Question: I am 38 years old with age-related infertility (at least that is what my doctor, a Reproductive Endocrinology and Infertility Specialist (REI), thinks). It has been suggested that I undergo super-ovulation with injectable Follicle Stimulating Hormone (FSH) along with intrauterine insemination. I really don’t want to have twins, if possible, and certainly not triplets or more! But ideally, I would like to have more than one child. Even if I am successful in having one baby now, I am worried about trying to have a second child when I am 40 or more. What do you suggest?

Answer: We agree that having one baby at a time is the safest thing for you and your family. However, undergoing FSH super-ovulation is intended to create more eggs in one cycle in order to increase the odds that one or two will fertilize and implant. This helps to overcome the relative inefficiency of conception for women in their late 30’s. The risks are as you stated, twins or more. Luckily, the risks that a woman undergoing this treatment will get triplets or more is really fairly low – on the order of less than 10% of all pregnancies, with careful monitoring. The risk of twins is higher – on the order of 20% of such pregnancies.

If a woman at 38 years old has no identifiable cause for infertility, the goal is usually to get 3-6 follicles. Most of the time, if the treatment is successful, the pregnancy will be a singleton pregnancy (one baby). Your issue of wanting to have a second child and concern for difficulties beyond age 40 is a real one. You may want to discuss with your REI the option of in vitro fertilization. If your doctor thinks you may be a good responder to fertility medications, you could have extra embryos to freeze, which provides some back-up and allows you to preserve some embryos from 38 year old eggs for down the road.

Patients contemplating conception must consider lifespan expectations as part of their decision on whether to conceive. Such considerations are not, however, a reason to withhold treatment, and are ultimately the individual and family should decide.

– Dr. Carolyn Givens

Question: We hope to have embryos left after transfer and need to consider storage. Can you help us understand what determines your storage fees?

Answer: Many Pacific Fertility Center patients have surplus embryos at the end of their IVF cycle. If you chose to freeze your embryos, you will need to consider how long you plan to store the embryos before being used for a frozen embryo transfer. Patients who are finished building their family, but are not interested in destroying the surplus embryos, may choose to freeze them, offer them for adoption or donate them to research. These options are included on the consent forms, which must be signed prior to transfer.

Once you choose to freeze embryos, you need to factor in the annual storage fee. Pacific Fertility Center strives for lower fees, but must be able cover the underlying costs of services. Storage fees include expenses from the following sources: storage tanks, liquid nitrogen, leased floor space, embryologists and staff hours, equipment maintenance, annual inventory, information dissemination, forms, billing, legal fees and liability.

Let’s begin with the storage tanks themselves. At PFC we have 3 state-of-the-art embryo tanks: two tanks hold a total of 1376 spaces each. Every one of these spaces can hold up to 5 straws of embryos and each straw holds 1 to 3 embryos. These two tanks are full. Recently, we purchased another, larger tank, which holds almost 1500 patient spaces. This tank is already almost half full.

Once these tanks are filled with liquid nitrogen, they are extremely heavy. Because of their weight, they cannot be clustered together in the same room, but must be strategically placed to spread out the weight over the center’s floor. In addition, they must be stored in a secure, locked location. Every time we add a tank, an appropriate new space must be located. With square footage at a premium, this is not an easy task.

Storage tanks must be monitored. Gauges and seals must be functioning and the temperature must be kept at the optimum level with the addition of liquid nitrogen. The tanks are fitted with an alarm, which sounds if there is a problem. This alarm automatically sends an alert to the embryologist on call 24 hour a day, 365 days a year.

All embryo straws are labeled and a file is maintained for every patient who has embryos in storage. This extremely important aspect of storage is taken very seriously. A thorough inventory is completed every year. This is a time-consuming process as every straw must be located and identified. Patient addresses are kept up-to-date and confirmed annually when the invoice is sent or when patients notify the center of an address change.

If patients fail to notify us of a move and/or abandon their embryos, we make every effort to locate them. When they repeatedly fail to pay their invoice, we may be forced to send their billing on to a collections agency. During this process, we continue to store their embryos. As a last resort, we will go before a judge, show proof that we are unable to contact the patient after multiple attempts over a reasonable period of time, and request permission to discard the abandoned embryos.

One of the most frequently asked questions is “When am I going to be billed?” You will be billed based on the month that your storage begins. Patients often forget they have a back-up sample of frozen sperm and are “surprised” when they receive an invoice indicating they must pay their storage fee.

