The laboratory team here at Pacific Fertility Center tested the over the counter Male Fertility Test from Baby Start. The test, also marketed by Embryotech as “FertilMARQ”, comes with everything needed to test two separate semen samples. We found the instructions easy to follow and we used semen samples from several men to run our tests on the kits.

The kit is FDA approved and readily available from major drugstores and through the Internet. It claims to tell you if you have a normal sperm count, which according to the World Health Organization (WHO) is having > 20 million sperm per milliliter of semen. The test does not measure any other parameters of the semen sample such as sperm motility (how many are swimming) or sperm morphology (size and shape).

We ran the test multiple times using kits that the manufacturer had supplied and asked us to test. We used a variety of semen samples with different sperm counts.

The kit contains a small test strip with 4 “wells” labeled A through D, and it looks similar to a home pregnancy or ovulation predictor test. Two of the wells (A and C) are controls and are a blue green color. The other 2 wells (B and D) are used for testing the semen samples and these change color depending on how many sperm are in the test sample. If the color is as dark as or darker than the control well, you have sperm. If the color is lighter than the control well, you have little or no sperm.

To perform a test, a fresh semen sample is collected either into the supplied cup or condom. If collected with the condom, this is simply emptied into the cup, which contains some small flakes of a dried enzyme. The enzyme helps to liquefy the sample over a period of at least 15 minutes and then the semen is ready to be tested. One drop of semen is added to a test well, followed by 2 drops of “blue solution” 1 minute later. After another minute, 2 drops of “clear solution” are added to the test well. The color of the test well is then compared to the control to determine if normal sperm numbers are present in the sample.

The kit comes with everything that is needed to perform the tests. All you will need to supply is a clock or timer. The instructions are clear and simple with helpful diagrams for guidance. The rules for when you should test are acceptable: no more than 3 days since your last ejaculation before you run the first test, and 3-7 days abstinence before running the second test. The instructions also contain common questions, with answers that might arise when you are doing the test. We also found a good and helpful frequently asked question page at http://www.webwomb.com/fertilmarq_faq.htm.

In our trials, the test easily distinguished between samples with normal sperm counts and those with little or no sperm. Clear positive results were obtained with sperm counts of 99, 73.5 and 32.6 million sperm/ml. Clear negatives were obtained with samples that we counted as 0, 3 and 4.4 million sperm/ml.

Only when we analyzed samples close to the test threshold did we find any discrepancies (a sample counted at 18 million sperm/ml came up positive).

The kit is no substitute for testing in a clinical laboratory. The main shortcomings are that the test only looks at sperm number and not other parameters in the semen sample that are equally important for fertility diagnosis and treatment. If you have sperm, but they are not swimming, you would pass this test. Also, individuals with sperm counts that are slightly below normal can pass the test perhaps giving certain men a false sense of security. For these reasons, your fertility physician may order a more detailed sperm analysis.

In general, the test is easy to perform, readily available and inexpensive. The test kits that we received were part of a batch being shipped overseas, perhaps to a location where good clinical testing is not as accessible as it is in the US. And men that are too shy or embarrassed to go to their doctor for a semen analysis now have a better alternative.

Two of the wells (A and C) are controls and are a light blue green color. The other 2 wells (B and D) are used for testing the semen. Wells B and D change color depending on how many sperm are in the test sample. If the color is as dark as or darker than the control well, you have sperm.

– Joe Conaghan, PhD

It has been known for quite some time that many lubricants used to facilitate intercourse or as an aid in masturbation for sperm collection may actually be toxic to sperm. A new study presented at the American Society for Reproductive Medicine 2005 conference confirmed this through a more rigorous study analyzing sperm motility and DNA damage after exposure to four brands: FemGlide, Replens, Astroglide and Pre-Seed.

Although no single product left the sperm completely free of damage, the research identified the Pre-Seed product as causing considerably less motility and DNA damage than the others.

