Interested in self-diagnosis of fertility? The ability to screen for fertility in private, on one’s own schedule, with an at home diagnostic kit is an appealing option. A company from the UK, Genosis, has developed such a kit, called Fertell.

Fertell is a testing kit that offers a basic assessment of male and female fertility.

Fertell for the male is a specimen collection and testing kit that measures the concentration of motile sperm. A sperm specimen is collected into a cup and allowed to liquefy and then warmed to body temperature. Motile sperm pass through a filter and are colored red by exposure to a gold-coated antibody. Appearance of two red lines in a testing chamber indicates a sperm count over 10 million total motile.

Fertell for the female is a conventional urine test strip very similar to an ovulation prediction kit. The female places the absorbent tip in her urine stream for 5 seconds. FSH in the urine reacts with antibodies on the test strip and shows as a red line in the result window. The intensity of this line reflects the FSH concentration (the darker the line, the more FSH present in urine). High FSH levels are indicated by two dark red lines.

Traditional semen analysis measures sperm volume, count, and motility. Multiplied together, these numbers yield the total motile sperm count, that is, the number of moving sperm in the ejaculate. Total motile sperm count is a reasonable predictor of fertility for men. Fertell establishes that the sperm count is over a specific value of 10 million total motile, a reasonable threshold for male fertility.

The male test kit is not able to determine subtle gradations of male fertility. It cannot detect the effects of treatment or change in lifestyle that may cause improvement in sperm count, nor can it detect alterations in sperm morphology (shape). More sophisticated testing is available at a sperm lab.

The female test kit is used as a screening test, and cannot detect subtle gradations in FSH levels, or the relationship of FSH to other important hormones such as estradiol. Such issues have dramatic effect on the patient’s prognosis.

Neither of these tests can replace an expert’s opinion. An expert’s ability to interpret test results with a broad knowledge base and experience remains the best way to diagnose and treat infertility problems.

Of primary importance is that, while both test kits have been correlated with existing assays, neither has been evaluated for its ability to predict pregnancy. Such research takes time, and hopefully will be forthcoming. For now, Fertell is an interesting option for those seeking a private screening assessment of their fertility.

Question: I am an educator for a human sexuality class. A student asked me an interesting question that I was unsure how to answer. Given that we know sperm can survive about 72 hours in a woman’s body, how is it possible to keep sperm viable by freezing them?

Answer: Sperm can survive for a long time under the right circumstances. In a woman’s body we think that 72 hours is approximately correct, but the data supporting this estimate is not conclusive. In the lab, sperm can live 5 days or more provided they are removed from the seminal fluid and placed in a more nurturing environment. Seminal fluid contains many enzymes that first clot and then liquefy. This change in the fluid allows the ejaculated sperm to stay in the vagina initially, but then swim out as the seminal fluid becomes more liquid. These enzymes quickly destroy any sperm that can’t swim out of the semen within a few hours.

It takes approximately 72 days for sperm to mature in the body. During the last 14 days of this process, the sperm are very much alive and swimming. They are alive a long time prior to leaving a man’s body.

During freezing, sperm are cooled to a very low sub zero temperature (minus 196 degrees Centigrade). At that temperature, all biological activity is effectively stopped. The sperm cells are not metabolizing or depleting their energy reserves. They are truly in suspended animation. Bacteria or other microbes cannot attack or degrade the sperm in any way because they are also unable to function at such a low temperature. Everything is on hold.

Biologists believe that correctly frozen cells in long term storage can literally last forever, as long as the temperature is properly maintained. It is believed that constant exposure to normal levels of background radiation is the only thing that could cause loss of viability and this effect is difficult to measure. Studies done in the 1970’s, exposing frozen mouse embryos to the equivalent of 2,000 years of background radiation, showed no measurable mutagenic effects in offspring.

Cryobiology is a relatively new science, and human fertility treatments are newer still. Consequently, in humans there are no long term results with frozen sperm or embryos. There are a handful of reports showing babies born from embryos that had been frozen for 12-15 years. A couple in New York had a child in 2005 from sperm that had been stored for 28 years. Sperm frozen for domestic animal species have a longer record because samples frozen in the 1950’s are still viable.

The process used for freezing is very precise and works best when cells exist individually (such as sperm) or in very small groups (such as an embryo). Larger masses of cells, tissues or even whole bodies cannot be frozen and subsequently thawed alive. It is not currently possible to freeze and thaw a whole ovary or kidney.

To successfully freeze cells we must remove cell water (water expansion during freezing would burst the cell) and replace the water inside the cell with antifreeze. This is done by incubating the cells in a solution of antifreeze. The water and antifreeze swap places through the process of simple osmosis. In a complex tissue like an ovary, there is no way to get all the water out of all of the cells so easily, thus a whole ovary cannot be frozen. If the ovary is chopped up into tiny pieces however, more water can be extracted. Some success has been reported with freezing ovarian pieces in this way.

The following student experiment demonstrates the challenges of freezing. Place a whole peach into your freezer for 24 hours and then thaw it out and see what a mess you have. If however you slice the peach up and mix the slices with sugar for 15 minutes (the sugar will draw out water from the cells), you can freeze the peach quite successfully. If the technology is used correctly, you can keep your peach (or your sperm) for leaner times.

