The Male Fertility Lab offers the following tests and procedures. All testing is by appointment only.
The standard test of male fertility. Semen Analysis measures a man's ability to produce sufficient numbers of motile, structurally normal sperm. The main component tests of an SA are sperm count, motility, morphology, and a white blood cell differential (performed as a reflexive test if more than 1 million round cells per mL are present). A Live/Dead Viability test is performed if fewer than 25% of sperm are motile. We pay special attention to progressively motility and % rapid and linear motility (performed by computer analysis). We calculate Total Progressively Motile Sperm per ejaculate. Our reference ranges are based on the World Health Organization's 2010 (5th ed.) recommendations, and on decades of experience with our own patients.
Presence or absence of sperm and their motility is carefully evaluated before and after centrifuging the semen.
Sperm Cryopreservation (Freezing)
Special attention is given to achieve the best possible freezing result for the individual patient's reproductive needs. We tailor our methods to provide you the best outcome.
Fertility preservation for men or boys with cancer
Sperm or semen freezing is done for men or boys facing sterilization or impaired reproductive function from chemotherapy, radiation, surgery or other treatments which may harm future fertility. We work closely with oncologists and fertility specialists in UWMC clinics, Seattle Cancer Care Alliance, Seattle Children's Hospital, and individuals and clinics throughout the Northwest.
Testicular sperm freezing from a surgical retrieval is a routine clinical process for men. Testicular tissue retrieved by a surgeon to preserve sperm stem cells, including from pre-pubertal boys, is an experimental process which we perform for those meeting specific criteria.
We assist husbands, partners, directed donors, and individuals wishing to freeze sperm for other fertility reasons. Please contact us to begin this process. Directed donation to a known but not sexually intimate partner requires extensive FDA-regulated protocols; please allow two weeks to a month to complete this process.
Allow for the possible necessity of more than one visit for sperm freezing. We recommend 20-40 million motile sperm post-thaw be available per desired pregnancy by intrauterine insemination; fewer are needed for IVF. We typically perform a test-freeze and –thaw to estimate how many sperm retain good motility through this procedure. Read details by downloading this document:Cryo Sperm Methods Uses.pdf
Directed Donor Sperm Cryopreservation
A directed donor is a sperm donor who is known to the recipient but is not a sexually intimate partner. A directed donor requires extensive FDA-regulated protocols; please allow two weeks to a month to complete this process.
Samples can be stored long term on-site, or shipped to another facility. Our fee for freezing includes the first year of storage on-site. Subsequent years of storage are billed at each anniversary of the initial service date. Our fee is per patient, regardless of number of visits or vials.
Sperm Function Tests help you and your physician determine the next step in your reproductive care. Do you have enough sperm that can be purified for an Intra-Uterine Insemination (IUI)? Do they survive well (are they “hardy”)?
This is a “mock” IUI preparation which gives you two pieces of information: (1) Total number of sperm likely to be available during an IUI preparation (at least 5-10 million motile is good); and (2) How well do these sperm survive for 24 hours? (At least 70% corresponds with pregnancies in IUI cycles, when sufficient numbers of sperm are inseminated.)
Sperm DNA is easily damaged by oxidative stress, environmental toxicants, therapies and other exposures. We use the neutral COMET, alkaline Sperm Chromatin Diffusion and SCSA methods of quantifying DNA integrity, and a purification technique to attempt to isolate sperm with lower DNA damage.
Sperm must be stimulated to lose the acrosome (like a cap on their head), releasing enzymes that help sperm digest their way through the zona pellucida around the egg. Sperm reacting too soon or not at all will not be able to fertilize the egg.
Sperm kinematics in semen, or during capacitation and hyperactivation. Poor sperm motility may be improved by Motility Enhancement. Computer-assisted sperm analysis (CASA) provides objective measures of sperm function not available by manual methods. CASA is performed in only a small proportion of labs across the country.
Sperm must be able to go into a “whiplash”-like motility pattern to help them get through the zona pellucida. If either of these two tests show poor results, there is a chance that your sperm may not be able to fertilize an egg on their own, and Intracytoplasmic Sperm Injection (ICSI) may be the best choice.
- Diagnostic tests to determine the best sperm preparation method (see "Diagnostic IUI (Recovery Survival")
- Sperm preparation for insemination procedures (Intra-Uterine Insemination or In Vitro Fertilization)
- Specialized purification techniques for special problems (fragmented sperm DNA, viral infection)
Testis mapping of spermatogenesis performed on samples taken from numerous sites by a surgeon. (See "Sperm Identification and Preparation from Surgical Specimens")
Semen analysis plus examination of the post-ejaculatory urine (PEU) to determine if sperm are present in the bladder. Sperm motility and total sperm recovered from the urine are calculated. Urine pH and osmolality are measured, since these can affect sperm viability. Recovery of functioning sperm from the bladder in cases of Retrograde Ejaculation requires careful coordination between the clinic and lab.
- Anti-Sperm Antibodies.
- Reactive Oxygen Species (ROS) Assay and Antioxidant Assay - During inflammation, chemotherapy or exposure to toxicants, the body may respond by producing ROS. These damaging molecules are counteracted by antioxidants. Both can be measured in semen and purified sperm.
- Electron Microscopy - We use this to identify defects in the ultrastructure of the acrosome, nucleus, centrosome, tail or axoneme, for example to identify missing dynein arms related to Kartagener’s syndrome. Sperm Molecules - mostly experimental; we can identify the presence or absence of essential molecules such as phospholipase C zeta (needed to stimulate egg activation during fertilization) or other molecules.
Sperm identification and preparation from surgical specimens.
- Intra-operative assistance in sperm identification and collection
- Testicular, epididymal or vas deferens sperm ID, quantification, preparation
We process sperm obtained by surgical retrieval from the testis by aspiration (TESA), wedge biopsy (TESE) or microsurgical extraction (microTESE), from the epididymis by microscopic (MESA) or percutaneous (PESA) aspiration; or from the vas deferens by aspiration or during vasectomy.
PESA - Percutaneous Epididymal Sperm Aspiration - recovery of sperm from the epididymis performed in our clinic procedure room
TESA - Testicular Sperm Aspiration - recovery of sperm from seminiferous tubules within the testicle using a percutaneous needle performed in our clinic procedure room
TESE - Testicular sperm extraction - recovery of sperm from seminiferous tubules within the testicle using an incision in an operating room setting or clinic procedure room
MESA - Microscopic Epididymal Sperm Aspiration - recovery of sperm from the epididymis using a microscope in an operating room setting
MicroTESE - Microscopic Testicular Sperm Extraction - recovery of sperm from the testicle using a microscope in an operating room setting.