Microscopy

Computerized Semen Analysis (CSA)

The semen analysis includes a determination of semen volume, pH, color, viscosity, sperm concentration, total sperm count, percent motility, velocity, linearity, and morphology. Our CASA system is among the most technologically advanced systems and yields far more accurate, quantifiable results than manual methods.

Hypo-osmotic Swelling (HOS) Test

The ability of the human sperm tail to swell in the presence of a hypo-osmotic solution is a sign of membrane integrity and normal functional activity. HOS is correlated to the in vitro fertilizing ability of the spermatozoa and is a useful addition to the standard semen analysis.

Leukocytospermia Quantitation/Endtz Test

The presence of high numbers of white blood cells (WBCs) in semen has been associated with male factor infertility. WBCs can be quantitatively estimated by the Endtz test. The Endtz test also allows clear differentiation of WBCs from other immature germ cells in semen.

Strict Criteria Morphology Classification

Data indicates that normal sperm morphology is a significant predictor of pregnancy in vitro fertilization. We offer sperm morphology assessment with a modified method of strict scoring criteria. This determination is performed by our experienced laboratory personnel. It is a valuable aid in the evaluation of the infertile male.

Sperm Processing

* Tests marked with an asterisk require an appointment. All other tests do not.

Diagnostic Sperm Wash*

A diagnostic sperm wash can be ordered for a patient who has been selected for intrauterine insemination using the male partner’s semen sample. This procedure includes a prewash semen analysis and sperm washing by two different techniques. The ejaculate is divided into two equal aliquots and processed by swim-up and density-gradient techniques, yielding more accurate results than previously possible and also provide recovery rates with the two techniques. The results of this procedure will help decide whether swim-up sperm wash or density-gradient sperm wash is the best possible sperm-processing technique for each couple.

Swim-up Sperm Wash*

The swim-up method results in sperm fractions with improved motility and numbers adequate for conception, as well as a more consistent uniform morphology, free from seminal debris. The main advantage of a swim-up method is that high percentages of motile sperm can be recovered. However, the recovery rate of total motile sperm is low, especially if the initial motility is low.

Density-Gradient Sperm Wash*

The density-gradient separation method concentrates highly motile, viable and morphologically normal sperm in a small volume of fluid. Separated samples are free of seminal plasma, leukocytes and other debris. The density-gradient method is especially useful for cases in which normal wash and swim-up procedures may yield an insufficient number of sperm for clinical use.

Sperm Antibody*

Immunological analysis is an important part of the evaluation of infertile couples. Indications for testing may be a poor post-coital test, sperm agglutination, poor sperm motility, or simply overall unexplained infertility.

Direct MAR Test*

A patient’s semen specimen can be tested for the presence of antisperm antibodies by a MAR binding test, which detects IgG or lgA classes of antibodies that may be present on the surface of the sperm.

Semen Biochemistry

Fructose Test

Fructose is normally present in all semen specimens. The absence of fructose could indicate congenital bilateral absence of the vas deferens or bilateral ejaculatory duct obstruction. A qualitative measurement of fructose can be performed.

Sperm Function Tests

* Tests marked with an asterisk require an appointment. All other tests do not.

Hypo-osmotic Swelling (HOS) Test

The ability of the human sperm tail to swell in the presence of a hypo-osmotic solution is a sign of membrane integrity and normal functional activity. HOS is correlated to the in vitro fertilizing ability of the spermatozoa and is a useful addition to the standard semen analysis.

Semen oxidative stress profile

This consists of three advanced tests conducted to evaluate levels of reactive oxygen species, total antioxidant capacity and Sperm DNA fragmentation.

