A key differentiating feature of our center is our Unit of Andrology. The figure of andrologist in a Reproduction Unit is fundamental because it improves spontaneous pregnancy rate and the performance of assisted reproduction techniques.
The cytomorphological seminogram can give us valuable information on the expectations of fertility problems and pathologies of the male genitals.
The sperm test is considered base and initial study to guide research of male infertility. Concentration, mobility, vitality, survival and morphology (shape) of the sperm is evaluated. Also appreciates the maturation of sperm nuclei and macroscopic characteristics such as appearance, viscosity, liquefaction and semen volume.
The sperm selection is to clean the seminal plasma, to remove the contamination of non-sperm cells and sperm train to be fertile and evaluate their behavior in the laboratory. The purpose of the diagnostic process is to adapt the technique of ideal selection for each ejaculation. Once defined the selection, proceed to your application, provided that the therapeutic decision will allow progress with assisted reproductive techniques. In the laboratory Fertilab, we have a number of methods to separate, as soon and effectively as possible, sperm from seminal plasma.
The evaluation period sperm survival and mobility 24 hours after ejaculation is an important indicator of its function and a non exclusive predictor of oocyte fertilization (low sperm survival rate is related to 24 hours a failure or decrease in the rate of fertilization or IVF failure. A low survival rate can also be associated with increased fragility, often related to the presence of a high concentration of sperm apoptotic (programmed aging process that leads to death cell) or with fragmented DNA.
DNA fragmentation in the sperm might account for a high percentage of cases in which infertility is undiagnosed. This fragmentation can have a major role in the failure of fertilization in the arrest of embryonic development and in non-evolutionary pregnancies. 25% of sperm with fragmented DNA determines the probability of getting pregnant through natural or assisted reproduction fertilization is less than 1%.
The sperm, like all cells, takes its nutrients from oxidation processes, by which draws power to maintain its functions. Excess oxidation produces free radicals; they cause oxidative stress which damages the membrane and consequently the fragmentation and sperm DNA break. A higher number of lesions, the lower the integrity of genetic material, and the ability to lower the chances of fertilization and pregnancy evolutionary.
There are a number of factors and conditions that can trigger oxidative stress and a high level of DNA fragmentation of sperm and therefore reduce their ability to fertilize:
• Exposure to elevated temperatures
• Increased body temperature
• Testicular swellings
• Damage caused by chemotherapy and radiotherapy
• Damage caused by exposure to toxic (mainly the consumption of snuff)
• Presence of varicocele (testicular varicose veins)
• Infections of the seminal tract
• Sleep disturbances
The presence of a high number of sperm with compromised plasma membrane and the fragmented DNA has a negative impact on fertility.
Therefore, to have a method of effective molecular filtration, magnetic separation columns sperm annexin V (MACS) able to select a population of healthy sperm is a revolution in fertility treatments. Sperm that are in the process of apoptosis, phosphatidylserine exposed (a phospholipid typically found in the cytoplasm) in the surface of the cell. Phosphatidylserine has the ability to specifically bind to the protein annexin V. If sperm incubated with Annexin V, which previously would have coupled small metal spheres, will prove to be glued to the membrane of the sperm, which have begun the process of apoptosis, proteins bound to metal spheres. Then we move the semen sample by a magnetic field in which sperm remain stuck in its metal-containing membrane, separating damaged sperm from healthy, which are free and available. Using a population of non-apoptotic spermatozoa with intact membrane and unfragmented DNA, can optimize the results of assisted reproduction techniques and become an effective therapeutic alternative in cases where there is a failure of fertilization, one low quality embryo, repeat abortions and / or unexplained infertility.
Ultrasound is a test that involves the emission of ultrasound by a probe, reflected and return in image form. The images are obtained in real time and allow us to observe the movement of organs and blood flow (Doppler). Performing a testicular ultrasound requires no special preparation. It is the first diagnostic test we do patients with testicular pain and inflammation, a palpable mass or trauma. Ultrasound is also a compulsory examination in the study of male fertility, since it allows us to immediately assess the presence of varicocele, impairment of testicular veins that are often associated with fertility problems.
Varicocele is dilation of the veins of the spermatic cord that drain testis. You may receive up to 40% of patients with infertility. It is associate with testicular discomfort. The diagnosis is made by a physical examination, although the echo-Doppler is useful, since it detects the flow Anomalous venous blood that is associated with varicocele.
In asymptomatic, or low-grade cases, it is recommended to treat varicocele, because there is evidence showing improved fertility (both spontaneous and assisted reproductive techniques). A varicocele is usually treated with surgery. It’s a simple, outpatient under local anesthesia and surgical technique, which has a very high success rate.
The deferentovesiculography is a dynamic x-ray contrast seminal duct, which can diagnose obstruction and level. It is indicated in cases of hipospermia (seminal volume under) with azoospermia and palpable vas deferens (indicative of obstruction of ejaculatory duct) or when there is a history that may indicate a possible deferential obstruction (engonal and scrotal surgery, genital tuberculosis, etc …) The seminal pathway can be blocked by any level from intratesticular in its segment to introprostatic ejaculatory duct, through the epididymis, vas deferens and seminal vesicles. The seminal duct can become blocked due to an inflammatory, genetic, traumatic, neoplastic, iatrogenic or surgical procedure (vasectomy).
Testicular biopsy is a surgical procedure to extract small tissue fragments, whether for diagnosis or for the production of sperm in cases where it cannot obtain the ejaculate study.
Diagnostic testicular biopsy is usually done to find the cause of male infertility, when the semen suggests the presence of secretory problems (sperm production) or genetic alterations.
Therapeutic testicular biopsy (surgical sperm extraction techniques): When a man produces sperm but these either by obstruction or by a genetic disorder, do not appear in the ejaculate, we can proceed to surgical obtain. Removal of the epididymis is done through technical TABLE (Microsurgical Epididimary Sperm Aspiration); if we get the testicular pulp, the technique is called TESE (Testicular Sperm Extraction).
The chromosomal analysis is used in the diagnosis of a large number of human pathologies. The numerical and structural chromosome abnormalities are associated with different aspects of pathology, including male infertility.
Infertile men may show abnormalities mating or recombination synapse meiotic chromosomes and / or alterations in the chromosomes of the resulting sperm. For this reason, analysis protocols of male infertility include cytogenetics of meiosis in testicular tissue samples and / or studies of fluorescence in situ hybridization (FISH) of sperm in semen samples. It should always study the karyotype and in some cases, will also be necessary the screening chromosome microdeletions and cystic fibrosis.
Every day more increases the number of diseases caused by genetic abnormalities. In some of them you can identify the gene altered for later identification in the embryo (PGD – Preimplantation Genetic Diagnosis) and select embryos free of alteration to ensure healthy offspring that can not suffer or transmit the disease in question.