Sperm Quality and Age

My colleagues and I occasionally field questions from patients about age having an impact on sperm quality. This is an interesting topic and my colleague at Pacific Fertility Center, Joe Conaghan, PhD, High-complexity Clinical Laboratory Director (HCLD) has been kind enough to share his expertise on this issue.

Although there is no strong evidence that sperm suffer the same age related degradation as women's eggs undergo, older sperm do cause their fair share of genetic problems, albeit in a much different way.

In contrast to females, who are born with all their eggs, men have no sperm when they are born. They don’t make any sperm until they reach puberty, when a prolific and persistent production begins. The average man makes about 250 million sperm a day: that’s about 6,000 sperm every time his heart beats. As a man ages, sperm production continues unabated, and there is no strong clinical or scientific evidence that production decreases significantly even in 70 and 80 year old men.

Since sperm production is so high, a man has to keep copying his DNA over and over again to make sperm. All this DNA copying leads to small mistakes, called mutations. If you remember that at its most basic level, DNA is a series of letters that make up recipes called genes. If the recipe is copied millions of times a day, mistakes inevitably happen.

Imagine having a cake recipe that has 3 cups of flour as part of the text. You photocopy the recipe for a friend. She photocopies your photocopy for a friend and so on. After multiple copies, your 3 cups of flour might start to look like 2 cups of flour, and suddenly your cake recipe doesn’t work any more.

These subtle copying defects cause a long list of diseases in the children of older fathers. Lesch Nyhan Syndrome, Polycystic kidney disease and Hemophilia A are among the most well known. For fathers over age 40, the risk of having a child with a disease-causing mutation is similar to the risk the mother has for a child with Down syndrome.

The biology of eggs and the aging of ovarian reserves are relatively well understood phenomena. As people gain a better understanding of how aging sperm can contribute to fertility complications, older couples will have better tools for planning their families.

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How Do I Buy Sperm?

My colleagues and I occasionally field questions from patients about purchasing a sperm sample. This is an interesting topic and my colleague at Pacific Fertility Center, Joe Conaghan, PhD, High-complexity Clinical Laboratory Director (HCLD) has been kind enough to share his expertise on this issue.

At our clinic, Pacific Fertility Center (PFC), when it comes to finding a sperm bank and choosing a donor, you will have plenty of options. Typically, individuals have very specific ideas about the physical, intellectual and sporting abilities they would like in a donor and the sperm banks do a very good job of providing a wide variety of donors. They also ensure that the donors are healthy, disease free and have good quality sperm, though some banks have better quality sperm samples than others. All of this information will be made available to you, ensuring an informed choice.

Unfortunately, we do not see patients making donor choices based primarily on sperm quality. From a medical standpoint this is an important factor. You would be wise to choose a donor with high numbers of sperm with good motility. Motility tells you how many of the sperm are alive. Unfortunately human sperm samples contain a lot of dead sperm and freezing those samples will kill even more sperm. After thawing, most sperm banks will guarantee that at least 35-40% of the sperm will be alive, but it’s worth taking the trouble to find samples that will thaw with motility of 50% or more. To calculate the total number of live sperm that you are buying, multiply the sperm count by the motility. We expect this number to be at least 20 million sperm, but the more the better. This is especially important when choosing donor sperm for intrauterine insemination (IUI) as sperm are quickly attacked and killed by white blood cells (the foot soldiers of the immune system) when placed inside a woman’s body. So the more live sperm we have, the greater the chance that one will make it to fertilize the egg.

Once you have chosen your donor, and are satisfied that he has great sperm, your final decision will be whether to buy the sperm processed or unprocessed. If a fresh sperm sample is frozen without being processed, it will be cheaper for you to buy, and easy for you to take home to do your own vaginal insemination. This type of sample is usually referred to as Intra Cervical Insemination (ICI) prepared, and it is essentially neat semen to which they have added cryoprotectant. Sperm banks will also offer IUI prepared sperm at a higher price. This refers to specimens that have the dead sperm and seminal fluid removed before freezing. You would typically only buy this type of sperm if you were having your Physician perform your insemination. Your Physician will place the sperm directly into your uterus and thus closer to the site of fertilization. It is important to understand that ICI prepared sperm cannot be placed in the uterus as the seminal fluid may cause contractions that could be painful and also counterproductive to the sperm trying to swim up to reach an egg.

When buying donor sperm for an In Vitro Fertilization (IVF) cycle, we suggest buying ICI prepared sperm. It is less expensive and our laboratory will have to process the sample regardless if it is ICI or IUI prepared sperm for use in IVF.