PFC is always available to answer any questions you may have regarding the storing of your embryos and sperm. For disposition questions, please contact Alexis Von Austin, Tissue Bank Manager at (415) 249-3636. For questions regarding an invoice, please contact Rosemarie S. Tagle, Billing Supervisor at (415) 249-3651.

Question: How do I decide which one of your “Shared Risk” plans is best for me?

Answer: It is estimated that there are approximately 2 million infertile patients in the US. Approximately 1.5 million will seek treatment. Of these, about 750 K conceive with standard treatment and 750 K remain infertile. Of the 750 K who remain infertile, 50 K adopt, 50 K undergo IVF, and 650 K drop out of treatment. Only about ¼ to ¹/3 of infertile patients see a Reproductive Endocrinologist; most patients are only treated by gynecologists. The remaining ¹/3 don’t seek treatment because they believe that they can’t afford it, and ¹/3 don’t proceed to adequate treatment secondarily to financial barriers.

Given these daunting statistics, we understand that it is important for IVF clinics to help maximize access to all levels of fertility care, by sharing the financial burden and the risk of an IVF cycle. With these goals in mind, PFC offers two “shared risk” financial plans to our patients. We call our two plans: the Refund Plan and the Option 2 Plan.

When engaged with you in a shared risk plan, we are indicating that if you meet the appropriate medical criteria, we feel confident that we have a reasonable chance to help you achieve your goal of parenthood, and we are therefore willing to share in the financial risk associated with IVF. Sharing in the financial risk of treatment is a statement of confidence in our ability to help you overcome infertility.

As physicians, we are often asked by our patients to recommend a financial plan. Each patient’s case is different, and choosing the best plan for you has to do with your own comfort level in taking financial risk, dovetailed with your emotional comfort and commitment to treatment. These levels of comfort can only be addressed on a personal and individual level.

Some general questions to consider in analyzing the plans are the following:

• • What are your estimated chances of success with your fresh embryo transfer?
• • What are the chances of having any frozen embryos?
• • What are your estimated chances of success with your frozen embryos?
• • If you are not pregnant with this IVF cycle, would you want to proceed to another IVF cycle?
• • If you do not become pregnant after a treatment cycle, would you rather receive a refund and then decide on the next steps for treatment?

Depending on the answers to these questions, you can begin to define which financial plan may make the most sense. For patients who want some financial buffer if their cycle is not successful, the Refund Plan may be the best choice. It allows you to receive a refund and then decide if the next steps will be to do nothing more, to continue treatment, or to use the refund for other options such as adoption. For those who are ready to commit to a second IVF cycle attempt if the first cycle is not successful, the Option 2 Plan may be the preferred choice. This plan provides the option of 2 cycles for only a little more cost than a single cycle. In general, the Option 2 Plan is for those whose chances of having frozen embryos is less—making the probability of needing a second fresh IVF cycle greater. At PFC, we have two financial coordinators dedicated to providing all the information about costs which can then help you to make these important decisions.

As in any financial decision, there is no right or wrong answer, but only an answer which best fits your particular situation. This decision is then matched with your personal comfort level in sharing risk. For some patients, neither of these plans may seem appealing, and the Single Cycle Plan (pay for services as provided) will be most appropriate. For patients with insurance coverage for IVF, the Single Cycle plan is the only option.

While Pacific Fertility Center can not choose a financial plan for you, if you need more information about your specific fertility situation before deciding on a “shared risk” plan, please do not hesitate to discuss this with your physician or your financial coordinator.

– Dr. Isabelle Ryan

Question: I am an OB/GYN in the bay area and I have a patient that is interested in having a baby girl. She asked about “sperm spinning” as a method of gender selection and whether it would be useful in her situation.

Answer: Our office receives a lot of questions from patients and members of the public about sex selection. Our location in the very liberal San Francisco may be cause for the increasing demand we see in having a baby of a predetermined gender. People are also well informed about what can be achieved with modern technology, and since sex selection is a reality, there’s definite demand for it.