The company that distributes this product claims that Pre-Seed is of the same osmolarity (salt density) and pH as seminal fluid. They further claim that it contains a plant sugar that acts as an anti-oxidant.

The study was jointly conducted without funding from any of the lubricant companies by researchers at Cleveland Clinic Foundation in Cleveland, Ohio; South Dakota State University in Brookings, South Dakota; and Washington State University in Spokane, Washington.

In the first experiment, sperm from 13 different donors was analyzed for progressive motility after 30 minutes of exposure to each lubricant while compared to a control batch from the same sperm donors with no lubricant exposure.

The results showed that sperm activity ranged from a high of 66 percent in untreated sperm, followed by 64 percent with sperm treated with Pre-Seed, followed by 51 percent with FemGlide and 25 percent with Replens. The lowest reported sperm motility was 2 percent in a solution containing Astroglide.

In a second experiment, spermatozoa was exposed for 4 hours and then evaluated for sperm chromatin integrity and then analyzed for percentage of DNA fragmentation, and then compared to non-exposed sperm. Again, the results indicated that Pre-Seed was associated with the smallest amount of sperm DNA damage at 7 percent more than untreated sperm, followed by KY at 10 percent and FemGlide at 15 percent.

Besides the brands tested, it is also thought that KY Jelly, Vaseline, and even saliva can have a negative impact on sperm. (One of the least toxic substances is pure mineral oil but it is generally not advised that women use lipid-based products in the vagina. Mineral oil remains an excellent choice for lubrication for masturbation.)

We welcome the news that a product that is backed by independent laboratory analysis is now available that can make vaginal intercourse more comfortable as well as acting as a promoter of fertility.

– Carolyn Givens, MD

In the last ten years or so in the U.S., we have seen an explosion in the number of over-the-counter dietary supplements for all manner of ailments as well as for the promotion of general health. Some are vitamins with well-known beneficial properties. Some are herbal supplements with a history of traditional Chinese medicine yet with little in the way of Western scientific studies to substantiate their use. Many other supplements contain elements and substances with very little known benefit.

Now there are several preparations being marketed to promote fertility. In this article, I chose to review three of the major products being actively marketed for the purposes of improving sperm.

The oldest supplement is ProXeed™. ProXeed™ is a citrus-flavored powder and can be dissolved in juice or other cold beverages. It is recommended by the manufacturer to be taken twice a day. The active ingredients in Proxeed™ are L-carnitine, L-acetyl carnitine and fructose. The cost is approximately $335.00 per 3-month supply.

Fertile One® is a pill that contains L-carnitine, anti-oxidant vitamins (ferulic acid, vitamins C and E, garlic, co-enzyme Q10 and selenium), ginseng root, zinc and B-complex vitamins (B-6, B-12, B-9 and folic acid). Cost is approximately $273.00 per 3-month supply.

FertilityBlend® for Men is a supplement containing L-carnitine, ferulic acid, vitamins E, B6, B12, and the elements selenium and zinc. The cost is only about $80.00 per 3-month supply.

Several studies have shown that the amino acid L-carnitine may promote sperm development. In a recent clinical trial¹, 102 men with low sperm motility were treated with L-carnitine and acetyl L-carnitine. There was a significant correlation between higher levels of carnitine in the seminal (sperm) fluid and better sperm concentration, total sperm count, sperm total motility, rapid forward progression, live sperm count, membrane function, nuclear DNA integrity, capacity for cervical mucus penetration, linearity of spermatic movement, and amplitude of lateral sperm head movement after 3 and 6 months of L-carnitine/acetyl L-carnitine treatment. Another high quality study, a randomized, placebo-controlled trial of L-carnitine and acetyl L-carnitine showed that after 6 months of treatment increases were seen in all sperm parameters and the most significant improvement in sperm motility was present in patients who had lower initial absolute values of motile sperm (<4 million forward or <5 million total motile spermatozoa per ejaculate)². There are no published randomized controlled trials looking at pregnancy rates on L-carnitine.

