Download Andrology Laboratory and Reproductive Tissue

Glickman Urological & Kidney Institute
Andrology Laboratory
and Reproductive Tissue Bank
The Andrology Laboratory and Reproductive Tissue Bank at
Cleveland Clinic’s Glickman Urological & Kidney Institute provides
specialized tests and services to evaluate male infertility and help
couples who are attempting to conceive. Our laboratory offers
referring physicians quantifiable results using the latest, most
sophisticated technology available.
Our personnel include highly qualified and experienced laboratory
technologists who are well trained in fertility testing. Our laboratory
is certified by the Clinical Laboratory Improvement Amendments
(CLIA), certified by the Department of Health and Human
Services, and since 1994 has been accredited by the College
of American Pathologists in conjunction with the American Society
for Reproductive Medicine. Our reproductive tissue bank has
been accredited since 1999 by the American Association of
Tissue Banks.
The laboratory tests offered include a comprehensive semen analysis
using a computerized system that allows for the quality of the semen
to be studied through multiple exposure videomicrography. Results
are then analyzed by computer.
Other tests include: direct and indirect immunobead testing to
detect antisperm antibodies in serum, sperm or seminal plasma,
and fructose levels. Complex tests to measure levels of seminal
free radicals, antioxidant levels in seminal plasma and the extent
of sperm DNA damage, collectively known as semen oxidative
stress profile, are also available.
Additional services include the processing of sperm for intrauterine
insemination; providing frozen (cryopreserved) donor semen for
artificial insemination; and sperm cryopreservation for patients
prior to chemotherapy, radiation therapy, retroperitoneal lymph
node dissection or vasectomy. In addition, services to freeze ovarian
tissue, as well as testicular biopsies are also available.
Microscopy
Computerized Semen Analysis (CSA)
The semen analysis includes a determination of sperm volume, pH, sperm
concentration, total sperm count, percent motility, velocity, linearity, morphology,
color and viscosity. Our CSA system is among the most technologically advanced
systems and yields far more accurate, quantifiable results than manual methods.
Hypo-osmotic Swelling (HOS) Test
The ability of the human sperm tail to swell in the presence of a hypo-osmotic
solution is a sign of membrane integrity and normal functional activity. HOS is
correlated to the in vitro fertilizing ability of the spermatozoa and is a useful
addition to the standard semen analysis.
Leukocytospermia Quantitation/Endtz Test
The presence of high numbers of white blood cells (WBCs) in semen has been
associated with male infertility. WBCs can be quantitatively estimated by the
Endtz test. The Endtz test also allows clear differentiation of WBCs from other
immature germ cells in semen.
Strict Criteria Morphology Classification
Data indicates that normal sperm morphology is a significant predictor of
pregnancy in in vitro fertilization. We offer sperm morphology assessment with
a modified method of strict scoring developed by Dr. Thinius Kruger. This
determination is performed by our experienced laboratory personnel. It is a
valuable aid in the evaluation of the infertile male.
Sperm Processing
Diagnostic Sperm Wash*
A diagnostic sperm wash can be ordered for a patient who has been selected for
intrauterine insemination using the male partner’s washed semen sample. This
procedure includes a prewash semen analysis and sperm washing. The ejaculate
is divided into two equal aliquots and processed by swim-up and density-gradient
techniques, yielding more accurate results than previously possible. The results of
this procedure can help decide whether swim-up sperm wash or density-gradient
sperm wash is the best possible sperm-processing technique for each couple.
Swim-up Sperm Wash*
The swim-up method results in sperm fractions with improved motility and
numbers adequate for conception, as well as a more nearly uniform morphology,
free from seminal debris. The main advantage of a swim-up method is that high
percentages of motile sperm can be recovered. However, the recovery rate of total
motile sperm is low, especially if the initial motility is low.
Density-Gradient Sperm Wash*
The density-gradient separation method concentrates highly motile, viable and
morphologically normal sperm in a small volume of fluid. Separated samples are
free of seminal plasma, leukocytes and other debris. The density-gradient method
is especially useful for cases in which normal wash and swim-up procedures may
yield an insufficient number of sperm for clinical use.
Sperm Antibody*
Immunological analysis is an important part of the evaluation of infertile couples.
Indications for testing may be a poor postcoital test, sperm agglutination, poor
sperm motility, or simply overall unexplained infertility.
Direct Immunobead Test*
A patient’s semen specimen can be tested for the presence of antisperm antibodies by an immunobead binding test, which detects IgG or lgA classes of antibodies that may be present on the surface of the sperm.
Indirect Immunobead Test
The presence of antisperm antibodies also can be detected in the patient’s serum
or seminal plasma.
Semen Biochemistry
Fructose Test
Fructose is normally present in all semen specimens. The absence of fructose
could indicate congenital bilateral absence of the vas deferens or bilateral ejaculatory duct obstruction. Both a qualitative and a quantitative measurement of
fructose can be performed.
* Tests marked with an asterisk require an appointment. All other tests do not.
