If the couple is going to have IVF, then serious preparation is required for it. Both the man and the woman will have to do a lot of tests, as well as donate their biomaterial, since fertilization will take place outside the mother's body. Eggs are taken from a woman, and the man donates sperm, from which laboratory technicians will isolate the healthiest and most mobile sperm for subsequent fertilization.
Before delivery, the sperm must be examined, a spermogram is done. What are its norms, if IVF is to be done and whether it is possible to improve the composition of the semen before the procedure, we will tell in this article.
The need for a procedure
A spermogram is a laboratory microscopic and hardware study of the quality of ejaculate. Before in vitro fertilization, this analysis is always submitted, regardless of the factor of infertility. If a woman is infertile, doctors must be sure that her husband's seminal material is in perfect order.
If infertility is diagnosed in a man, then doctors need to know what kind of disorders caused it, as well as evaluate the possibility of fertilization with a bad spermogram, because such a chance is now quite real.
The peculiarity of the spermogram for IVF is that it is necessary to take the analysis more than once. Sperm is a biological material that is highly susceptible to any external and internal influences. To form a more or less objective idea of a man's fertility, the analysis before IVF is repeated 2-3 times within two weeks. At this time, the woman undergoes preparatory hormonal treatment aimed at stimulating the ovaries.
Even if a man is 100% sure of his health, they won't take his word for it - the risks are too great. Hormone therapy, which a woman undergoes, cannot but affect her health, so it will be better for everyone if fertilization and embryo implantation take place as early as possible. For the success of IVF, both the quality of the oocytes and the quality of the sperm are equally important.
How to take?
It is important to take all spermograms before the upcoming in vitro fertilization procedure in the same clinic, in the same laboratory. The fact is that different laboratories give different estimates due to differences in equipment, as well as the approach to standardization. The concept of norms in different clinics can also vary.
Preparation for a spermogram is required. For 3-5 days before delivery, you should refrain from sex and masturbation. A few days is enough for new cells to mature. However, prolonged abstinence makes semen thicker and test results may be outside the normal range. A man should avoid overheating, especially the scrotum, a few weeks before the delivery of ejaculate. Alcohol should be severely limited in two weeks, preferably - to quit smoking. Taking antibiotics, hormonal drugs during the preparation for IVF is permissible only if fertilization with frozen sperm or donor sperm is planned and the biological material has already been tested and is ready for use.
Sperm for analysis is donated by masturbation in a clinic or at home with the collection of material in a sterile container. However, delivery in a clinical setting is considered more effective since there is no need to worry about the shelf life of the ejaculate. Semen must be delivered to the laboratory within 40-60 minutes. If the material is collected in the clinic, the issue of urgent delivery is removed from the agenda.
Normal indicators
Ejaculate in preparation for IVF is assessed by a number of indicators recommended by the World Health Organization (WHO). Let's take a look at each of them.
Volume
Normally, it is desirable that it correspond to the volume of a tablespoon. If we speak in the dry language of medical numbers, then the volume should be equal to 1.5-2 ml.
Liquefaction time
Sperm after ejaculation gradually becomes more liquid. The time period that this process takes is estimated. Normally, semen becomes liquid in 15–55 minutes.
Acidity level
This is a very important parameter when preparing for IVF. If the acidity is below normal, sperm practically lose their ability to dissolve the egg membrane and penetrate inside. Since with IVF this process takes place, although not in the mother's body, but nevertheless, special attention is paid to the acidity level on their own. Normally, it is 7.2-7.7.
Number of cells
High-precision laboratory equipment counts the number of sperm in the total volume of ejaculate and in 1 milliliter of semen. Normally, there should be at least 15-20 million cells in 1 milliliter and at least 40 million in total.
Sperm motility
Not all sperm are mobile, and this is completely normal. Laboratory technicians in the ejaculate submitted for analysis will select 4 groups of cells, depending on their ability to move.
- sperm type A - the most active and mobile, they always move straight and quickly;
- type B cells - also move straight, but a little slower;
- sperm type C in general, they are able to move, but their movement is non-linear: they circle in place, they can go not forward, but in the opposite direction;
- cells D motionless.
In a normal spermogram, the ratio of different groups is displayed in percent. Sperm is considered good and suitable for conception if it contains at least 49-50% of group A and B sperm.
Morphology
For successful IVF, it is important to assess not so much the quantity as the quality of the male sex cells. Under a microscope, sperm cells are compared with the existing standard and mutated cells are discarded. The structure of the head, its size, structure, shape, number and structure of the sperm tail, as well as the structure of the sperm neck are evaluated. Only the cells corresponding to the standard are considered morphologically healthy.
Normally, the proportion of healthy sperm with unchanged "appearance" should be at least 14-15%.