Several studies on the B Vitamins have been published showing anti-oxidant effects and virtually all find some benefit to the addition of this group to a daily vitamin regimen.

Ferulic acid is found in various medicinal herbs, has recently been shown to scavenge oxygen free radicals and increase the intracellular cAMP and cGMP (energy molecules). The only published article on ferulic acid involved adding this substance to previously ejaculated sperm specimens where it was shown to improve sperm motility³. A medline search did not reveal any studies on sperm after ingestion of ferulic acid.

It is interesting that Fertile One® contains garlic; at least one study has reported an inhibitory effect on garlic on sperm motility and survival in human and mouse sperm⁴ and crude extracts of garlic bulbs have been shown to immobilize ram sperm and are being investigated as a potential male contraceptive⁵.

Selenium is a trace mineral that is incorporated into several anti-oxidant proteins. It has been shown to improve human sperm parameters⁶ and fertility improved slightly when selenium-deficient mice were treated with it ⁷. What is not clear is whether most men with a normal diet would be selenium-deficient.

Folic acid supplementation may also be beneficial, especially for men who smoke Cigarettes⁸. Treatment of men with folic acid and 5 mg zinc improved sperm counts by 60% and also improved morphology (shape)⁹. Vitamin E has also been shown to improve sperm parameters and sperm-egg binding¹⁰. Co-enzyme Q10 has been shown in one small uncontrolled study to improve sperm motility in males¹¹ but studies of men with a varicocele (dilated scrotal veins) suggest that high levels of seminal fluid Co-enzyme Q10 are found with men with the lowest sperm motility, suggesting that Co-enzyme Q10 would not be beneficial for men with a varicocele¹².

Considering all these studies, there does seem to be a beneficial role for dietary supplementation for men with low sperm counts and low motility. The supplement marketed as FertilityBlend® for Men has almost all of the most well studied ingredients and is considerably less expensive than the others. Avoidance of garlic extracts and further supplementation with folic acid may also be beneficial.

– Carolyn Givens, MD

References:
1. Correlation between seminal carnitine and functional spermatozoal characteristics in men with semen dysfunction of various origins. De Rosa M, Boggia B, Amalfi B, Zarrilli S, Vita A, Colao A, Lombardi G. Drugs R D. 2005;6(1):1-9.

2. A placebo-controlled double-blind randomized trial of the use of combined l-carnitine and l-acetyl-carnitine treatment in men with asthenozoospermia. Lenzi A, Sgro P, Salacone P, Paoli D, Gilio B, Lombardo F, Santulli M, Agarwal A, Gandini L. Fertil Steril. 2004 Jun;81(6):1578-84.

3. Effects of ferulic acid on fertile and asthenozoospermic infertile human sperm motility, viability, lipid peroxidation, and cyclic nucleotides. Zheng RL, Zhang H. Free Radic Biol Med. 1997;22(4):581-6.

4. Spermicidal effect in vitro by the active principle of garlic. Qian YX, Shen PJ, Xu RY, Liu GM, Yang HQ, Lu YS, Sun P, Zhang RW, Qi LM, Lu QH. Contraception. 1986 Sep;34(3):295-302.

5. Sperm immobilization activity of Allium sativum L. and other plant extracts. Chakrabarti K, Pal S, Bhattacharyya AK. Asian J Androl. 2003 Sep;5(3):230.

6. Male fertility is linked to the selenoprotein phospholipid hydroperoxide glutathione peroxidase. Foresta C, Flohe L, Garolla A, Roveri A, Ursini F, Maiorino M. Biol Reprod. 2002 Sep;67(3):967-71.

7. Sperm oxidative stress and the effect of an oral vitamin E and selenium supplement on semen quality in infertile men. Keskes-Ammar L, Feki-Chakroun N, Rebai T, Sahnoun Z, Ghozzi H, Hammami S, Zghal K, Fki H, Damak J, Bahloul A. Arch Androl. 2003 Mar-Apr;49(2):83-94.

