What should be taken into consideration when giving a semen sample?
The semen sample should be collected after a 3-4 day sexual abstinence, in a clean glass or plastic container, without leaking, and preferably by masturbation.
Samples must be examined within 2 hours. The best method is to take at least 2 sperm samples at 2-3 week intervals and use samples that support each other as a basis. There is no need for repetition in samples found to be normal.
Can a healthy result be obtained by having a spermiogram done once?
In a man who complains of infertility, at least two spermiograms should be performed 2-3 weeks apart. Sperm production in men is a process that takes 64-72 days and it cannot be expected to have the same characteristics all the time. Sperm production may be temporarily impaired by various factors affecting sperm production. Especially in azoospermic men (who do not have sperm in the sample given), more than two sperm analysis must be done, and especially a detailed examination of whether there is sperm in the sediment after centrifugation.
What is the solution for patients who have difficulty giving samples in the hospital environment?
A problem such as erectile dysfunction and inability to ejaculate may occur due to a person not being able to give a sample in the hospital through masturbation or due to excessive stress in the hospital environment. When such a situation occurs, the problem should be reported to the doctor in advance in order to avoid any problems, especially during in vitro fertilization treatment, such as on the egg retrieval day.
Before going to give samples to patients with such a problem, appropriate drug treatment or in cases where drug treatment is insufficient, sperm can be obtained by testicular sperm extraction methods (MESA/TESA).
Will there be any problems if the sperm sample is given at home and brought to the center from outside for examination or processing?
For example, the transition from the gel consistency when given to the liquid state occurs faster and healthier at body temperature (37°). Since sperm motility shows its true value at body temperature, the most accurate evaluation can be made on a sample that has not been kept outside. Under normal circumstances, the sperm sample to be given at the medical center is evaluated after being kept at room temperature for 20 minutes. If the sample is to be brought from home in extreme cases, it should be kept at body temperature, under the armpit or between the palms, and delivered to the center in a period not exceeding 20 minutes.
Is it a problem if some of the semen escapes while giving a sample?
The first part of the semen sample given is very important as it contains more sperm cells. If the first part of the sample leaks out or is lost during sperm collection, this should be reported to the laboratory staff, and if possible, the sample collection should be repeated.
Why are sperm samples sometimes asked to be given twice in a row?
In cases where the sperm count is found to be very insufficient, it may sometimes be necessary to take more than one sample to obtain more sperm. In the first example, sperm are taken from the sperm carrier channels (vas deferens). In the second example, it is possible to obtain less mature sperm in the epididymal channels. With the possibility of obtaining a higher rate of fast motile sperm, a second or rarely a third sample is needed. This procedure is performed in men whose sperm count and motility are very limited.
REGARDING SPERM PROBLEMS.
Do the frequency of sexual intercourse, masturbation (self-gratification), and different positions during intercourse change the woman's probability of becoming pregnant by affecting the sperm?
If sexual intercourse or masturbation is performed very frequently (every day), sperm production in the testicles may be relatively insufficient and the number of sperm excreted may decrease. It has been determined that ejaculating every 2-3 days will not cause a decrease in sperm count. In case of prolonged failure to ejaculate, the vitality and mobility of sperm are negatively affected. Although there is generally no positional difference in terms of getting pregnant, the probability of becoming pregnant will increase in positions that will allow the semen to fully ejaculate into the cervix.
What is the effect of congenital testicles in the canal (cryptorchidism) on infertility?
It has been observed that if the unilateral testicle remains in the canal, the reproductive ability is preserved to a great extent. However, the sperm count in these people is still slightly below normal. If bilateral testicles remain in the canal or in the abdomen, sperm production is seriously affected.
What is the importance of sperm deformities (morphology)?
In our center, sperms are evaluated in detail according to the Kruger classification according to disorders in the head, midsection and tail structure. Especially the predominance of some forms in the head structure (macrocephaly, double head, globozoospermia) is an indication that the sperm of these men may have a high probability of failure in ICSI (micro injection) applications.