The procedure that you ask about, “sperm spinning” is better known in the medical and scientific communities as the “Ericsson Method”. The technology was developed by the German scientist Dr. Ronald Ericsson and has been licensed in the US and internationally since the early 1970′s. It takes advantage of the fact that sperm bearing a Y chromosome (that would make a boy) are very slightly lighter than X-chromosome bearing sperm (that would make a girl). The distribution of X and Y bearing sperm in a normal sperm sample is equal, but Ericsson’s method uses gentle centrifugation of sperm through a slightly viscous fluid to segregate the heavier (girl) sperm from the lighter (boy) sperm. Since the difference in the weight of the 2 types is so slight (about a 3% difference in amount of DNA), a perfect separation cannot be achieved. Ericsson’s website (www.childselect.com) claims a 78-85% success rate in couples seeking a boy and a 73-75% success rate for girls. At PFC, we do not endorse or recommend this method of sex selection, nor can we verify the above success rates. As far as we know, couples availing of sperm spinning are not given details of how well purified their samples are prior to using them for insemination.

A more reliable method for separating sperm in our opinion is the “Microsort” technique offered at the Genetics and IVF Institute (www.givf.com) in Fairfax, Virginia. The technique was developed originally by Dr. Lawrence Johnson at the US Department of Agriculture, and was later refined for use in humans in collaboration with GIVF. Microsort also takes advantage of the small difference in DNA content between “boy” and “girl” sperm. The sperm are dyed with a stain that binds to DNA and then an instrument called a flow cytometer can effectively separate populations of sperm based on how much dye they have incorporated. The Microsort scientists test a small aliquot of every separated sample to determine the exact enrichment that they have achieved. According to the latest figures posted on their website (microsort.net) the average enrichment for X-bearing sperm is 88% with 91% (525/574) of babies born being female. The technique is less effective for Y-bearing sperm with an average sample purity of 73% and 76% (127/152) of babies born being male. Bear in mind that the figures for babies born might be distorted since some patients may have terminated pregnancies that were not the gender that they were seeking. You may also have noticed from the GIVF data that there’s more demand for girls than boys. This is likely due at least in part to the fact that X separations work much better and therefore may be used more, but Dr. Ericsson’s website also claims a much stronger female demand even though his technology supposedly works better for boys. We do support the use of Microsort sperm here at PFC but there are limitations on the use of this technology. First, the sperm can only be separated in 2 laboratories in the US, (Fairfax and Huntington Beach in southern California), and the Microsort researchers prefer that you attend in person to give a fresh sperm sample. Second, the technology is currently only offered under an FDA approved clinical trial, and you have to be doing family balancing or trying to avoid a sex-linked disease in your family to be enrolled. For most people, unless you already have a child of a different gender from the one you are seeking, you won’t be able to participate in this FDA study.

Last, but not least is preimplantation genetic screening (PGS) that can be used to tell the sex of embryos created during in vitro fertilization (IVF). We feel that this technology is the most accurate of the sex determining strategies since there’s less than a 3% chance of a misdiagnosis. Embryos generated in an IVF cycle are subject to a biopsy procedure on the third day of growth that allows a single cell from the embryo to be analyzed to see if it has 2 X chromosomes (female) or X and a Y chromosome (male). IVF with PGS is the most accurate method for sex selection, but also the most involved and the most expensive. The Ericsson method is the easiest and the cheapest, but carries a greater risk of being inaccurate.

Joe Conaghan, PhD

Question: I had two elective abortions more than 10 years ago and I am worried that somehow that has something to do with the infertility I am now experiencing. Could the abortions be the reason I am now having trouble conceiving?

Answer: Most elective pregnancy terminations are done in the middle of the first trimester and are relatively simple, uncomplicated procedures. There is no reason to automatically assume that abortions have anything to do with subsequent infertility. Unless there is an infection, excessive bleeding requiring a second procedure or some other complication, the uterus and fallopian tubes should not suffer any long-term damage. On the other hand, any uterine procedures associated with prolonged bleeding or infection can lead to minor or major scarring of the uterine cavity or the fallopian tubes.

A mid-cycle ultrasound, just before ovulation, should be able to verify that your uterine lining is adequately thick and free of scar tissue. Also, a hysterosalpingogram (HSG) can detect uterine scarring or any obstruction of the fallopian tubes. Even if there is any scarring, which is unlikely, a simple procedure called operative hysteroscopy can often remove the scar tissue effectively. Only the most severe cases would require the use of a gestational carrier (surrogate).

Many, many women have had prior elective abortions and go on to have uncomplicated pregnancies. Women suffering from infertility often also suffer feelings of guilt about prior terminations. Some even think they are being punished for having elected to terminate a pregnancy. This thinking is irrational and is best replaced with positive thinking and a healthy attitude towards the future. This allows them to be active partners in the process of overcoming infertility.