8. Low seminal plasma folate concentrations are associated with low sperm density and count in male smokers and nonsmokers. Wallock LM, Tamura T, Mayr CA, Johnston KE, Ames BN, Jacob RA. Fertil Steril. 2001 Feb;75(2):252-9.

9. Effects of folic acid and zinc sulfate on male factor subfertility: a double-blind, randomized, placebo-controlled trial. Wong WY, Merkus HM, Thomas CM, Menkveld R, Zielhuis GA, Steegers-Theunissen RP. Fertil Steril. 2002 Mar;77(3):491-8.

10. A double-blind randomized placebo cross-over controlled trial using the antioxidant vitamin E to treat reactive oxygen species associated male infertility. Kessopoulou E, Powers HJ, Sharma KK, Pearson MJ, Russell JM, Cooke ID, Barratt CL. Fertil Steril. 1995 Oct;64(4):825-31.

11. Coenzyme Q(10) supplementation in infertile men with idiopathic asthenozoospermia: an open, uncontrolled pilot study. Balercia G, Mosca F, Mantero F, Boscaro M, Mancini A, Ricciardo-Lamonica G, Littarru G. Fertil Steril. 2004 Jan;81(1):93-8.

12. Coenzyme Q10: another biochemical alteration linked to infertility in varicocele patients? Mancini A, Milardi D, Conte G, Bianchi A, Balercia G, De Marinis L, Littarru GP. Metabolism. 2003 Apr;52(4):402-

Q.
Can you give me some advice about choosing and buying donor sperm?

A.
When it comes to finding a sperm bank (check with our New Patient Guides for a list of recommended banks) and choosing a donor, you will have plenty of options. Typically, individuals have very specific ideas about the physical, intellectual and sporting abilities they would like in a donor and the sperm banks do a very good job of providing a wide variety of donors. They also ensure that the donors are healthy, disease free and have good quality sperm, though some banks have better quality sperm samples than others. All of this information will be made available to you, ensuring an informed choice.

Unfortunately, we do not see patients making donor choices based primarily on sperm quality. From a medical standpoint this is an important factor. You would be wise to choose a donor with high numbers of sperm with good motility. Motility tells you how many of the sperm are alive. Unfortunately human sperm samples contain a lot of dead sperm and freezing those samples will kill even more sperm. After thawing, most sperm banks will guarantee that at least 35-40% of the sperm will be alive, but it’s worth taking the trouble to find samples that will thaw with motility of 50% or more. To calculate the total number of live sperm that you are buying, multiply the sperm count by the motility. We expect this number to be at least 20 million sperm, but the more the better. This is especially important when choosing donor sperm for intrauterine insemination (IUI) as sperm are quickly attacked and killed by white blood cells (the foot soldiers of the immune system) when placed inside a woman’s body. So the more live sperm we have, the greater the chance that one will make it to fertilize the egg.

Once you have chosen your donor, and are satisfied that he has great sperm, your final decision will be whether to buy the sperm processed or unprocessed. If a fresh sperm sample is frozen without being processed, it will be cheaper for you to buy, and easy for you to take home to do your own vaginal insemination. This type of sample is usually referred to as Intra Cervical Insemination (ICI) prepared, and it is essentially neat semen to which they have added cryoprotectant. Sperm banks will also offer IUI prepared sperm at a higher price. This refers to specimens that have the dead sperm and seminal fluid removed before freezing. You would typically only buy this type of sperm if you were having your Physician perform your insemination. Your Physician will place the sperm directly into your uterus and thus closer to the site of fertilization. It is important to understand that ICI prepared sperm cannot be placed in the uterus as the seminal fluid may cause contractions that could be painful and also counterproductive to the sperm trying to swim up to reach an egg.

