CRH has developed a major Andrology division for
evaluating, testing, and treating men with
infertility to maximize IVF success rates. Andrology
services are available not only for a man with
suspected infertility, but also for couples who have
failed to conceive following IVF, and for younger
males with developmental disorders. Our
state-of-the-art laboratory is licensed by the
Medical Laboratory Board of the Tennessee Department
of Health.
The Andrology laboratory provides the following
testing:
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Extremely accurate sperm analysis
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Specialized measures of sperm function
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Sperm washing for Intrauterine insemination
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Hypo-osmotic swelling tests
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Monitoring of capacitation with specific
techniques to label the acrosome reaction
Another
very important service offered by the Andrology
laboratory is sperm
cryopreservation and storage.
During an IVF cycle, semen can be cryopreserved for
men who are not able to produce a sample on the day
of oocyte retrieval (due to performance anxiety),
who are oligospemic, or azoospermic (post-MESA, PESA,
or TESA). In men with azoospermia, epididymal or
testicular samples are usually cryopreserved until
the day of oocyte retrieval. On the day of oocyte
retrieval, the semen sample(s) are thawed, the
cryoprotectant is removed, and ICSI is performed.
Semen cryopreservation is an extremely important
procedure for men (and even boys as young as 14) who
want to preserve their fertility potential after
cytotoxic treatment for cancer. The significance of
notifying the patient of the potential risk of
sterility as early as possible cannot be
overemphasized. Physicians often are aware early
during the diagnostic process that the patient will
most likely need to receive potentially sterilizing
cytotoxic therapy, although the exact diagnosis,
stage, and treatment regimen have not yet been
decided. This time should be used to initiate and
complete the cryopreservation procedure.
The banking of at least three semen samples with at
least a 48-hour period of abstinence between samples
is recommended. This usually requires 5 to 8 days
to complete. Additional samples (four) and longer
abstinence periods (72 hours) to achieve higher
total sperm counts may be considered. But fewer
samples with shorter times are often obtained
because of the need to initiated anticancer therapy
quickly, and it is important to avoid possible
increased genetic damage in sperm collected after
the start of therapy.
Because of the low overall success rate with
artificial insemination using banked semen in the
past, it had been recommended that only samples with
high sperm counts and motilities be stored.
Currently, the success of In vitro fertilization (IVF)
and intracytoplasmic sperm injection (ICSI) make
cryopreservation of all samples containing any live
sperm appropriate. The facts that the cost of sperm
banking is relatively low and that sperm may be
stored for years make this approach very cost
effective.
Andrology and other laboratory services are
accredited by the Commission on Laboratory
Accreditation of the College of American
Pathologists (CAP) also including sperm washing for
intrauterine insemination and performance of
artificial insemination upon request. Sophisticated
techniques used in this laboratory include
hypo-osmotic swelling tests, and monitoring of
capacitation with specific techniques to label the
acrosome reaction, which may predict fertilization.
Embryo Cryopreservation & Storage
After controlled ovarian hyperstimulation and fresh
embryo transfer, 60% of stimulated IVF cycles will
produce excess viable embryos, which are available
for cryopreservation. Cryopreserved or frozen
embryos can be thawed and transferred back into the
uterus, during a subsequent frozen embryo transfer
cycle. This allows for higher overall pregnancy
rates per attempted IVF cycle. The indications for
embryo cryopreservation include:
-
Storing excess embryos for
future use after a fresh embryo
transfer
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Decreasing the risk of OHSS in a
fresh embryo transfer cycle at
very high risk of OHSS.
-
Uterine conditions that are
unfavorable for fresh embryo
transfer after retrieval (e.g.,
uterine bleeding, polyps,
leiomyomas, severe cervical
stenosis, or a thin endometrial
lining).
Cryopreservation
techniques attempt to minimize cell damage to
embryos during the freezing and thawing process with
the aid of cryoprotectants. Embryos are frozen at a
slow rate with the cryoprotectant. A gradient is
induced that allows intracellular water to leave the
cell. The embryo is dehydrated to avoid the
formation of cytotoxic intracellular ice crystals.
Once they are frozen, the embryos are loaded into
cryostraws and stored in liquid nitrogen at -196°C.
When embryos are needed for transfer, they are
thawed rapidly to avoid formation of intracellular
ice crystals. Typically, cryopreservation results in
an 80% survival rate after thawing frozen embryos.
Patients should be extensively counseled prior to
oocyte retrieval with regard to cryopreserving
excess embryos. Informed consent is obtained as
outlined in the ASRM committee opinion on elements
to be considered in obtaining informed consent for
ART.