Joe Conaghan, PhD, HCLD

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

In vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) has made a significant difference in the lives of thousands of couples facing infertility due to severe male factor — problems within the male reproductive system or the sperm, which account for 40% of all infertility cases. The process of injecting sperm into eggs at the time of in vitro fertilization was developed in 1992 and has now allowed for the birth of thousands of children whose parents would have otherwise not been able to conceive.

Since the IVF with ICSI procedure has a shorter track record, compared to a thirty year plus history for the IVF procedure, scientists and infertility specialists have been carefully monitoring children born utilizing IVF-ICSI. Prior studies of the genetic makeup of children born after being conceived via IVF-ICSI have reported that the risks of chromosomal abnormalities may be slightly increased as compared to natural conception. But these studies have been inconclusive.

However, a new study, presented at the annual meeting of the European Society for Human Reproduction and Embryology in Madrid, Spain this summer, prompted a collective sigh of relief. This extensive study involved 1,500 children from several European countries, who were followed up to age 5. The study was designed to examine both birth defects and mental development differences.

All the children underwent a thorough physical examination, including checking for birth defects, hearing and vision tests and psychological development. Although the rate of birth defects was slightly higher in the IVF-ICSI group at 5 years of age, there were no differences in language or physical skills, and no differences in behavior and temperament. The amount of difference seen in birth defect rates was not considered to be statistically significant enough to warrant concern. Moreover, the lack of difference in developmental skills was clearly an indication that IVF-ICSI children are expected to grow into thriving, healthy children.

The results of this study should be reassuring to parents of children conceived through IVF-ICSI, or those who are considering undergoing this procedure. The vast majority of children that result from the IVF-ICSI process do very well and show no major differences as compared to naturally conceived children.

If you are particularly interested more background and further details of this study, please read further

IVF-ICSI Study Details

In the general population, the risk of sex chromosome abnormalities is about 2 in every 1000 births (0.2%). With IVF-ICSI, the rate of sex chromosome abnormalities is estimated to be about 6 in every 1000 births (0.6%). These types of abnormal chromosomes can lead to a variety of defects but virtually all chromosomal abnormalities can be diagnosed by prenatal genetic testing (CVS or amniocentesis).

It is not certain that this increased risk is due to the injection procedure itself or whether it is due to the fact that the sperm of men with male factor infertility, being otherwise incapable of fertilization, has a higher percentage harboring chromosomal abnormalities. In fact, recent studies on the chromosomes from embryos created via IVF-ICSI have shown that abnormalities are primarily confined to embryos using sperm from men with the most severe forms of male infertility, usually sperm requiring surgical extraction from the testicles.

This new study focused not only on the sex chromosomal abnormalities but also on the mental development of children conceived with this method. (Prior studies had revealed conflicting results, some showing a slower development in a portion of the children and other studies finding no differences in mental and psychological development.)

Over 1,500 children from Britain, Belgium, Sweden, Denmark and Greece were followed up to age 5. Out of this total, 541 children were conceived through IVF-ICSI, 440 were conceived with IVF without ICSI and 542 were conceived naturally. The children underwent a thorough physical examination, including checking for birth defects, hearing and vision tests and psychological development. Although the rate of birth defects was slightly higher in the IVF-ICSI group (6.4% vs. 2.4%), at 5 years of age, there were no differences in language or physical skills, and no differences in behavior and temperament. The amount of difference seen in birth defect rates was not considered to be statistically significant enough to warrant concern. Moreover, the lack of difference in developmental skills was clearly a significant indication that IVF-ICSI children are expected to grow into thriving, healthy children.

At birth, IVF-ICSI children were similar in birth weight and maturity (only singleton births were included in the study). They were no more likely to have been in the neonatal intensive care unit and the Apgar scores (measuring general health at birth) were similar. However, children conceived with IVF-ICSI were more likely to have undergone mostly minor surgeries, such as kidney and urinary problems, and to have been hospitalized sometime in the first 5 years of life.

One potential explanation for the differences in the birth defects could also attributed to the mother’s age at conception, as there is clearly a trend towards slightly higher rates of birth defects with maternal age. Also, for unknown reasons, the IVF-ICSI mothers were more likely to have had illnesses during pregnancy. An additional problem with drawing conclusions from the birth defect data was pointed out by Dr. Arne Sunde, chairman of the ESHRE society. In this study, the control group of naturally conceived children was more likely to be skewed towards healthy children, as this group was recruited from mainstream schools. It is likely that some of the children with the most severe birth defects may not be enrolled in regular schools. More data is needed to confirm or refute these results.

Regarding the psychological development findings, one of the researchers of the study, Dr. Susan Golombok from the City University of London stated, “I think we can feel very reassured about children’s social, emotional, and cognitive development up to age 5. If they were doing all right up to age 5, you wouldn’t necessarily expect things to get worse as they grow older. By that time, they are starting school and if they are doing okay, there would be no particular reason to expect problems would suddenly start to manifest.”