When buying donor sperm for an In Vitro Fertilization (IVF) cycle, we suggest buying ICI prepared sperm. It is less expensive and our laboratory will have to process the sample regardless if it is ICI or IUI prepared sperm for use in IVF.

If a sperm sample thaws with less live sperm than guaranteed by the bank, (an event that we occasionally see) we will give you a report that you can take to the sperm bank for a refund. Their liability however, is limited to the amount you paid for the sample. We therefore recommend that you buy more than one vial of sperm at a time, and suggest that you buy sperm that was frozen on different dates. This will minimize the chance that you will end up with sub-optimal sperm on the day of your insemination. Couples undergoing IVF with donor sperm should always have a minimum of 2 vials on hand for their cycle, even though we usually only need one.

If you have sperm left over after your cycle, you cannot return it to the sperm bank for a refund. You can continue to store it at PFC and you will be billed annually for the cost of storage (currently $400 regardless of how many vials you have stored). The sperm banks will also store the sperm for about the same storage fee, or you can ask for it to be discarded if you no longer need it. Bear in mind however, that the same donor may not be available the next time you want to get pregnant. If you are hoping to have two or more children that will be true genetic siblings, you may want to stockpile some sperm from your favorite donor.

On May 25, 2005 new FDA regulations go into effect that will drastically change certain areas of Assisted Reproductive Technology. At PFC, we feel it is important for our patients to understand the implications of these regulations and the effect they may have on their fertility care. We have created an in-house task force to not only ensure that PFC is in compliance with these new regulations, but also to provide patients with as much information as possible. While these new FDA laws will require more time and expense on the part of patients and clinics, federal law mandates that we adhere to them.

These new FDA requirements will affect the infectious disease screening of egg and sperm donors and individuals using gestational carriers. The law as currently written also will affect couples that may wish to donate their frozen embryos to another individual at some time in the future. The source of the eggs or sperm must be screened in accordance with the new rules if the eggs are retrieved or sperm collected on or after May 25, 2005 at any IVF clinic or sperm bank in the United States.

In compliance with California State laws PFC currently performs infectious disease testing on all individuals involved in IVF as well as sperm donors for intrauterine insemination (IUI). The FDA regulations apply to any situation in which eggs or sperm (or the resultant embryos) from an individual are being placed into another person with whom the source is not sexually intimate. The FDA requires screening for some diseases such as Jacob-Creutzfeldt disease and cytomegalovirus that California does not. Screening involves review of medical records, an interview, physical examination and testing.

The most difficult of the federal requirements is that testing must be performed within seven days of collecting the sperm or eggs. This means predicting the exact day that an egg retrieval or IUI will take place and relying upon sometimes slow outside reference laboratories to send test results back quickly.

The embryo transfer or IUI CANNOT OCCUR until the results are received and the donor(s) determined to be eligible. If results are not available by the day of scheduled embryo transfer, transfer may be postponed up to day 5 (blastocyst transfer) or ultimately cancelled. The embryos would be frozen for transfer at a later date. IUI’s with donor sperm would have to be cancelled if results are not available.

In an effort to minimize the likelihood that a retrieval or IUI will be cancelled and to maintain compliance with FDA and California regulations, PFC will continue to perform infectious disease testing on ALL IVF patients, egg donors and sperm sources (IVF & IUI) prior to cycle commencement. Individuals subject to FDA screening will complete the infectious disease questionnaire and physical examination. Within seven days of the anticipated egg retrieval or IUI, a second set of infectious disease tests will be done. Sperm sources will be requested to freeze a sperm sample within seven days of the initial screening as backup in case the second set of tests are not available on the day of retrieval or IUI. For couples wishing to maintain the option of donating their embryos in the future, the egg and sperm sources will need to be retested six or more months after the egg retrieval.

PFC staff are working to identify outside reference laboratories that meet the FDA criteria and that will provide quick turn around time at reasonable cost to our patients. Your clinical coordinator in conjunction with the PFC FDA Task Force will address any concerns you may have on this issue.