Reactive Oxygen Species (ROS)

Free oxygen radicals, called reactive oxygen species (ROS) are unstable substances and can cause damage to the spermatozoa. A small amount of ROS is needed for successful sperm-egg fertilization. Normally, antioxidants present in seminal fluid neutralize any increased production of ROS. However, in case of infection or some other clinical conditions such as varicocele, significant amounts of ROS can be generated. This increased ROS can damage the normal spermatozoa in semen. Levels of ROS can be measured using a chemical probe that reacts with the free radicals. This test may be ordered in the presence of high numbers of round cells in semen due to infection, idiopathic infertility, or in the presence of a clinical varicocele.

Total antioxidant capacity test Free radicals attack all cells and can damage lipids, proteins and sperm DNA, resulting in onset of a variety of diseases. Living organisms have developed a complex antioxidant system to counteract the harmful effects of free radicals and reduce damage. A balance between the amounts of free radicals produced and the antioxidants available is therefore important. A shift in this balance results in a decrease in the available antioxidants or increase in free radicals and is undesirable. This imbalance results in oxidative stress. Data suggest that antioxidant concentrations are significantly lower in patients who have increased levels of reactive oxygen species and this may cause oxidative stress. The test utilizes fluid obtained after spinning a semen specimen that has been stored at -20˚C.

DNA fragmentation test

Intact genetic material, or DNA, is important for healthy fertilization. A morphologically normal looking motile sperm can have DNA damage. DNA damage to the sperm can result in impaired fertilization, miscarriage or subsequent complications associated with pregnancy. DNA damage can be examined by TUNEL staining and a technique called flow cytometry. The test involves the freezing of a small number of sperm and batching them. Based on the extent of DNA damage found, certain assisted reproductive techniques may be recommended.

Sperm Banking and Long-Term Storage by Cryopreservation

* Tests marked with an asterisk require an appointment. All other tests do not.

Cleveland Clinic’s Sperm Bank program was established in 1980, making it one of the first established facilities of its kind in the Cleveland area. We offer members of the medical community and their patients’ comprehensive services and a reliable system for the long-term preservation of human semen, epididymal aspirate or testicular tissue.

Therapeutic Patient Sperm Banking*

The Cleveland Clinic Sperm Bank may be used to store frozen semen specimens for patients of reproductive age who have been diagnosed with testicular carcinoma, lymphoma, Hodgkin’s disease, or any other disease that requires gonadotoxic treatments such as chemotherapy, radiation therapy or transurethral resection.

Frozen semen specimens may be stored prior to a vasectomy to allow the participant the option of future insemination.

Ovarian tissue cryopreservation

Women who are undergoing treatment for cancer and are in the reproductive years have the option of freezing their ovarian tissue at the time of surgery and the procedure is done under IRB guidelines. Frozen tissue can be stored long term and transplanted back at a later time if the woman is interested in having children.

Testicular tissue freezing

Men who do not have sperm in their ejaculates can undergo a surgical procedure to remove small pieces of testicular tissue. At the time of surgery these tissues are examined for the presence of sperm. The tissue can be frozen and later used to obtain sperm that can be used for fertilization using advanced reproductive techniques. In this technique, called intracytoplasmic sperm injection, a single sperm is needed for fertilization.

Out-of-Town Specimen Shipping

Patients have the option to come to our Sperm Bank from outside of Ohio. Cryopreserved semen specimens can be prepared for shipping to out-of-town facilities. A letter from the patient’s physician requesting transfer of his specimen is required.

To Refer Patients

To refer a patient to Cleveland Clinic’s Andrology Laboratory and Reproductive Tissue Bank, please call 216.444.8182 or toll-free 800.CCF.CARE (223-2273), ext. 48182. Although we cannot take telephone calls on the weekend, selective testing is performed Saturdays and Sundays for patients’ convenience.

You will receive a report concerning your patient by mail, generally within one week of testing. Results of some tests can be sent by fax or email to your office on request within 24 hours. Questions?

For more information or to schedule a laboratory appointment, please contact us:

Phone: 216.444.8182 or 216.444.3019

Fax: 216.445.6049

Online: clevelandclinic.org/urology

Reviewed by a Cleveland Clinic medical professional.

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