If a sperm sample thaws with less live sperm than guaranteed by the bank, (an event that we occasionally see) we will give you a report that you can take to the sperm bank for a refund. Their liability however, is limited to the amount you paid for the sample. We therefore recommend that you buy more than one vial of sperm at a time, and suggest that you buy sperm that was frozen on different dates. This will minimize the chance that you will end up with sub-optimal sperm on the day of your insemination. Couples undergoing IVF with donor sperm should always have a minimum of 2 vials on hand for their cycle, even though we usually only need one.

If you have sperm left over after your cycle, you cannot return it to the sperm bank for a refund. You can continue to store it at PFC and you will be billed annually for the cost of storage (currently $400 regardless of how many vials you have stored). The sperm banks will also store the sperm for about the same storage fee, or you can ask for it to be discarded if you no longer need it. Bear in mind however, that the same donor may not be available the next time you want to get pregnant. If you are hoping to have two or more children that will be true genetic siblings, you may want to stockpile some sperm from your favorite donor.

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Sperm Samples at Home

My colleagues and I occasionally field questions from patients about whether they can collect a sperm sample at home. This is an interesting topic and my colleague at Pacific Fertility Center, Joe Conaghan, PhD, High-complexity Clinical Laboratory Director (HCLD) has been kind enough to share his expertise on this issue.

At Pacific Fertility Center (PFC), where I practice, sperm samples can be produced at home and brought into our office provided that you follow some simple guidelines. Most importantly, the instructions for producing a sample must be followed as if you were producing a sample in one of the two dedicated rooms in our office. You should shower in the morning and wash the genital area with soap and then rinse with plenty of water. Most of the samples we receive are produced by masturbation and you should be careful to wash your hands immediately before and after the collection. If you need lubrication and/or a condom to produce the sample, these must be supplied by PFC. Most condoms and commercially available lubricants are toxic to sperm in some way, but we can supply you with materials that we have tested and that we know do not kill sperm. You can take them home if that’s where you’ll produce your sample. Similarly, we must provide the container into which you will collect; again to ensure that it is sperm friendly.

The most important part of producing the sample at home is getting it to our office within 60-90 minutes of collection. Your semen sample contains sperm but also many enzymes that are important in the natural process of reproduction. One part of your reproductive tract, the seminal vesicles, produces enzymes that coagulate the semen immediately upon emission. This allows the viscous sample to remain within the vagina, a process that might be an evolutionary vestige of the copulation plugs that are seen in other mammals and that prevent the female from mating with a second male. Within 5-20 minutes however, other enzymes in the semen (this time from the prostate gland) liquefy the clotted semen, liberating the trapped sperm so that they can enter the cervix. Sperm in the first fraction of the semen are bathed in prostatic secretions and have better motility and survival than sperm in latter fractions which are bathed in vesicular fluid, since the seminal vesicles emissions are last in the ejaculatory sequence. This is why we always ask if any part of the ejaculate was lost during collection. If the first few drops of semen don’t get into the collection cup, we may have lost the best sperm and we may underestimate the quality of your sample.

All of these enzymes in the semen make it a hostile environment. Sperm trapped or left in semen will die relatively quickly, but sperm washed out of this enzyme bath can survive easily for 4 or 5 days in the laboratory. Semen can also cause uterine contractions, which is why we have to process sperm samples and remove it before performing your intra uterine insemination. Getting your semen sample to the laboratory within 60-90 minutes of collection allows us to assess your sperm before the enzymes can do any damage.

It is important that you have an abstinence period of at least 48 hours but not more than 7 days before giving us a sample. Samples produced after 2 days abstinence will usually have the highest numbers of motile sperm with the greatest forward velocity, when compared to samples produced after shorter or longer abstinence. Waiting too long between ejaculates is the biggest mistake we see, possibly because some men think that they can save all their sperm for the day of their big test. However, older sperm begin to die if ejaculations are infrequent and we see the percentage of live sperm decrease with increasing abstinence. Also, please remember that abstinence means no ejaculation, not just no intercourse!

Once your sample has been collected, it is important to avoid exposing it to extremes of heat or cold before bringing it to us in the laboratory. Don’t put it in the refrigerator while you take a shower. Don’t leave it on your dashboard in the sun while you pick up your dry cleaning. And don’t leave it in the glove compartment, forget about it for a week, and then deliver it to the lab. The sample will be fine at room temperature, and you don’t have to break the speed limit in trying to get it to us.