– PFC FDA Task Force

In graph A (pregnant) DNA fragmentation index is nice and low at 7.5%. You can see clearly that there are very few sperm (7.5%) with moderate or high fragmentation and that most of the sperm are bunched tightly together with very little fragmentation. These healthy sperm were able to establish and maintain a pregnancy.

In graph B (not pregnant), the sperm DNA is much more unstable and there is a fairly even spread of low, moderate and high fragmentation. The DNA fragmentation index is 65% and these sperm were unable to establish a viable pregnancy.

Intracytoplasmic sperm injection (ICSI), a procedure where a single sperm is injected into an egg, went into widespread use in the US in the early 1990′s. With it came the view that as long as a man had any sperm, he could father a child. In many ways ICSI was a remarkable procedure, allowing thousands of infertile males to have children. And ICSI worked even when the sperm didn’t swim well, had poor morphology or were surgically recovered from the epididymis or testicle. It appeared as though there was no physical obstacle to fertilization as long as a live sperm was available for injection.

Now, with over 10 years experience with this procedure, and regardless of sperm or egg quality, we understand that on average 70-80% of all eggs will fertilize following ICSI. If we physically place the sperm inside the egg, fertilization happens most of the time. However, fertilization is not a very reliable measure of sperm quality, or even egg quality, and the rate at which your eggs fertilize has little bearing on whether or not your embryos will implant after transfer. Eggs recovered from women aged 40 and older, where we know that egg quality is poor, will fertilize at the same rate as younger eggs. Similarly, sperm with poor morphology will fertilize eggs at the same rate as sperm with normal morphology.

After fertilization, if embryo quality is poor, or if embryos fail to implant after transfer, we tend to implicate the eggs as the likely source of the problem. It is very hard to pin the blame on the sperm and we usually have very little evidence that would implicate the male partner in the failure. After all, much time and effort was needed to get the eggs, the egg is mostly responsible for preimplantation development, and the developing embryo was placed safely in the uterus. The tiny sperm brought only the male’s genetic material or DNA, and we saw that that was safely inside the egg at fertilization.

Even when we start to worry about the DNA, eggs are much better known for genetic problems than sperm. Down syndrome is the classic example, as it is well known that the incidence increases with increasing maternal age. Genetic problems in children due to paternal age are less well known and in fact less than 10% of Down Syndrome cases arise as a result of a genetic error in the sperm.

In trying to visualize what DNA looks like, you have to think of a ladder. DNA is a double strand that is held together by the rungs, and the ladder is twisted and coiled. In sperm or eggs the DNA is organized on 23 distinct structures called chromosomes. Each chromosome is simply a very long twisted and coiled ladder.

When we count chromosomes in sperm and eggs, sperm have the right number about 90% of the time and for eggs this varies according to maternal age. For women over age 40, we would expect at least 50% of their eggs to have an incorrect number of chromosomes. These abnormalities don’t appear to stop eggs from fertilizing, but the majority of the resulting embryos either won’t implant or will miscarry early in pregnancy.

Because we know that sperm don’t carry a lot of chromosomal abnormalities, we have to dig deeper to find problems that may cause infertility. The sperm chromatin structure assay (SCSA) is a test developed to look at the integrity of the DNA. Basically it looks at the structure of the ladder and determines if the strands are coming apart due to broken rungs. The more severe the DNA fragmentation is, the less likely that the sperm can establish a viable pregnancy.

To have the test performed, we ship a frozen semen sample to Donald Evenson, PhD, in Brookings, South Dakota www.scsadiagnostics.com. There the sperm are assessed and any sample with less than 15% DNA fragmentation is considered normal. Levels of fragmentation up to 30% may cause reduced fertility, and men with greater than 30% fragmentation are considered to have significantly reduced potential to father a child.