Viability
All motile sperm are alive. But not all motionless ones are dead. That is why the number of living cells is counted separately. The presence of at least 50–58% of living cells in the ejaculate is considered normal.
The presence of leukocytes
Leukocytes in semen are present in the vast majority of men. Normally, their number does not exceed 1 million per 1 milliliter.
Antisperm antibodies
With IVF, they practically do not matter, but normally their number according to the corresponding special tests should not exceed 50%.
What to do with “bad” analysis?
It must be said that the current level of development of reproductive assistive techniques will very often make it possible to do the almost impossible - most forms of male infertility are not an obstacle to IVF. Even in a completely immobile sperm there is its DNA set, which is necessary for introduction into the egg. True, the procedure in this case will be called ICSI.
If a man has pathologically few spermatozoa, including living and motile ones, in preparation for IVF it is possible to select several completely healthy cells by microscopic methods in the laboratory. This will be enough to fertilize the egg, because in the end only one single sperm from tens of millions of cells that enter the woman's body during natural conception penetrates under the oocyte membrane.
With a changed morphology of germ cells, if the number of mutant cells is high, an analysis with DNA fragmentation is required to find out if everything is in order with the genetic material. Then several reference cells are selected, which can be used in IVF or ICSI.
Only if a man does not have living and suitable sperm cells at all, or they are not produced at all, or the man is a carrier of a dangerous genetic disease, IVF with donor biomaterial is recommended for a woman. Usually, frozen material is used that is tested, researched and safe. The shelf life of cryopreserved semen is 3 years. The thawed material is valid for about an hour.
Ways to improve ejaculate
It is desirable and possible to improve the quality of sperm before donating the biomaterial that will be used in the IVF protocol. Even if the deviations in the spermogram are insignificant, simple and understandable recommendations will help a man to improve his fertility and his own well-being. If the tests showed the presence of infections, preliminary treatment is required.
After cleansing the male body of ureaplasma, chlamydia, after curing prostate diseases and other ailments, the quality of the seminal fluid will become higher, and the quantity - more.
If the leukocytes are overestimated, it is imperative to find the cause of the inflammatory process and eliminate it. With varicocele, surgery is performed.
If none of this is required, recommendations for improvement are almost always standard and traditional. To begin with, a man needs to part with bad habits: smoking and alcoholic beverages. Proper nutrition will also be useful: a man should not overeat, but his diet should be saturated with foods containing animal proteins (meat, milk, fish).
The work schedule of the stronger sex may also require correction. To normalize spermatogenesis, a man must sleep at least 8 hours at night, and therefore work on the night shift is contraindicated. Lovers of baths and saunas are advised to temporarily abandon their habits, since any overheating of the scrotum leads to a decrease in the number of motile and active sperm. Underwear and trousers should be quite loose, not constricting or disturbing the blood supply to the genitals and pelvic organs.
The doctor who is planning the IVF protocol will tell you what vitamin and mineral preparations can be taken by both women and men. Representatives of the sterner sex are prescribed drugs such as Speman, SpermAktiv, Spermaplant, Vitaprost, Speroton, Viardo, Spermastrong, about 2–3 months before taking the biomaterial.
Among folk remedies, a decoction of elecampane root, a decoction of wild rose, tea with sage, and juice from raw pumpkin pulp are especially popular. A man will benefit from nuts, figs and honey. Beekeeping products should be looked at especially: royal jelly and bee bread have a pronounced effect on the composition of sperm. The main thing is that the man is not allergic to these products.
In any case, the use of folk remedies is best coordinated with your doctor, since not all herbs are safe and are not always exclusively beneficial.
A moderately active lifestyle, lack of contact with harmful substances (nitrates, varnishes and paints, heavy metal salts) during preparation for IVF will help a man to significantly improve the quality of semen.
Do not underestimate the properties and characteristics of semen. Very often the IVF protocol fails only because the spermatozoa were weak or their DNA set was damaged... With an average IVF efficiency of 20%, with a bad spermogram, the success rate decreases to 5%. In this case, the couple is advised to take a break and try to improve the quality of the husband's sex cells.
If this fails, despite strict adherence to all the doctor's recommendations, fertilization can be carried out using ICSI or IMSI methods. With them, a specific sperm cell is injected directly under the oocyte membrane, while with IVF, the eggs are in the same incubator with spermatozoa and the penetration of sperm into the oocyte occurs almost spontaneously.
In any case, it is important not to despair, not to lose optimism and trust the doctor. The IVF quota, which is issued for medical reasons to a couple diagnosed with infertility, is valid for a year. If something goes wrong, the procedure can then be repeated.
For information on how to take a spermogram, see the next video.
