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:

	Extremely accurate sperm analysis
	Specialized measures of sperm function
	Sperm washing for Intrauterine insemination
	Hypo-osmotic swelling tests
	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   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.

To make an appointment, please call us
TODAY at 615-321-8899.

About CRH | Causes of Infertility | Treatments | Corrective Surgery | Facilities | Success Rates
Egg Donation | Embryo Adoption | Testimonials | Financial Services | Glossary | Contact Us | Home

 

The Center for Reproductive Health | 2008 | All Rights Reserved