You will need to have made an appointment with us so that we know you will be bringing in a sample, and when you arrive in our office, a member of our staff will check your specimen in. We need to be sure that it is labeled properly and we will get some details from you regarding your abstinence period and how and when you produced the sample. And we will check your identification (usually your driver’s license). This last step is important in establishing the identity of the sample and is part of a “chain of custody” procedure that we use with all samples passing through our facility. We will examine and if appropriate, process the sample within 30 minutes of receiving it, or immediately if the sample is already 1 hour old. Hopefully we won’t be calling you to say that we need to repeat the test!

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Follicles and Fertility

My colleagues and I occasionally field questions from patients about what fertility physicians are looking for in conducting an antral follicle count. This is a fascinating topic and my colleague at Pacific Fertility Center, Isabelle Ryan, MD, has been kind enough to share her expertise on this issue.


Women are born with all of the eggs (oocytes) that they will ever have. This is a set number, which is determined before birth. This pool of eggs is never replenished. A female fetus will have the greatest number of eggs around 16-20 weeks of pregnancy (6-7 million); at birth this number decreases to about 2 million; and by puberty to about 300,000. This constant and dynamic process of decline continues until menopause and is not interrupted by birth control pills, pregnancy, or ovulation. From this reservoir of eggs, fewer than 500 eggs will ovulate during a woman’s reproductive life.

There is a continuous process occurring in the ovaries, where eggs are constantly being prepared for the maturation process. It takes 3-6 months for eggs to develop and mature. As the eggs are developing, they transition from a primordial, to preantral, to then antral follicle. Antral follicles are visible by vaginal ultrasound. Antral follicles therefore represent the reserve of eggs in our ovaries and those that are candidates for selection and growth by fertility stimulation medications (gonadotropins).

When assessing one’s ovarian reserve (potential for a successful pregnancy), a number of parameters are evaluated. One of these is called the “antral follicle count” (AFC). An antral follicle count is typically done during the 2nd-4th days of menstrual flow, though it can probably be as accurately done during other times of the menstrual cycle. Studies show that the AFC is predictive of the expected ovarian response to gonadotropins. An AFC less than 6 total (between both ovaries), predicts a poor stimulation response. For those undergoing IVF, a similarly low AFC will be associated with a higher cancellation rate. As women approach their 40s, and as day-3 FSH results rise above 10 mIU/ml, this typically correlates with fewer eggs overall in our ovaries, and therefore a low AFC. Indirectly, a low AFC can correlate with diminished ovarian reserve.

In the same way that there can be monthly variability in day-3 FSH test results, there can be monthly variability in the AFC. More variability is observed in the AFC of young infertile women than in older women. However, overall a single AFC is still quite predictive of ovarian response under gonadotropin stimulation, and there is fairly good agreement between repeated AFC over consecutive cycles. In conclusion, doing an AFC is an adjunct to the day 3-FSH test to predict ovarian reserve and ovarian response to fertility medications.

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Allergic to Sperm?

My colleagues and I occasionally field questions from patients who have concerns about sperm “allergies”. This is a fascinating topic and my colleague at Pacific Fertility Center, Isabelle Ryan, MD, has been kind enough to share her expertise on this issue.

Many people say that they are allergic to their partner’s sperm, and that can mean different things, depending on the testing done. True incompatibility with sperm is very uncommon. Some female patients may have had a blood test to see if they have “anti-sperm antibodies” circulating in their blood stream. A positive test result actually does not correlate well to a true problem of incompatibility and infertility, and therefore this blood test is no longer recommended as part of infertility testing. An uncommon, but more relevant problem would be if the MALE partner were making sperm antibodies against his OWN sperm. Men who are at risk of this are those who have had testicular injury (scrotal trauma) or testicular surgery (torsion, tumors, or other indications). Antibodies are also commonly found in men who have undergone vasectomy reversal, especially if the interval between vasectomy and vasectomy reversal is a long one.

The sperm has 3 parts: the head, midpiece and tail. If the male patient makes sperm antibodies against the sperm midpiece or tail, this is probably of no consequence. If he makes antibodies against the sperm head, then this can prevent the sperm head from fusing with the egg membrane, and progressing with the important steps of fertilization. The remedy for this condition is to proceed to IVF, and have the embryologist inject the sperm directly into the egg membrane and cytoplasm. This injection process is called ICSI (intracytoplasmic sperm injection), and will restore normal fertilization rates for that couple.

It therefore is important to be clear about the appropriate testing to be done, if one suspects a sperm incompatibility. The anti-sperm antibody test is done directly on the SPERM, and done in a laboratory which has the ability to do this specialized testing (usually an IVF or an Andrology laboratory). If you have a history that might place you at risk of making antibodies against your own sperm, please discuss this with your fertility physician.

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