Because abnormalities have been detected in the DNA (genetic material) structure of sperms with this abnormal head structure. Therefore, people with high amounts of these sperm in their semen have a high risk of poor fertilization and embryo quality and, ultimately, not being able to get pregnant. Some defects in the sperm tail structure (short tail) disrupt the mobility of the sperm and cause infertility. The chance of success after microinjection is also low in males with frequent tail stump in morphology.
What can be done in cases related to lack or absence of sperm production?
In patients with high levels of the hormone secreted from the brain and enabling sperm production and small testicle sizes, it is possible to become biological fathers by finding sperm from the testicle and micro-injection method.
Our center achieved the first pregnancy and live birth in Turkey using testicular sperm. In the past, multiple biopsy methods were used to find sperm by randomly taking tissues from various parts of the testicle. In our center, we conduct testicular sperm research with a new surgical method under the microscope, which will be a pioneer in Turkey. In this technique, the testicle is completely opened with a single incision, the tissue is magnified 20 times with a microscope, the areas where sperm production is detected and tissue samples are taken from those areas.
Therefore, the chance of success is higher than the random method used in the past and it is possible to obtain a higher number of sperm. The patient's tissue loss is very low in the microsurgical method. This ensures minimal damage to the testicles from the operation and affects the testosterone hormone release of the testicles very little. Another advantage of the microsurgical method performed under a microscope is that the vascular structure in the capsule surrounding the testicular tissue is seen and the incision is made without damaging the vessels feeding the testicle. This minimizes possible problems after the operation.
With this method, we find sperm rates as high as 55-65% in our patients who were not successful with the old operation method and who previously had sperm deficiency due to some genetic structural reasons.
What is MikroTESE?
In vitro fertilization treatment has allowed men to have children even if there is no sperm in their semen. However, performing this procedure requires the presence of even a small amount of sperm production in the patient's testicles. In other words, sperm must be obtained from the patient's testicles. Obtaining sperm from the testicles is done using different methods depending on the patient's condition.
Testicular biopsy may be performed in men whose semen analysis does not detect any sperm. With this procedure, the reason for the absence of sperm is revealed. In other words, this method reveals whether it cannot be seen in the semen because sperm cannot be produced or whether it cannot be seen in the semen because there is an obstruction. TESE is a method used to find small sperm-producing foci within the testicle in cases with severe defects in sperm production. The presence of sperm is investigated by taking a few millimeter-sized pieces from a few foci from the testicle.
Microtesting is the process of finding sperm from tubes where sperm is produced under a microscope. With this method, there is a 36%-68% chance of finding sperm in cases that are not due to obstruction, that is, in cases where there is a problem in sperm production. With the microtese method, the chance of finding sperm in each biopsy increases with less testicular tissue. In other words, this chance is higher than the classical TESE procedure. Another advantage is that it minimizes vascular injuries in the testicular tissue area during biopsy and helps the embryologist find sperm more easily in small pieces.
Is short and tight (slip) type men's underwear related to infertility?
In general, men who wear short and tight underwear may experience infertility due to increased temperature in the testicles. However, many studies have not found any difference in sperm count and motility in men with different underwear habits.
What is the importance of hormone research in men with sperm problems?
Hormones secreted from the brain and testicles (ovaries) in men are the hormones that affect sperm production. Therefore, FSH, LH, and Total Testosterone levels should be checked. If total testosterone level is low, LH and FSH are normal, prolactin level should also be checked.
Which hormone gives information about sperm production?
FSH is especially related to sperm production. It is secreted from the brain by the pituitary gland. Its increase reflects the lack of egg production in women and approaching menopause, as well as a disorder in sperm production in men.
Being within normal limits usually indicates normal sperm production. However, as an exception, FSH may be normal and sperm production disorders may also be observed. Moreover, according to our experience in azoospermic patients, sperm can be found in microTESE even if FSH is very high. Today, there is no blood test that definitively shows sperm production. In azoospermia due to sperm production disorder, only TESE or micro TESE can be used to determine whether there is sperm production in the testicle.
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