Environmental stresses such as smoking, exposure to other chemicals or toxins, or any other chemical or physical stresses that the sperm may be subjected to may cause or contribute to high levels of sperm DNA fragmentation. In the testes it takes over 70 days to make each sperm, so the potential for exposure to stress is high. Consequently, it’s important for men to look after their health in the months leading up to their attempts to conceive. As always it’s good to eat well, exercise, avoid illnesses, hot tubs and exposure to toxins and take your vitamins. We particularly recommend vitamins C and E, beta-carotene and anti-oxidants for sperm health. We don’t routinely recommend the SCSA for our male patients since sperm fragmentation is likely to affect a very small number of men. The significance of a high fragmentation index is still under debate as there are reports in scientific literature of pregnancy successes despite a bad test result. Further, it is unclear what the prognosis is for men that succeed in reducing their fragmentation score by taking their vitamins and living healthier lives. An alternative solution for men with high fragmentation is to use donor sperm, however most couples choose to use their own sperm despite high fragmentation.

The trend towards using more laptop computers in public places and airports will continue to grow as wireless internet access “hot spots” proliferate. This year laptop use in the U.S. is projected to grow to 60 million users. Additionally, laptops are also increasing their heat output with ever-faster processing power. Which begs the question: are we staring at a potential cause of male infertility without even knowing it?

It is well known that healthy sperm are produced ideally at a testicular temperature of 2 – 4 ºC below body temperature. Established studies have revealed a considerable decline in healthy sperm production – up to 40 % – resulting from scrotal or testicular temperature increases as small as 1 ºC. A long-term decline in sperm quality over several decades has also been identified by at least seven research studies, although definitive causes have yet to be determined. Given this, it was only a matter of time before the connection between laptops and infertility would be examined.

As reported in Human Reproduction, Vol.2, 2005, a group of scientists at State University of New York, Stony Brook embarked upon a research study monitoring the scrotal temperature change in 29 healthy male volunteers, median age 24, from laptop computer use. The researchers used two different types of laptop computers and randomly measured their thermal effect on the scrotum by using right and left scrotal temperature gauges in two separate 60 minute sessions.

They recorded scrotal temperature increases averaging 2.6 – 2.8º C.

The heat emitted by the laptops appears to be a factor, but curiously not the solo factor. The researchers also directed the study participants to sit upright without the laptop, but with their knees tightly pressed together. After sitting this way for an hour, researchers recorded their scrotal temperature, which increased on average 2.1 ºC.

This initial study may prompt further research seeking a more definitive link between laptop use and infertility, or it simply may be added to the myriad considerations of exogenous scrotal heat exposure related to lifestyle. In this same category are prolonged driving and sedentary sitting. Naturally this study calls for prudent use of laptops by men trying to become fathers while weighing in on how modern life in all of its ramifications might be boosting scrotal temperature and causing an overall decline in sperm count.

Q:
Can I collect my sperm at home and store it in my freezer? I have heard there is a kit that allows me to do this?

A:
There are collection and storage kits that allow you to initially collect and freeze your sperm specimen at home, but are not intended for storage in your kitchen freezer. The necessary temperature for maintaining sperm viability is far colder than a home freezer maintains. Specialized kits sold by only a few andrology clinics are designed to let you manage the collection process in the comfort of your own home. They can be purchased and shipped to you for about $350. (Please go to www.nwcryobank.com). These kits maintain the necessary frigid temperature for up to about a week, providing plenty of time to store several specimens for return to the andrology clinic. The kits include the necessary sterile implements for collection.

Naturally, home sperm collection is preferable over visiting a clinic, but freezing sperm is rather involved, and requires a great deal of attention to detail. Be sure to carefully follow the clinic’s instructions.

If you decide this process is for you, here’s what to expect:
The kits usually contain several vials for collecting multiple specimens over several days, thus ensuring back-ups. The specimen must be collected through masturbation using no lubricants, to avoid contamination. Once collected, the sample needs to sit at room temperature for 30 minutes while enzymes in the seminal fluid allow the initially thick sample to become more liquid.

