At FIRST's Andrology Laboratory, we offer sperm testing, cryopreservation, preparation and storage of male reproductive tissues for the full range of fertility treatments:
Semen Analysis begins by scheduling an appointment. We do not accept unscheduled specimens. Please take the time to read through the instructions you will be given. Men can either take a special, sterile cup from our office for collection at home, is able to transport the sample to our office within an hour of collection or collect the specimen here, at Florida Institute for Reproductive Sciences and Technologies. The cost of a simple semen analysis is $125 and, if requested, there is a $25 additional fee for a special collection condom, for men who are absolutely unable to collect a specimen by masturbation.
Once we have a semen sample, we can evaluate volume, number, motion, and shape of the sperm (morphology).
* Volume is the amount of ejaculate in milliliters (ml)
*Concentration is the number of sperm in each milliliter of ejaculate
*Total sperm count is calculated by multiplying the concentration by the volume
*Motility is the percentage of sperm that is moving
*The percentage progressive is the percentage of sperm moving forward with at least moderate speed
* Morphology is the percentage of sperm with normal appearance when compared to a standard for sperm
For men with severe male factor or history of poor outcome in in-vitro fertilization procedures, a sperm DNA fragmentation test (that assesses damage of sperm DNA) may be recommended, as well. The fee for this test is $400.
Sperm freezing and storage is available at FIRST. Some patients find this service particularly convenient if the male partner has difficulty producing a specimen on demand or has a schedule that will not enable him to be readily available to give a semen specimen when needed. We also freeze sperm for directed sperm donors (see below). The fee to freeze a specimen is $385. Often, one ejaculate may be divided and used for more than one treatment cycle. We will store your specimen for three months free of charge, after which storage.
If you have been diagnosed with cancer and will be undergoing chemotherapy or radiation in the near future you will need to bank your sperm emergently, before these cancer treatments negatively impact your ability to produce sperm. For such cases, we will gladly set up an emergency consult for you so we can get to work as quickly as possible to give you an opportunity to extend your fertility.
For patients scheduled for a testicular biopsy to obtain tissue for a TESA/E or PESA procedure, we will provide media and will pick up your specimen directly from the operating room to bring to our laboratory for immediate use or cryopreservation.
Therapeutic Donor Sperm Insemination
In cases where the male partner is sterile, has a very low sperm count, or there is a possibility of a male-linked genetic abnormality, or if no male partner is available, anonymous donor sperm may be used. Some patients may choose to use sperm from a known sperm donor. Both options can be effective and are extremely safe. For patients with a very severe male factor, or if the male partner has had a vasectomy, using donor sperm is an economical alternative to IVF with ICSI. Some patients decide to use donor sperm when multiple ICSI cycles have failed.
Donor semen is available from a number of very reliable and trustworthy sperm banks. Sperm donors are tested for transmissible diseases, such as HIV, Hepatitis B and C, Gonorrhea, Chlamydia, Syphilis, and Cytomegalovirus, as well as their blood type. Cryopreserved sperm purchased from a sperm bank is quarantined for six months, and the donor is retested for infections. Only then, if the tests remain negative, is the donated sperm, already frozen for six months, made available for insemination.
A woman can carry a baby of any blood type, but if the carrying female is Rh negative, she may elect to choose a donor who is also Rh negative to avoid the need for RhoGAM injections during pregnancy. She may also wish to match her sperm donor's blood type to that of her male partner.
If a potential carrier of a pregnancy is CMV negative (her test shows that she has not been exposed to Cytomegalovirus), she should select a sperm donor who is also CMV negative for insemination. Sperm from a CMV positive donor can be used only by women who are also CMV positive or who are using in-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) to achieve a pregnancy.
Information about the sperm donor's physical characteristics such as hair color, skin tone, and eye color as well as blood type of the sperm donor is available in each sperm bank's catalog which can usually be viewed online. A donor's ethnicity and level of education are often indicated and many sperm banks offer pictures and even more data on their sperm donors for a fee.
Below is a list of some leading sperm banks in the U.S. By doing a Google search for any of those listed below, you will find more information about each bank. Most catalogs are available online:
- Seattle Sperm Bank
- Manhattan CryoBank
- Sperm Bank of California
- Fairfax Cryobank
- Pacific Reproductive Services
- Xytex Cryo International
- New England Cryogenic Center, Inc.
- California Cryobank Inc.
- Cryos International – USA; Enter PROMO CODE: FIRSTFL15 for 15% off sperm and eggs
- Midwest Sperm Bank
- International Cryogenics Inc.
- N W Andrology & Cryobank
- NW Cryobank
- Repro Lab
- Rainbow Flag Health Services
You can easily arrange to have your specimen(s) delivered to FIRST directly from your chosen sperm bank or transferred from another doctor's office. Just call us to ask how! We have the facilities to keep your specimen frozen and safe for as much time as necessary before you are ready to use your sperm. Fees will apply for cryopreserved specimens remaining at FIRST for more than one year.
Designating a Known, Non-Intimate Sperm Donor
Nowadays, many patients request to use a non-intimate friend, acquaintance, or relative as a designated sperm donor. FIRST recommends following the Society for Reproductive Sciences and Technology (SART.org) donor tissue banking guidelines (followed by all proprietary, licensed sperm banks in the U.S.) regarding infectious disease screening and quarantining of donor sperm from a non-intimate male that you may decide to use as a sperm donor. In such cases, you and your sperm donor are advised to seek legal counsel prior to the insemination procedure.
