to see if they are carriers of the change occurring in the parent.

Parental karyotype is a completely non-invasive study. Partners donate only a few milliliters of peripheral blood.

Habitual miscarriages and thrombophilia

After a miscarriage, a woman should make sure that there is no innate propensity for thrombosis or congenital thrombophilia. It is conducive to the development of this dangerous disease. Congenital thrombophilia itself is asymptomatic. A woman most often reports to a doctor when she develops the first signs of thrombosis, i.e. redness and swelling of one of the lower limbs. Congenital thrombophilia, although not visible to the naked eye, can have serious consequences. In addition to the mentioned thrombosis, it also causes obstetric complications, including in the form of habitual miscarriages.

Congenital thrombophilia is diagnosed today using genetic tests that identify specific mutations in DNA, primarily the mutation of factor V Leiden and the prothrombin gene.

The first step – genetic testing

The result of a genetic test can really decide about the course of all miscarriage diagnostics, because genetic disorders are responsible for the majority of miscarriages in early pregnancy, and the diagnostics is doften finished after DNA tests. However, if it is not possible to determine the direct cause of miscarriage with their help, it means that it should be looked elsewhere.

Therefore, miscarriage diagnosis should begin with genetic testing. This does not mean, however, that it should end with them. The reason for losing pregnancy may not necessarily be in genetics. Miscarriage can also occur as a result of hormonal disorders, anatomical defects of the reproductive organs, infections (cytomegaly, toxoplasmosis, rubella, chlamydia trachomatis). When looking for the cause of miscarriage, it is worth excluding all these factors, especially if the first genetic tests do not provide an unambiguous answer.

Psychological comfort

It is certainly easier for parents to come to terms with the loss of a child when they know that the miscarriage was not the result of their neglect, but a matter of case that they could not protect themselves in any way. By determining the child’s gender through genetic testing, they can also give the child a name and apply for the rights they are entitled to after a miscarriage (funeral grant, maternity leave).

And finally, knowing that the cause of the miscarriage was a genetic defect, the doctor will be able to estimate the risk of the miscarriage recurring in subsequent pregnancies. It should be emphasized that miscarriage is usually a one-off event. Women who lose pregnancy usually give birth later to healthy children and their pregnancy goes without complications.