Carolyn Givens, MD

Question: I’m a heavy coffee drinker, consuming five cups per day. I’m concerned that my addiction to caffeine will hurt my chances of getting pregnant. How much caffeine is acceptable?

Answer: Moderate caffeine intake for women trying to conceive is acceptable. As a general guideline, women trying to conceive should limit intake to 3 cups of coffee (or 300 mg of caffeine) per day (Organization of Teratology Information Services (OTIS) 2001). Results from large published studies have not demonstrated that moderate caffeine intake adversely affects fertility (International Food Information Council (IFIC) August 2002). Furthermore, caffeine consumption has not shown to have an impact on fertility or birth defects for the male partner or sperm donor (OTIS 2001).

For women who are pregnant, there have been several studies analyzing the affect of caffeine and pregnancy with the conclusions of those individual studies being mixed (IFIC August 2002). Keep in mind that if you are pregnant or breastfeeding, the caffeine you consume may transfer to the infant. As such, guidelines for caffeine intake of pregnant or breastfeeding women are a little more rigid. The recommendation by OTIS and Motherisk is that consuming less than 1½ cups of coffee (or 150 mg of caffeine) per day is not likely to increase the chances of miscarriage or a low birth weight baby. The American Academy of Pediatrics states that: “no harm is likely to occur in a nursing child whose mother drinks one cup of coffee a day.”

For more information on the affect of caffeine on fertility, visit the National Toxicology Program-Department of Health and Human Services website. The website provides a more detailed look at some of the clinical studies referenced above. Additionally it provides a chart showing the levels of caffeine in certain food and drinks. This information is available at: http://cerhr.niehs.nih.gov/common/caffeine.html.

– Eldon Schriock, MD

Question: Can I collect my sperm sample at home?

Answer: Yes, sperm samples can be produced at home and brought into our office provided that you follow some simple guidelines. Most importantly, the instructions for producing a sample must be followed as if you were producing a sample in one of the two dedicated rooms in our office. You should shower in the morning and wash the genital area with soap and then rinse with plenty of water. Most of the samples we receive are produced by masturbation and you should be careful to wash your hands immediately before and after the collection. If you need lubrication and/or a condom to produce the sample, these must be supplied by PFC. Most condoms and commercially available lubricants are toxic to sperm in some way, but we can supply you with materials that we have tested and that we know do not kill sperm. You can take them home if that’s where you’ll produce your sample. Similarly, we must provide the container into which you will collect; again to ensure that it is sperm friendly.

The most important part of producing the sample at home is getting it to our office within 60-90 minutes of collection. Your semen sample contains sperm but also many enzymes that are important in the natural process of reproduction. One part of your reproductive tract, the seminal vesicles, produces enzymes that coagulate the semen immediately upon emission. This allows the viscous sample to remain within the vagina, a process that might be an evolutionary vestige of the copulation plugs that are seen in other mammals and that prevent the female from mating with a second male. Within 5-20 minutes however, other enzymes in the semen (this time from the prostate gland) liquefy the clotted semen, liberating the trapped sperm so that they can enter the cervix. Sperm in the first fraction of the semen are bathed in prostatic secretions and have better motility and survival than sperm in latter fractions which are bathed in vesicular fluid, since the seminal vesicles emissions are last in the ejaculatory sequence. This is why we always ask if any part of the ejaculate was lost during collection. If the first few drops of semen don’t get into the collection cup, we may have lost the best sperm and we may underestimate the quality of your sample.

All of these enzymes in the semen make it a hostile environment. Sperm trapped or left in semen will die relatively quickly, but sperm washed out of this enzyme bath can survive easily for 4 or 5 days in the laboratory. Semen can also cause uterine contractions, which is why we have to process sperm samples and remove it before performing your intra uterine insemination. Getting your semen sample to the laboratory within 60-90 minutes of collection allows us to assess your sperm before the enzymes can do any damage.

It is important that you have an abstinence period of at least 48 hours but not more than 7 days before giving us a sample. Samples produced after 2 days abstinence will usually have the highest numbers of motile sperm with the greatest forward velocity, when compared to samples produced after shorter or longer abstinence. Waiting too long between ejaculates is the biggest mistake we see, possibly because some men think that they can save all their sperm for the day of their big test. However, older sperm begin to die if ejaculations are infrequent and we see the percentage of live sperm decrease with increasing abstinence. Also, please remember that abstinence means no ejaculation, not just no intercourse!