Then the sample needs to be mixed with cryoprotectant, or antifreeze, which should be prepackaged inside the vials included in the sperm collection kit. The antifreeze must be separated from the sperm before insemination.

Do not attempt to freeze and thaw the sperm on your own for home insemination. Only an andrology lab can perform the critical step of extracting the sperm from the antifreeze upon thawing.

Also, even if you know that the sperm is of good quality, it is important to know how well it tolerates freezing and thawing. Your infertility clinic or a sperm bank can provide you with valuable information on the quality of the sperm and its capacity to withstand freezing. Results can be extremely variable. Northwest Andrology reports that on average, healthy normal sperm in one out of ten men simply do not hold up to cryopreservation. Poor sperm survival rates can greatly impact the outcome of IUI, which requires more sperm than other procedures like IVF and IVF with ICSI.

Unfortunately, there is no “in between” process that allows for short term home freezing in one’s freezer for out-of-town moments, or other reasons. And timing fresh sperm for home insemination also requires a certain degree of precision. If the sperm provider cannot be there at the exact time he is needed, the sperm will die in the seminal fluid fairly quickly. If fresh sperm are to be used, it is necessary to do the insemination within an hour or two of collecting the sample.

After my husband and I learned that we had no chance to become pregnant by natural means, we began to investigate IVF/TESE (sperm obtained by biopsy of the testes) with ICSI (Intracytoplasmic sperm injection) as a way to realize our dream of starting a family. We expected the procedures to be challenging to our bodies, minds, and finances.

We were also concerned about the frequency of twin and triplet births with IVF. As much as we hoped to have a child, we wanted to do everything we could to provide the best start for our child-to-be. We wanted to optimize our chances for a healthy full-term singleton pregnancy, natural childbirth, and breastfeeding, if we could become pregnant.

Dr. Carolyn Givens patiently answered our many questions about IVF and embryo cryopreservation and supported us when we made a choice that was quite unusual at the time: we requested that only one embryo be placed in my uterus during the IVF cycle and that any remaining embryos be frozen. I was 34 at the time and had never been pregnant.

Eight-cell embryo

We had the exceptional fortune that our first IVF/ICSI cycle in August of 1997 produced 13 beautiful embryos, and our transfer of a single fresh 3-day-old embryo during that cycle resulted in the birth of our son Benjamin nine months later.

I was still breastfeeding Ben in 2001 when we decided to try for a second pregnancy. Dr. Givens transferred a single 8-cell frozen embryo during an unmedicated natural cycle. We had explained to Ben that there was a little, little baby in Mommy’s tummy that we hoped might grow to be his brother or sister. About a week after the transfer, Ben said, “Mommy, the little, little baby in your tummy is crying.” A few days later, my period began, and I felt like crying too.

The next month, Dr. Givens transferred another frozen embryo, also without medication. Ben thought this embryo was happy, and he was right: she grew to be his sister Charlotte.

When we were considering the choice to have our embryos transferred one at a time, we were glad to learn that the expense of frozen embryo transfers was only a small fraction of that for the IVF/ICSI procedures. I found embryo transfers performed by Dr. Givens to be gentle and comfortable. Dr. Givens’ respect for our individual preferences made our infertility treatments a very positive experience. Our children have brought us unimaginable happiness.

– Camille, Redwood City

Most couples going through IVF or frozen embryo transfer choose to transfer at least two embryos in order to improve the chances of conception with any one embryo transfer procedure. As Camille’s story indicates, however, in younger patients with nice embryo quality and overall good chances for success, electing to transfer a single embryo is a viable option to avoid the risks of multiple gestation pregnancy. It also illustrates the benefits of embryo cryopreservation for having more than one child with a single IVF stimulation cycle.

– Carolyn Givens, MD