We are a research clinic and have dealt and successfully treated thousands of cases of male infertility over the last 26 years.
Infertility is not that affects only women, men are also equally affected. Among infertile couples, 40 percent of the male partner is either the sole factor or a contributing factor to infertility.
Male infertility is caused by some problem in the male, due to which he is unable to deposit normal, healthy, sperms, in sufficient quantity in the female reproductive tract to fertilize the eggs.
Andrology is the science of the male reproductive system associated with reproduction only.
In recent times Andrology has grown in response to the need to help infertile couples along with the development of laboratory technology and research facilities. The diagnostic tests available to the clinician are:
A semen analysis is a set of tests which tells is about the sperms and the functioning of accessory glands. It is routinely done to help evaluate male fertility. Some of the parameters routinely looked for male fertility are:
Sperm count= Sperm concentration x semen volume
Sperm count in million is directly related to pregnancy rate, and hence an important indicator of male fertility. With the advent of ICSI, this parameter has lost some of the significance in IVF procedures. WHO has lower limit of 20 million sperms for normal fertility.
A lower sperm count is termed oligozoospermia Near complete absence of sperm is termed azoospermia
The WHO has a value of 50% and this must be measured within 60 minutes of collection. But if the total count is less than twenty million but high motility the fertility is considered good.
A more specified measure is motility grade, where the motility of sperm are divided into four different grades:
Morphology is a good predictor of success in fertilizing ability of oocytes during in vitro fertilization. Up to 10% of all spermatozoa have observable defects and as such are disadvantaged in terms of fertilizing an oocyte. Some of the sperm abnormalities are shown below.
Also, sperm cells with tail-tip swelling generally have lower frequency of aneuploidy.
A motile sperm organelle morphology examination (MSOME) is a particular morphologic investigation where a special microscope is used to magnify the sperm to X6000 to look for sperm large vacuoles, which indicate sperm chromatin immaturity.
According to WHO guidelines on semen analysis the semen volume varies from 1.5 ml to 4.0 ml. Semen volume less than 1.5 ml may indicate partial or complete blockage or absence of seminal vesicles.
Semen normally has a whitish-gray color. It tends to get a yellowish tint as a man ages. Presence of blood in semen (hematospermia) leads to a brownish or red colored ejaculate but it is a rare condition.
Some other causes of different color may indicate sexually transmitted diseases.
Fructose level in the semen may be analyzed to determine the amount of energy available to the sperm for moving. Fructose level of 13 u mol is considered normal. Absence or very low levels may indicate some problem with seminal vesicles.
WHO specify normal pH as 7.2-7.8 a neutral acidity . An acidic or low pH semen may indicate one or both seminal vesicles are blocked. A basic semen (high pH) may indicate some infection. Any difference in pH from normal range affects the egg penetration ability of the sperm.
The liquefaction is the process when the gel-like semen, is liquefied by enzymes in the semen.
It normally takes nearly 20 minutes for a semen sample to liquefy. A liquefaction time within 60 minutes
is regarded as within normal ranges.
MOT is a measure of how many million sperm cells per ml are highly motile at room temperature. This is a combination of both sperm count and motility. So for Intra-cervical insemination 0.5 ml volume should have 20 million motile sperms.
In WHO terms, it is thus recommended to use approximately 20 million sperms for IUI.
DNA damage in sperm cells is related to infertility and can be probed by analysis of DNA susceptibility to de-naturation in response to heat or acid treatment and/or by detection of DNA fragmentation revealed by the presence of double-strand breaks detected by the TUNEL assay.
Total motile sperms can be calculated by multiplying sperm count, motility and volume. It tells us how many motile sperms are present in a ejaculate.
Use of approximately 20 million sperm of motility grade C or D in ICI, and 5 million in IUI is an approximate recommendation.
Abnormalities:
An antisperm antibody test which looks for special antibodies that fight against a man’s sperm in blood, vaginal fluids, or in the semen. The test is based on sperm agglutination when blood or vaginal fluid or semen is added to diluted sperms. Semen can cause antigen antibody response either in man’s or women’s body.
The sperm penetration assay (SPA), “hamster egg penetration test” (HEPT), is a in vitro test to
find the functional ability of the sperm to penetrate the human egg. This test is based on the ability of capacitated human sperm to penetrate zona free hamster eggs in vitro.
This test is superior to seminal fluid analysis in predicting both fertility and infertility. This test has application both clinically and experimentally.
This test is a diagnostic test to find the tight binding of sperm and zona pellucida of the egg to find fertilization ability of the sperm. This test is an excellent test to predict the outcome of IUI and IVF. So this test is very relevant as a diagnostic test for infertility.
There are a few more techniques which are used for improvement in semen storage and fertility treatments.
Sperm washing is a procedure for separation of sperms from the semen. These washed sperms are used in IUI, IVF and ICSI.
It is another procedure which involves the separation of healthy motile sperms for IVF-ICSI.
A frequently employed procedure is cryopreservation of sperms where the sperms are washed and stored in straws or vials for subsequent use in IUI, IVF or IVF-ICSI.
