What are the investigations done for Male Infertility?

There are numerous tests that are done to evaluate Male Infertility. But first and foremost important test is Semen Analysis. It is important to have semen analysis done at a place where the embryologist performing it is expert and experienced. At Janini IVF, one of the best IVF centres in Delhi NCR, our team of experienced embryologist headed by Dr Akanksha Mishra would ensure a complete and thorough evaluation of your case. Every patient walking into our clinic is subject to semen analysis and you get a detailed report which would mention all the parameters of semen including count / motility / morphology / pH of semen / total volume of semen / presence of Leukocytes / viscosity / liquefaction time / and additional tests like semen fructose assay for Azoospermia patients to rule out obstructive Azoospermia.

Apart from the semen analysis, there are case to case scenarios where one would need additional testing. For example if there is severe oligospermia (< 5 million sperm/ml) or Azoospermia (0 sperms) then one may be subjected to additional genetic, hormonal and imaging tests.

Dr Dalal who has a passion for treating Male Infertility examines and evaluates all Male Infertility cases at Janini IVF himself. One of the few FNB degree holders of the country, Gold Medalist Dr. Dalal, our infertility specialist doctor in Delhi, has the privilege of having had training from one of the most reputed Andrology centres of the world - ‘Androfert’ at Brazil. He is one of the most experienced surgeon in micro-TESE procedure (more details elsewhere) which is the best procedure for successfully harvesting sperm in even the most difficult cases of Azoospermia. This proficiency of his is well-known in peer groups because of which he is frequently called upon by many other IVF centres to perform micro-TESE on their patients. He is absolutely passionate about giving babies to difficult cases of Azoospermia with their own sperm who are asked to go for sperm donation at other IVF centres.

How is semen analysis done?

At Janini IVF, our expert in-house team of embryologists will ask you for semen sample by showing you in the semen collection room. You will be given a wide mouthed sterile plastic container in which you have to produce the sample via masturbation. If you have issues in masturbation we can arrange your wife to accompany you in the semen collection room An abstinence period of 2-5 days is ideal for semen analysis but even if there is shorter period it is okay In case of any spillage you have to let us know about it The sample would be marked by your full name and your wife’s name on BOTH the lid and the main container. At Janini IVF we make sure there is no mis-match of samples at any cost. You will be given a detailed, printed report the same day evening along with other reports if any Our experienced embryologists strictly follow the guidelines of WHO Vth manual on Semen Analysis. This is the final authority on the analysis and your report will be a valid document abroad as well (for International patients) Additional tests like semen fructose assay / DNA fragmentation index (DFI) / Semen culture / Sperm auto-antibody assay, etc would be done if felt necessary or is requested for.

What are other tests that could be done?

After a detailed history and thorough physical examination, including local genital examination, additional tests are ordered deepening on the semen analysis report. If semen report is normal, no further testing is required. But if we find severe oligospermia (count < 5 mn/ml) or Azoospermia (No sperms in the sample) you may be subjected to additional tests :

Hormone testing - serum FSH, LH, Testosterone, Prolactin Karyotyping and Y chromosomal micro-deletion study Trans rectal ultrasound if there is suspicion of ejaculatory duct obstruction (low volume, acidic pH of semen) CFTR gene mutation study of the wife if you have bilateral absence of vas deferens

Scrotal ultrasound which most IVF centres believe in doing is a totally useless test and we don’t do it here. Reason being, varicocele (a condition for which the testing is done) is only relevant if seen on a clinical examination. Varicoceles that are detected by scrotal ultrasound are not relevant at all. So scrotal ultrasound is a waste of money.

What is the ‘Sperm function test’ and is it done at Janini IVF?

There are many sperm function tests which try to determine the functional competence of the sperm in fertilising the egg. It is believed these tests would help in determining line of management. Some of the sperm function tests include the Sperm survival assay, Sperm zona free hamster egg penetration assay (SPA), sperm binding assay and sperm DNA fragmentation index (DFI). Out of these tests only DFI is worth doing as other tests have not been found to be much useful in published literature.

What is DFI and how is it done?

DFI is DNA fragmentation index and basically tells us how intact the sperm DNA is. So if for any reason there is a damage to the sperm DNA the DFI could be high. Higher the DFI higher is the sperm DNA damage. High DFI can lead to infertility and is also a prognostic marker of failed fertilisation in IVF. So DFI can be a cause of infertility that conventional semen analyses won’t diagnose. It can also reduce the pregnancy rates in IUI treatment. For DFI testing we do a test called SCD or Sperm chromatin dispersion test. Sometimes we also offer TUNEL - Terminal deoxynucleotidyl transferase dUTP nick end labelling for sperm DNA fragmentation but it is more laborious. We have a cut-off of 30 in order to consider it significant and offer altered line of management like TESA with ICSI.

Who should go for sperm DNA fragmentation index or DFI testing?

(a) Patients who have poor semen report (b) Age more than 40 (c) Diabetes (d) Leukocytospermia (pus cells in semen) (e) Previous repeated miscarriages (f) Previous multiple IVF or ICSI treatment failures

So what causes DNA damage or high DFI?

(a) Environmental factors like pollution (b) Chemical exposure - either occupational or otherwise (c) Oxidative stress eg fever, infection, smoking, alcohol abuse, etc. (d) Unhealthy lifestyle (e) Excessive weight gain (f) Presence of varicocele

What is the treatment of high DFI?

(a) We may prescribe be a course of antioxidants for 2-3 months (b) Extracting testicular sperm is the best option. It has been found that testicular sperm is healthier than ejaculated sperm with a lower DFI. Probably less exposure to oxidative stress plays a role (c) Stop Smoking and take alcohol only in moderation (d) Weight loss (e) Varicocelectomy if grade 2/3 varicocele present