Once your sample has been collected, it is important to avoid exposing it to extremes of heat or cold before bringing it to us in the laboratory. Don’t put it in the refrigerator while you take a shower. Don’t leave it on your dashboard in the sun while you pick up your dry cleaning. And don’t leave it in the glove compartment, forget about it for a week, and then deliver it to the lab. The sample will be fine at room temperature, and you don’t have to break the speed limit in trying to get it to us.

You will need to have made an appointment with us so that we know you will be bringing in a sample, and when you arrive in our office, a member of our staff will check your specimen in. We need to be sure that it is labeled properly and we will get some details from you regarding your abstinence period and how and when you produced the sample. And we will check your identification (usually your driver’s license). This last step is important in establishing the identity of the sample and is part of a “chain of custody” procedure that we use with all samples passing through our facility. We will examine and if appropriate, process the sample within 30 minutes of receiving it, or immediately if the sample is already 1 hour old. Hopefully we won’t be calling you to say that we need to repeat the test!

– Joe Conaghan, PhD, HCLD

Pacific Fertility Center Team
Left to Right: Front: Philip Chenette, MD, Isabelle Ryan, MD, Carolyn Givens, MD
Back: Joe Conaghan, PhD, Carl Herbert, MD, Eldon Schriock, MD

Question: My doctor says I have blocked tubes. What causes this and what treatment options are available?

Answer: A blocked fallopian tube is a common cause of infertility. The fallopian tube is the harvester of the egg, floating over the surface of the ovary, picking up the egg after it is released. Sperm meets the egg in the outer one-third of the tube. If the tube becomes blocked, the egg may not be picked up, the tube may not transport sperm, and pregnancy will not occur.

Tubal blockage can occur from infection, such as chlamydia, gonorrhea, appendicitis, or tuberculosis, from an abnormal pregnancy, an ectopic pregnancy, or from surgery, as in a tubal ligation, when the tubes are intentionally tied to prevent pregnancy.

New easier procedures have been developed to improve pregnancy rates in women with tubal blockage. In the past, surgery was performed to fix the fallopian tubes, but these procedures are now rare. Today, techniques like tubal cannulation for proximal tubal occlusion, and salpingectomy for distal tubal occlusion are more often used. The choice of procedure depends on the location of the blockage.

Proximal tubal occlusion (PTO) is the blockage of the fallopian tube at its connection to the uterus. On a hysterosalpingogram, the uterine cavity can be imaged, but the opening to the fallopian tube appears only as a small dimple. PTO is commonly caused by muscular spasm in response to the test but often is an indicator of inflammation of the fallopian tube.

PTO can be treated with tubal cannulation, in which a small tube or wire is used to open the connection to the tube. This procedure can be done on an outpatient basis, using a fluoroscopy, an x-ray technique, or through hysteroscopy, a minor surgical procedure in which a narrow viewing tube is placed into the uterus for a direct look inside.

Hydrosalpinx is a blockage at the other end of the fallopian tube, the “distal” portion near the ovary. The blockage tends to form a pocket where fluid collects. Hydrosalpinx literally means, ‘water in the tube’. The hydrosalpinx indicates severe damage to the fallopian tube and indicates complete blockage.

Hydrosalpinx creates problems for patients undergoing in vitro fertilization (IVF). These blind pockets of fluid sometimes will leak their contents into the uterus, interfering with embryo implantation. Toxic effects on both the uterine lining and the embryo can result. In patients undergoing IVF, the chance for pregnancy if a hydrosalpinx is present drops by 50%. In addition, there is a higher risk of miscarriage and ectopic pregnancy.

Removal of the fallopian tube is a simple laparoscopic procedure that improves pregnancy rates with IVF. The procedure can be performed in under an hour, under anesthesia, as an outpatient procedure. Pregnancy rates with IVF are dramatically improved after removal of the fallopian tube.

PFC’s doctors are pioneering other techniques for treatment of tubal blockage that do not require surgery, such as Essure. Essure is a small micro-insert that is inserted into the fallopian tube under hysteroscopy. Without using an incision, the problem tube can be treated, and IVF performed.

Thankfully, medical advancements designed to treat blocked tubes have demonstrated significant success, helping many patients have a successful pregnancy when they otherwise might not have.

– Philip Chenette, M.D.

Blocked Tube & Open Tube Pregnancy Rates
Women with blocked fallopian tubes on average have better embryo quality than those with open tubes. Since there is an obvious single barrier to pregnancy, the chance of problems with eggs and sperm is lower. Patients with tubal blockage cannot conceive on their own, but with treatment can carry and deliver a pregnancy at excellent rates.

