What is andrology?
Andrology is the medical specialty that deals with male health, particularly relating to the problems of the male reproductive system. It is a Greek term. The Andrology laboratories at ISIS Fertility are accredited laboratories (under the Reproductive Technologies Accreditation Committee Code of Practice) that specialise in the understanding of male conditions contributing to difficulty with conception. Worldwide, males are experiencing a decrease in fertility. The good news is that these conditions are now able to be successfully treated. Andrology services are performed in accordance with internationally recognised standards and incorporate the latest research and developments.
What tests might we do?
Some of the possibilities are as follows, but your fertility specialist will determine and explain which test is right for you:
- Semen analysis — a sample of semen is usually obtained by masturbation and then carefully analysed for the number of sperm, motility, and the shape (morphology).
- Sperm freeze — Sperm can be frozen for long term storage or as back up on the day of your partner’s egg collection or insemination, or as a fertility preservation method. Sperm can be thawed and successfully used years after the initial freezing. Please note that sperm is not frozen at the time of the diagnostic semen analysis test unless requested.
- Trial wash — The sperm is prepared, as it would be for IVF or IUI insemination, to see the number of viable sperm that the sample yields. This result can help determine the specific treatment that will be required to assist in achieving a pregnancy.
Other information about Andrology
For diagnostic purposes, it is recommended that couples who are on the IVF treatment programme have at least two semen analyses, a minimum of six weeks apart. This will allow assessment of the degree of variability between ejaculates. Generally there is variation between samples, but it is important to ensure that this variability is not large enough to potentially cause problems occurring on the day of your partner’s egg collection or insemination.
A genetic cause of infertility
What do genetics have to do with infertility?
Until recently little was known about the causes of male infertility. Many studies point to genetic variations causing at least 40 percent of male infertility. A diagnostic test is now offered at ISIS Fertility to help identify genetic causes of male infertility.
Men with zero or very low sperm counts are at increased risk for deletions of either the DAZ or RBM genes and therefore Y chromosome testing is recommended.
What is the Y chromosome and how does it affect fertility?
Each cell in the human body has 46 chromosomes (like volumes of an encyclopaedia) which contain all the genetic information (genes) for the development and function of the body. Genetic causes of male infertility are thought to involve the Y (or male) chromosome.
Up to 15 percent of men with zero or very slow sperm counts have small pieces of the Y chromosome missing.
The loss of this genetic information (called a deletion) can lead to poor sperm production. There is no known reason for the loss of this genetic material. Interestingly the fathers and brothers of these men usually have normal sperm counts.
How does this test work?
A blood test determines whether five Y chromosome genes responsible for normal sperm production are missing. An example of this gene is the DAZ gene. While some men with severe infertility are missing the DAZ gene, testing of over 1000 fertile men showed that none were missing this gene. We are at an early stage in understanding the male contribution to fertility. Previously most of the focus had been on the female, but male factor infertility is being increasingly recognised worldwide. In the future, hopefully additional genes important to male fertility will become known and tests developed for these.
Using a blood sample, chromosomes will be extracted from the blood and tested for deletions of the DAZ and RBM genes using a procedure called the polymerase chain reaction (PCR).
What if the test is positive for a Y chromosome deletion?
If the DAZ and RBM genes are missing, it strongly indicates a genetic cause for your infertility. Unfortunately, there is no treatment available to replace the chromosome. If you conceive naturally or with the assistance of an IVF technique and have a son, there is a chance he may also be infertile. Your fertility specialist will discuss your options with you.
What if the test is negative for a Y chromosome deletion?
If no deletion is found, it is still possible that you have a genetic cause for your infertility. New tests for genetic infertility are being developed. ISIS Fertility in association with Monash IVF are continuing research into this important area and aim to provide the most comprehensive range of tests as soon as they become available.
Why is this test necessary?
- To understand that there is a genetic cause of your infertility may help resolve feelings in your relationship
- To assist in predicting whether a son may have infertility.
- Each male child receives his only copy of the Y chromosome from his father.
- Whether men with Y chromosome deletions produce a conception naturally or with the help of assisted reproductive techniques, it is likely that infertility will also occur in their sons.
© ISIS Fertility 2013
Canberra Australia