Once you are counseled regarding the risks (and benefits) of using a known, designated sperm donor with whom you have not been sexually intimate, you may decide to use his sperm to try to achieve a pregnancy without quarantining his frozen sperm sample for at least six months, as recommended by SART guidelines. Patients electing to take this alternative to purchasing sperm from a sperm bank are permitted to forgo the six month waiting period, or even use a fresh semen sample for donor insemination, if willing to assume the small but finite risk of being exposed to a potentially serious health problem.
Treatment for Male Factor Infertility
Male factor infertility results when the sperm count is extremely low or the sperm quality is very poor. It is a common reason couples present for treatment; around 40% of infertility cases are attributed to male factor. When there is no reason for poor semen parameters identified, which is usually the case, there is no treatment that can be recommended to normalize semen parameters when male factor infertility is unexplained. Lifestyle changes may help to improve sperm quality, such as increasing exercise, improving one's diet, eliminating obesity and quitting smoking and/or use of recreational drugs. No vitamins or supplements have been shown to reverse male factor infertility, though some may offer general health benefits.
Intra-Cytoplasmic Sperm Injection (ICSI)
Conventional IVF without ICSI, it turns out, often ends in disappointing results for patients experiencing male factor infertility, such as no fertilization of eggs or a low percentage of eggs fertilized in vitro, with no or few embryos available for transfer. Until the 1990s, the only available treatment was the use of donor sperm. With the development of ICSI in Belgium, a powerful tool became available for what had been an intractable problem. IVF with ICSI is the best treatment for male factor infertility and has been employed at FIRST for almost two decades, so we've had vast experience with this technique! And IVF/ICSI is always necessary when sperm is obtained by surgical means (see below).
The steps leading to ICSI are identical to IVF until just after the eggs are retrieved. Instead of mixing the sperm and eggs in a dish and waiting for fertilization to occur naturally, individual eggs are isolated and, with the use of sophisticated micromanipulation techniques, a single sperm is injected into each normally formed, mature egg. The fertilized eggs resulting from the ICSI procedure identified 24 hours later, are then incubated as in IVF until they are ready for transfer. Note that not all eggs subjected to ICSI will necessarily fertilize.
Percutaneous Epididymal Sperm Aspiration (PESA) and Testicular Sperm Aspiration/Extraction (TESA/E)
Some men have no sperm in their semen because of vasectomy, previous infection or trauma, or a congenital defect. In such instances, sperm may be obtained by extracting it through a needle placed in the testicle or epididymis under local anesthesia. Sometimes, the scrotum is opened surgically, and a small piece of testicular tissue is excised in an attempt to obtain sperm. Sperm obtained by these means must be used in conjunction with ICSI because such sperm cells are too immature to fertilize eggs on their own.
We do not perform these procedures at FIRST, but we do collaborate closely with specialists who have extensive experience with surgical sperm extraction.
Intrauterine Insemination (IUI)
Many women with infertility do not require high technology treatment. If one or both of a woman's fallopian tubes are open and free of surrounding scar tissue, the ovarian reserve is adequate, and there is sufficient quality sperm consistently available, a patient may be a candidate for IUI. Though lUI is often used to treat male factor infertility, it is not very effective for this problem unless the female partner’s ovaries are stimulated. In fact, IUI alone is associated with a very low success rate for any sort of infertility problem, so, when IUI is recommended at FIRST, the female’s fertility is enhanced by using medication to make more eggs available to the sperm at the time of insemination.
When an IUI is planned, a woman’s ovaries are first stimulated to produce multiple eggs (superovulation) by using clomiphene (pills) or gonadotropins (injections). The progress of egg maturation is monitored by serial ultrasound examination of the ovaries and, for patients using injectable medication, blood tests, as well. Ovulation is triggered by a final injection that will cause the woman to release the eggs from her ovaries in about 36 - 40 hours. The male partner produces a semen sample, by masturbation, shortly before the time the woman will be ovulating, or a previously frozen sample is thawed. The sample is then processed in our laboratory in preparation for intrauterine insemination.
The purpose of processing, or "washing," a semen sample for IUI is to yield a specimen containing a high concentration of sperm with normal activity and configuration. The final volume of the specimen must be very small because the uterine cavity cannot accommodate the entire volume of the ejaculate. Also, chemicals present in the semen must be separated from the sperm, since placing unprocessed semen directly into the uterine cavity will cause the woman to have violent, painful uterine cramping. Bacteria and debris are removed from the specimen by the processing, as well.
The final IUI specimen is mixed with a sterile culture medium and placed into the uterine cavity, through the cervix, or uterine opening, located within the patient's vagina, at its apex. A special, thin tube, or catheter, manufactured for this purpose is used to deposit the sperm high in the reproductive tract. Unlike at other South Florida fertility centers, where a nurse, a physician assistant, or an unfamiliar doctor may perform your IUI, at FIRST, Dr. Selub herself is the only person who will perform your IUI procedure.
Expect your IUI to feel similar to a Pap smear. It is rarely painful or very uncomfortable, but some women will experience a mild cramping sensation at the time the thin tube (catheter) containing the semen specimen is placed into the uterus by the doctor, or for a short time after the procedure. Ten minutes after an IUI, you may return to normal activity. Some patients may feel more bloated or have lower abdominal discomfort for several days following the IUI, which is a side effect of the fertility-enhancing medication taken prior to the procedure. It is all right to use over-the-counter pain medication, such as acetaminophen, ibuprofen, or Naprosyn for relief. Such symptoms are usually mild. Typically, the success rate associated with IUI is about 10-25% depending on a patient’s age, her ovarian reserve, and the reason she is experiencing infertility.