The first diagnostic test in the male, before starting the assisted reproduction treatment, is the ejaculated semen study. Our Andrology laboratory is one of the oldest and most experienced in Spain.
The seminogram provides information related with possible clinical pathologies or alterations in the semen quality which can generate a difficulty when getting pregnant. The basic study guides us on possible infertility causes by analysing macroscopic (liquefaction, colour, volume, pH, viscosity) and microscopic characteristics (concentration, mobility, morphology, vitality and round cells).
Once we have the diagnosis, the possible treatment is discussed when necessary. If not, the complementary tests to extend the study are decided.
We usually obtain semen samples through masturbation. The Mobile Sperm Count (REM) is known as the sperm capacitation test which identifies the number of spermatozoa with good mobility that can be retrieved from a semen sample.
The two techniques used in this process are:
Swim up. The sample is washed with a specific medium to eliminate the seminal plasma and the spermatozoa are centrifuged in the bottom of the test tube so that the sperms with high mobility rise to the surface.
Density gradient. The sample is washed with a specific medium to eliminate the seminal plasma and the spermatozoa pass through different medium layers with increasing density to create several filters where the little mobility or motionless sperm are held.
Depending on the concentration value and the percentage of progressive mobility, we decide if the suitable treatment is artificial insemination, conventional in vitro fertilisation or ICSI (intracytoplasmic sperm injection) to achieve the best result and chances of success.
The current reproductive medicine provides us with techniques to obtain spermatozoa when we find ourselves dealing with a vasectomy, damaged DNA or azoospermia. Mobile spermatozoa are extracted with a simple testicular puncture, that is, directly from the testicle and not from ejaculation, with needle aspiration. It is a simple surgical intervention on an outpatient basis and does not require of general anaesthesia. It is a well tolerated process and with low risk of complications.
This surgical intervention involves a cut in the skin of the testicle of about 2-3 centimetres which will provide us with testicular tissue and therefore spermatozoa. A part of the sample obtained is applied to the reproduction treatment and the other is analysed. This procedure is done under sedation although it can also be done with anaesthesia depending on the tolerance.
The analysis of the testicular tissue allows us to know at which point of the spermatogenesis there is no more spermatozoa production and guide us to diagnose the azoospermia.