Seminal analisys is one of the most important tests in infertility diagnosis. During the first consultation, undergoing a basic computer assisted seminal analisys (CASA) will be advised. If the results of the CASA test indicate that some seminal parameters diverge from the norm, our specialists will recommend further detailed seminal tests, testicular ultrasound, andrological and urological consultations in order to obtain as much information as possible and apply a precise treatment in the shortest possible time.
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For your convenience and information a couple of typical courses of action are listed below. If the basic semen analisys shows abnormalities in parameters, in order to continue the diagnostic process we recommend a relevant set of tests . The presented sets of tests are merely an attempt to systemise the tests used in male infertility treatment. Each problem should be treated individually. For detailed analysis, please make an angdrological appointment with our specialist Wojciech Pabian, MD. All seminal tests are conducted with care and the use of state of the art technologies and equipment. Whenever the test results show abnormal parameters a urological consultation is recommended.
The Green set
- If there are abnormalities in the seminal volume (<1,5ml) or aspermia has been diagnosed we recommend choosing the green set.
- Note! In the case of low seminal volume a post-void residual urine test is only recommended if very low sperm count – oligozoospermia (with concentration <1mln/ml) or azoospermia occur at the same time. In that case we also recommend having transrectal prostate and seminal vesicles ultrasound (TRUS) – performed by a urologist – we can refer you for a consultation with a urologist, with whom we cooperate.
- In the case of increased seminal viscosity only seminal smear and CASA are recommended.
The average cost of the green set of tests is 670 PLN
The set includes the following tests: CASA, testicular ultrasound, hormonal test, seminal smear, andrological consultation and, if necessary, post-void residual urine test (+100PLN) – 770PLN in total.
In the case of high seminal viscosity a set for 370PLN is recommended, which includes CASA, seminal smear and andrological consultation.
The blue set
- if there are abnormalities in sperm concentration or azoospermia is diagnosed we recommend the blue set
- The set includes such genetic tests as: karyotype analisys, mutations in the AZF genes, and in the case of low seminal volume also mutations in the CFTR gene.
The average cost of the blue set is 1230 PLN.
The set includes the following tests: CASA, testicular ultrasound, genetic test, hormonal test, andrological consultation.
The red set
- If the abnormalities relate to low sperm motility or high sperm agglutination, we recommend the red set.
- Note! in the case of isolated tetrazoospermia (abnormal sperm morphology only) we recommend only some of the tests: DFI, ROS, CASA, ultrasound and seminal smear.
- if patients are preparing for intrauterine insemination we additionally recommend two other tests: HBA and MAR.
The average cost of the red set id 1360 PLN.
The set includes the following tests: triple test, testicular ultrasound, MAR, seminal fructose levels (biochemistry), seminal smear, andrological consultation (plus potentially fructose with citric acid analysis and alpha-glucosidase).
In the case of isolated tetrazoospermia we recommend the following tests: triple test, testicular ultrasound, seminal smear, andrological consultation – at the price of 950 PLN.
Description of seminal analisys
Sperm analysis- the core element of male infertility diagnosis. It helps to evaluate if the process of sperm production and development in the testicles and its transportation within the male reproductive system is correct. Semen analysis should be an integral part of the couple's fertility evaluation before the procedures of artificial insemination are commenced.
- Before semen analisys the patients should
- refrain from sexual activity (for 3 to 5 days)
- follow a healthy lifestyle, refrain from drinking alcohol, smoking and using other stimulants, avoid stressful situations and overexertion.
Semen analysis contains the following tests:
Computer Assisted Semen Analysis (CASA)and manual semen analysis are aimed at objective analysis of semen motility. They can be used in standard semen analysis, studies of the effectiveness of different sperm preparation methods, sperm cryopreservation methods and a variety of treatment methods. The CASA system consists of a phase contrast microscope, a camera, a computer and specialist software. It enables to show each consecutive sperm position with a frame rate of 5 to 60 images per second. The images are then changed into digital data and computer analysed, which enables a precise and objective evaluation of the trajectory of each individual sperm.
