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Fertility Road Magazine 46 - September/October 2018

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  • Fertility
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The latest issue of Fertility Road Magzine brings you our latest Fertility Journeys update, a closer look at stress and infertility, natural approaches to endometriosis and a how your weight can affect your chances of getting pregnant plus lots, lots more.


MEN ONLY A F A F TESTINGryan oodward is the erson esponsible at Fertility, a new fertility clinic in eicester specialising in male fertility, and lowtech fertility treatments such as and D. ryan is coeditor of the book ale nfertility Sperm Diagnosis, anagement and Delivery’ which covers all aspect of male fertility for professionals and patients. 64 | | fertilityroadmag | follow us @fertilityroad

MEN ONLY EXPERT: Bryan Woodward When it comes to fertility problems, it is a sad fact that some GPs, will go gung-ho into investigating the female partner, whilst the male is often left on the side-lines with no investigations. As a result, he may watch whilst his wife has numerous blood tests to check her various hormone levels throughout her menstrual cycle; some women are even admitted to hospital to have their Fallopian tubes checked out, to ensure they aren't blocked, and this is all before the man has any questions raised about his fertility status Yet, nowadays, fertility problems are attributed more or less equally between the male and the female. Therefore, one of the first tests to perform for a couple who experience trouble conceiving is a semen test for the man. Please note, this is called a ‘semen test’, rather than a ‘sperm test’. Yes, we will be looking for sperm – after all we need to find sperm so that we know there is a chance of this cell fertilising an egg. However, a semen test is so much more than just looking for sperm, as I’ll explain later. To assess semen, the first step is to ask the man to produce a sample. For some, this is a simple process, over in less than 5 minutes. For others, this can be a source of great anxiety. Some men may not be able to masturbate, whilst for others the act of masturbation may be contrary to their religious belief or way of life. If this is the case, then condoms can be used, to obtain the semen sample by sexual intercourse. However, use of a condom can cause complications; firstly, it is important to check that the condom material is not toxic to sperm, and secondly, much t is a sad fact that some s, will go gungho into investigating the female partner, whilst the male is often left on the sidelines with no investigations. care is needed to ensure that the sample isn’t contaminated by any other cells during the withdrawal process, such as cells from the vagina, as these may affect the sperm. There is also the question of whether the man should produce the sample ‘on-site’ at the clinic, or whether he should produce it ‘off-site’, for example at home. Specialist fertility clinics usually have specific rooms for on-site production, although the quality of the room is variable. Oddly, the name for this room also varies, from the basic “Male production room” to the more Latin-sounding “Masturbatorium” (this word has made it into Google’s Wiktionary but has yet to be included in the Oxford English Dictionary!). There are many advantages to producing a semen sample on-site, since the environment and timing can be better controlled. Ideally the specimen container should be pre-warmed to body temperature (37C) and then placed into an incubator at the same temperature immediately after the sample is collected. Off-site production inevitably runs the risk of variations in temperature during the journey to the clinic (may be not so much in the recent summer heat-wave, but certainly in during the colder months. There is also the time-factor to consider: the semen needs to be analysed within 60 minutes of production, to ensure an accurate assessment of the swimming ability of any sperm. Many clinics will reject a semen sample if it arrives even 1 minute later, which can add to the stress for the man who produces ‘off-site’. Once the sample is safely in the andrology lab, the semen analysis can begin. The first test is to assess the colour, which optimally should be an opalescent grey. An opaquer sample may indicate a low sperm count, whereas a more yellow sample may indicate a possible infection, jaundice, or that the man may be taking some form of drugs. A reddish-brown colour usually indicates that red blood cells are present. In this case, it is essential to check how this might have been caused – was it by the masturbation process, or is the man’s natural ejaculate colour? If the latter, then further testing should be sought as soon as possible to rule out any internal problems with any of the reproductive system or the prostate. We then test the volume of the ejaculate. In 2010, the World Health Organisation (WHO) stated that the lower limit of fertility was a volume of 1.5ml. This means that if the volume of the sample is less than 1.5ml, then there could be a problem. If a man produces an ejaculate with a small volume or even no volume at all, then retro-ejaculation is a possibility. Retro-ejaculation is a condition where, at the point of orgasm, the semen passes backwards into the bladder rather than out of the penis. It should be noted that this is a rare condition, affecting 1% couples undergoing fertility investigations, and is more common in men who have had prostate surgery, suffer from diabetes, or take medication for high blood pressure. The next parameter to be tested is semen pH, a test of alkalinity and acidity. Semen is made up of secretions from various glands which support the sperm when it is deposited at the top of the vagina during intercourse. Secretions from the prostate are acidic, whilst those from other glands, such as the seminal vesicles, are more alkaline. If there is an obstruction or problem with any of the ducts, then this can affect the pH. Semen should be slightly alkaline (above pH7.2). However, sample pH increases with time from production, as the sample is exposed to air in the container. This is another reason why it is important to control the time from production to analysis. If the pH is too high, then this could indicate an infection, possibly due to decreased secretions from the prostate. The final test that is performed, before looking down the microscope, is the liquefaction and viscosity of the sample. The reason Mother Nature made semen viscous immediately after ejaculation, is to keep the semen within the vagina to allow the sperm to start swimming towards the egg. The medical term for the semen at this stage is a coagulum. If it wasn’t viscous coagulum, the semen would immediately fall out after intercourse! A normal sample should liquefy within 30-60 minutes, although liquefaction is often completed within 20 minutes. If a sample doesn’t liquefy after 60 minutes, this could compromise sperm motility, hence the importance of the test. At the same time as assessing liquefaction, the general consistency of the semen is also assessed for anything unusual, such as the presence of crystals. These could be caused by uric acid, but if crystals are present, regardless of the cause, then further investigation by a urologist is recommended, as ejaculation may also be painful. Once these ‘macroscopic’ tests (visual tests without use of a microscope) are complete, it is time to begin the ‘microscopic’ tests. he Shape of Sperm In fertile men, and even super-fertile sperm donors, the majority of sperm are not the correct shape. The WHO has put a lower limit of just 4% sperm needing to be the correct shape for fertility. The grading of each sperm follows strict criteria, and a full assessment requires the grading of at least 400 sperm. Of particular importance is detecting if a | fertilityroadmag | follow us @fertilityroad | 65

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Fertility Road Magazine 46 - September/October 2018

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