Pacific Fertility Center Team
Left to Right: Front: Philip Chenette, MD, Isabelle Ryan, MD, Carolyn Givens, MD
Back: Joe Conaghan, PhD, Carl Herbert, MD, Eldon Schriock, MD

Question: My husband and I have two boys and want to have a girl.
What are our options?

Answer: Gender selection is a complicated and difficult issue. Ethics aside, there really are only two proven methods. The first is a technique of sorting sperm cells called Microsort. If there is a healthy number of motile sperm present (no significant male infertility), the husband can fly to Southern California to the Microsort lab and have the sperm sorted. That sperm can then be used to inseminate the wife at Huntington Reproductive Center in Laguna Hills or can be frozen and shipped back to PFC for use in IVF. Because the technique results in such poor recovery of sperm, insemination may take several tries. This is why most of our patients will use the sperm in conjunction with IVF, in which case we can inseminate by single sperm injection (ICSI) several of the wife’s eggs, producing and then transferring embryos back to the uterus, and giving the couple a better chance of success. The sperm sorting method is much more efficient if the gender desired is female (see Microsort Facts below). We receive a report from Microsort about the estimated percentage of sperm that are X-bearing (female) vs. Y-bearing (male). Usually, for a female, that is about 85% and most couples interested in a girl are comfortable with those odds. For a male, the odds are lower (about 73%) and therefore, if a boy is really desired, most couples look to PGS (Pre-Implantation Genetic Screening).

With PGS, the patients undergo IVF with ICSI to create the embryos, and when the resulting embryos have 5-8 cells, a single cell is removed and analyzed for a number of chromosomes, including X and Y. If the couple wishes to transfer only the embryos of one gender, they will have to decide what to do with the remaining embryos. The technique is close to 93% accurate, which is a huge advantage over Microsort if male gender is desired. However, our most recent statistics with PGS indicate implantation rates tend to be lower. We do suspect that the procedure of removing a cell from the embryo may be decreasing the chances of successful implantation.

There are many more complex issues involved with PGS so we require our patients considering this process to meet with a genetics counselor (we work with the Perinatal Genetics program at California Pacific Medical Center for this counseling) to discuss the implications of undergoing this process in more depth.

– Carolyn Givens, M.D.

Microsort Facts • Sperm sorting technique

Two locations: Virginia and Southern California

Must be younger than 40 years old (or using egg donor)

Must be for Family Balancing (not first child)

Low % of sperm recovered

Efficiency for a girl is about 85%

Efficiency for a boy is about 73%

For more info, visit the website: www.microsort.net

Question: My wife and I have been trying to have a child for a while now. I have been told that she is “allergic” to my sperm. What are our best treatment options at his time?

Answer: Many people say that they are allergic to their partner’s sperm, and that can mean different things, depending on the testing done. True incompatibility with sperm is very uncommon. Some female patients may have had a blood test to see if they have “anti-sperm antibodies” circulating in their blood stream. A positive test result actually does not correlate well to a true problem of incompatibility and infertility, and therefore this blood test is no longer recommended as part of infertility testing. An uncommon, but more relevant problem would be if the MALE partner were making sperm antibodies against his OWN sperm. Men who are at risk of this are those who have had testicular injury (scrotal trauma) or testicular surgery (torsion, tumors, or other indications). Antibodies are also commonly found in men who have undergone vasectomy reversal, especially if the interval between vasectomy and vasectomy reversal is a long one.

The sperm has 3 parts: the head, midpiece and tail. If the male patient makes sperm antibodies against the sperm midpiece or tail, this is probably of no consequence. If he makes antibodies against the sperm head, then this can prevent the sperm head from fusing with the egg membrane, and progressing with the important steps of fertilization. The remedy for this condition is to proceed to IVF, and have the embryologist inject the sperm directly into the egg membrane and cytoplasm. This injection process is called ICSI (intracytoplasmic sperm injection), and will restore normal fertilization rates for that couple.

It therefore is important to be clear about the appropriate testing to be done, if one suspects a sperm incompatibility. The anti-sperm antibody test is done directly on the SPERM, and done in a laboratory which has the ability to do this specialized testing (usually an IVF or an Andrology laboratory). If you have a history that might place you at risk of making antibodies against your own sperm, please discuss this with your fertility physician.

– Isabelle Ryan, MD