Chromatin- (Sperm Chromatin Structure Assay test SCSA) allows determination of the genetic quality of sperm (the quantity of sperm with damaged DNA in the nuclei). The test shows the level of sperm chromatin damage (DFI - DNA fragmentation Index ) and the degree of condensation (HDS – High DNA stainability). SCSA plays an important role in estimating the fertilizing capability of sperm. The test indicates to what extent damaged DNA in the sperm influences the possibility of getting pregnant.
ROS (i.e. oxidative stress)- demonstrates the level of reactive oxygen species in sperm; high levels of ROS damage the sperm; when levels of ROS are high the antioxidant capacity of seminal plasma is reduced.
Triple test- consists of sperm analysis, SCSA and ROS
MAR test (Mixed Antiglobulin Reaction)- enables us to determine the presence of auto-antibodies in semen. This test can be a part of routine testing or when it is likely that infertility is caused by immune factors (low sperm motility or sperm agglutination indicated by general sperm analysis).
Post-void residual urine test- determines the presence of sperm in urine and evaluates the possibility of retrograde ejaculation (when semen is redirected into the urinary bladder)
Postcoital test PCT– evaluation of the sperm's interaction with cervical mucus, i.e. evaluation of "cervical mucus hostility".
Biochemical analysis of seminal plasma- seminal plasma is the liquid holding sperm. This is the largest component of seminal volume (around 90%) and consists mainly of mucus secreted by the prostate and seminal vesicles. The substances contained in seminal plasma influence correct functioning and development of sperm. Evaluation of each component of seminal plasma allows us to determine whether the organs of the male reproductive system function correctly and, if not, where the abnormalities occur.
Seminal fructose levels- measure of seminal vesicle secretion. Fructose stimulates energy metabolism of sperm and is crucial for its correct motility. In diagnostics, fructose levels are used as markers of seminal vesicle inflammation and ejaculatory duct obstruction. Fructose level evaluation is also helpful in diagnosis of congenital agenesis of seminal vesicles (connected with congenital bilateral absence of the vas deferens – CBAVD), retrograde ejaculation, or in low androgene levels. Undergoing the fructose levels test is recommended when the following conditions are suspected: inflammation of the seminal vesicles, hypoandrogenism, asthenozoospermia, azoospermia, leucocytospermia, increased seminal volume and/or viscosity and low semen PH value.
Note: required sexual abstinence 2-5 days, results available within 14 days (the analysis is conducted on every 2nd and 4th Wednesday of the month)
Microbiological smear of the semen- when an infection of the male reproductive system is suspected. Our laboratory conducts:
- Microbiological seminal smear - for aerobes, anaerobes, fungi and Trichomonas vaginalis
- Supplementary microbiological smears – for Mycoplasma hominis, Ureaplasma urealyticum and Chlamydia trachomatis
Sperm-Hyaluronan Binding Assay (HBA)- positive results of the general seminal analisys does not always mean that the sperm is capable of fertilization. In order to diagnose the sperm quality in detail the assesment of sperm maturity in a fresh semen specimen can be conducted. The sperm selected in vitro with hyaluronan are mature, functioning, live, have lower percentage of DNA damage and regular numbers of chromosomal aneuploidy (genetic abnormalities). As a result, the sperm selected with hyaluronan prior to artificial insemination procedures are equivalent to the sperm that could successfully take part in a natural fertilization process (natural binding between sperm and zona pellucida – egg coat).
The evaluation of hyaluronan binding points on the sperm surface may be the best indicator of male reproductive potential.
The hyaluronan based tests are of high diagnostic value. High percentage of immature sperm discovered in the patients semen specimen allows for further course of action in infertitlity treatment and enables us to explain the failure of previous artificial insemination procedures.
The test should be conducted in the case of idiopathic infertility (from unknown cause) or as a supplement to general semen analysis.
Note:required sexual abstinence: 2-5 days, results available after 1 day.