The andrology laboratory is a support service to a practitioner, a urologist and a reproduction specialist. With state-of-the-art technology, physicians are better able to address infertility, minimize patient distress and provide patients with reasonable options.
| We performed our first sperm retrieval procedure in 1994. Since then we have been performing these procedures over the last 26 years and have more than 11000 babies in 55 countries |
Sperm harvesting is different from a diagnostic testicular biopsy because, in this case, the aim is to find sperms in a patient who has no sperms in the ejaculate (azoospermia). In such patients the sperms have to be harvested directly from epididymis or testis.
There are several different procedures to retrieve sperms, depending on sperm production and blockage.
The simplest and most cost-effective procedure is sperm aspiration. This is performed under local anesthesia and takes approximately 10 minutes
The procedure is performed by inserting a needle with a syringe in the testis and aspirating fluid and tissue with negative pressure. The procedure, can be performed under local anesthesia, by any Obstetrician-Gynecologist in a operating theater or office setting. The procedure is generally coordinated with the female egg retrieval. TESA is performed for men with obstructive azoospermia (s/p vasectomy).
Some times TESA doesn’t provide enough tissue/sperm then an open testis biopsy is needed for sperm retrieval.
TESE is a little more complicated than TESA. It is a surgical procedure similar to testicular biopsy. It has to be performed by trained surgeon. There has always been debate, as to which procedure is “better” for obtaining sperm for successful intracytoplasmic sperm injection (ICSI). MicroTESE has replaced this procedure as the optimal form of sperm retrieval for men with no sperm in their ejaculate from a problem with production.
PESA is a procedure for men with obstructive azoospermia, due to vasectomy or infection. This procedure is done under local anesthesia in operation theater or in the office setting coordinated with egg retrieval of the female.
Micro TESE is a procedure performed on men who have problem with sperm production and are azoospermic. Micro TESE is performed in the operating room under general anesthesia with the help of operating microscope. Micro TESE is coordinated with the female partner’s egg retrieval. Micro TESE has significantly improved sperm retrieval rates in azoospermic men, and is also a safer procedure since less testicular tissue is removed. Patients can also opt for cryopreservation of sperm during this procedure for future IVF/ICSI.
It is a procedure performed for men who have vasal or epididymal obstruction including vasectomy, congenital bilateral absence of the vas deferens. It can be done as a scheduled procedure or is coordinated with their female egg retrieval. MESA is performed in the operating room under general anesthesia utilizing the operating microscope. Patients can cryopreserve sperm during this procedure for future IVF/ICSI. it is a preferred method of retrieval of sperms for with congenital bilateral absence of the vas deferens.
| We at Delhi IVF provide comprehensive andrology services for the treatment of male infertility. We provide andrology consultant and a state of the art laboratory to deal with factors causing sexual and infertility problems such as Erectile dysfunction, hydroce nle, Retrograde ejaculation, Varicocele etc. |
Feeling very happy to have this type of experience. Just because of (IVF) we got twince babies in our life. Thanks you so much Dr. Anoop Gupta and his team. Thanks
First of all thanks to Delhi IVF centre & it’s all staff to bring happiest moment of our life. We feels proud every time we are here. One of the Best IVF centre I have visited ever. Staff is very co-operative. If someone will ask for IVF centre reference then definitely my answer will be Delhi IVF centre.
मेने डॉ. साहब का दिल से धन्यवाद करती हूँ क्यूंकि डॉ. साहब की कोशिश से हमारा सपना पूरा हुआ है | मुझे एक प्यारी सी बेटी की माँ बनने का सपना पूरा हुआ | मै बहुत खुश हूँ
We are so happy for the treatment of Dr. Gupta. We have so many problem in India before I tried many hospital for my wife and i found Delhi IVF. Thank you so much to the all team everyone was friendly with us. All the best for everyone.
I had the opportuned to see you early this year as regards my infertility problem and i am proud to inform you that i was delivered yesterday by C-section of a healthy 3.2 kg baby girl!!!! Many thanks to you, your lovely wife Dr. Alka and your dedicated management team. May God continue to bless you and the works of your hand.
Dear Dr. Anoop Gupta, & Team Greetings !!! Thanks You Once Again for changing our lives with your professional team and today we are living a happy and contented life as we got a gift with your efforts and medicines and our little Baby Girl Aaira was born on 20th February 2017 and our Family in now complete. My another friend Mr. Amin has shown his interest to visit your clinic and he wants to meet you and he has a great desire to have his treatment in your clinic.
Dear Dr. Aastha, Dr. Gupta and Team Hi from italy… I am so happy today Really want to thanks you. You’re so wonderful I had laparoscopy fibroid surgery few months ago. I went to see my doctor here in my country today and all my fibroids are gone. You have a done my surgery so sincerely you’re such a good human being can’t thank you enough I am so happy i had 2 surgeries earlier here in my city and both times I didn’t get better and it was the same. Now I am so happy May God Bless you
After long time my wishes fulfill. Thanks to Delhi IVF & Dr. Anoop Gupta & his team for giving me & my husband such a beautiful gift. Thank you very much.
Feeling very happy to have this type of experience. Just because of (IVF) we got twince babies in our life. Thanks you so much Dr. Anoop Gupta and his team. Thanks
Thank you to Dr. Anoop and his incredible team at Delhi IVF for bringing this bundle of joy to our family after a very long time.