Sperm Function Tests
Hypo-osmotic Swelling (HOS) Test
The ability of the human sperm tail to swell in the presence of a hypo-osmotic
solution is a sign of membrane integrity and normal functional activity. HOS is
correlated to the in vitro fertilizing ability of the spermatozoa and is a useful addition to the standard semen analysis.
Semen oxidative stress profile
This consists of three advanced tests conducted to evaluate levels of reactive
oxygen species, total antioxidant capacity and DNA damage.
Reactive Oxygen Species (ROS)
Free oxygen radicals, called reactive oxygen species (ROS) are unstable substances and can cause damage to the spermatozoa. A small amount of ROS is needed
for sperm-egg fertilization. Normally, antioxidants present in seminal fluid neutralize any increased production of ROS. However, in case of infection or some other
clinical conditions such as varicocele, significant amounts of ROS can be generated. This increased ROS can damage the normal spermatozoa in semen. Levels of
ROS can be measured using a chemical probe that reacts with the free radicals.
This test may be ordered in the presence of high numbers of round cells in semen
due to infection, idiopathic infertility, or in the presence of a clinical varicocele.
Total antioxidant capacity test
Free radicals attack all cells and can damage lipids, proteins and DNA, resulting in onset of a variety of diseases. Living organisms have developed a complex
antioxidant system to counteract the harmful effects of free radicals and reduce
damage. A balance between the amounts of free radicals produced and the antioxidants available is therefore important. A shift in this balance resulting in a decrease in the available antioxidants or increase in free radicals is undesirable. This
imbalance results in oxidative stress. Data suggest that antioxidant concentrations
are significantly lower in patients who have increased levels of reactive oxygen
species and this may cause oxidative stress. The test utilizes fluid obtained after
spinning a semen specimen that has been stored at -20˚C.
DNA damage test
Intact genetic material, or DNA, is important for healthy fertilization. A morphologically normal looking motile sperm can have DNA damage. DNA damage to
the sperm can result in impaired fertilization, miscarriage or subsequent complications associated with pregnancy. DNA damage can be examined by a technique
called flow cytometry. The test involves the freezing of a small number of sperm
and batching them. Based on the extent of DNA damage found, certain assisted
reproductive techniques may be recommended.
* Tests marked with an asterisk require an appointment. All other tests do not.
Sperm Banking and Long-Term Storage by Cryopreservation
Cleveland Clinic’s Sperm Bank program was established in 1980, making it
one of the first established facilities of its kind in the Cleveland area. We offer
members of the medical community and their patients’ comprehensive services and a reliable system for the long-term preservation of human semen,
epididymal aspirate or testicular tissue.
Therapeutic Patient Sperm Banking*
The Cleveland Clinic Sperm Bank may be used to store frozen semen specimens
for patients of reproductive age who have been diagnosed with testicular carcinoma, lymphoma, Hodgkin’s disease, or any other disease that requires chemotherapy, radiation therapy or transurethral resection.
Frozen semen specimens may be stored prior to a vasectomy to allow the
participant the option of future insemination.
Donor Insemination
Frozen donor specimens, for use in the artificial insemination of women who
cannot achieve pregnancy with their husbands’ sperm, also are available.
Approximately 60 pregnancies occur each year in women who are enrolled
in the program. Donor information is kept confidential.
Ovarian tissue cryopreservation
Women who are undergoing treatment for cancer and are in the reproductive
years have the option of freezing their ovarian tissue at the time of surgery. Frozen
tissue can be stored long term and transplanted back at a later time if the woman
is interested in having children.
Testicular tissue freezing
Men who do not have sperm in their ejaculates can undergo a surgical procedure
to remove small pieces of testicular tissue. At the time of surgery these tissues are
examined for the presence of sperm. The tissue can be frozen and later used to
obtain sperm that can be used for fertilization using special advanced reproductive techniques. In this technique, called intracytoplasmic sperm injection, a single
sperm is needed for fertilization.
Out-of-Town Specimen Shipping Available
Many patients come to our Sperm Bank from outside of Ohio. Cryopreserved
semen specimens can be prepared for shipping to out-of-town facilities. A letter
from the patient’s physician requesting transfer of his specimen is required.
* Tests marked with an asterisk require an appointment. All other tests do not.
To Refer Patients
To refer a patient to Cleveland Clinic’s Andrology Laboratory and Reproductive
Tissue Bank, please call 216.444.8182 or toll-free 800.CCF.CARE (223-2273), ext.
48182 from 7:30 a.m. to 4:30 p.m., Monday through Friday. Although we cannot
take telephone calls on the weekend, selective testing is performed Saturdays and
Sundays for your patients’ convenience.
You will receive a report concerning your patient by mail, generally within one week
of testing. Results of some tests can be sent by fax or email to your office on request
within 24 hours.
Questions?
For more information or to
schedule a laboratory appointment,
please contact us:
216.444.8182 or 216.444.3019
Fax: 216.445.6049
clevelandclinic.org/urology
09-URL-012