Preparation for infertility treatment, precautions for immune antibody testing and semen collection
What preparations should infertile couples make before seeking medical help?
Before the appointment, the man should abstain from sexual intercourse for 3-5 days. The night before the appointment, he should wash his external genitalia with warm water. If the man has a long foreskin, he should retract it and clean away all smegma to avoid affecting the accuracy of the semen analysis results the next day. He must also bring all previous semen analysis and prostate examination reports, medical records, and other relevant documents to the hospital. If the woman has started taking her basal body temperature, she should also bring the temperature record.
The woman should measure and record her basal body temperature for the past three months before her appointment. She should clean her vulva with warm water the night before. She should also bring any previous reports and medical records related to procedures such as fallopian tube patency testing, hysterosalpingography (HSG), diagnostic curettage, or endocrine tests. If a blood test for sex hormones is required, she should not eat or drink anything in the morning. If an ultrasound examination is required, she should have a full bladder. These preparations will greatly help with the examination and treatment of the disease.
Why do we need to do an immune antibody test?
When the human body encounters bacteria and viruses, its immune system rises up to fight and eliminate them; this is how the immune system defeats disease. Recent studies have found a close relationship between these immune responses and infertility. Approximately 10% to 30% of patients with unexplained infertility may have the presence of immune antibodies.
For women, sperm is a foreign object, but the uterus and fallopian tubes can accommodate it, allowing it to travel freely and fertilize an egg for implantation. Previously, the uterus was considered a "special zone," unresponsive to foreign objects. However, this is not the case; the uterus also has a strong immune response. Sperm can travel freely because it has a strong "escort team" that destroys immune cells along its path. If sperm ventures alone, it will be eliminated. Furthermore, if intercourse occurs when the woman's reproductive tract mucosa is damaged or inflamed, sperm can enter and trigger an immune response, producing antisperm antibodies (AsAb) in the blood or cervical mucus, rendering the sperm incapable of fertilization. Even if conception does occur, the sperm and early embryo share antigenicity, and the antisperm antibodies will attack the early embryo, making conception impossible or even leading to early miscarriage.
Besides antisperm antibodies, anti-zona pellucida antibodies (AzpAb) are also a cause of female infertility. The zona pellucida is a glycoprotein shell on the surface of the egg; sperm must first recognize the zona pellucida before penetrating the egg. Anti-zona pellucida antibodies can cover the surface of the zona pellucida, thus preventing sperm from recognizing the egg and interfering with fertilization. In addition, there are anti-ovarian antibodies (AoAb). Recent studies have found that the presence of anti-ovarian antibodies can affect ovarian function; a positive result is seen in premature ovarian failure and can cause infertility and miscarriage.
For men, autoimmune antisperm antibodies are also present in blood and semen, causing sperm to lose their ability to fertilize an egg. Therefore, checking for antibodies in blood, cervical mucus, or semen is one of the important steps in diagnosing infertility, especially unexplained infertility.
What precautions should be taken when collecting semen?
Incorrect semen collection methods can distort semen analysis results, leading to misdiagnosis and mistreatment. To ensure that the test results accurately reflect the actual situation, the following precautions should be taken during semen collection.
(1) There should be no ejaculation 3 to 5 days before the collection of semen, that is, there should be no ejaculation during sexual intercourse, no ejaculation during masturbation, and no nocturnal emission.
(2) Collect 2 to 3 semen samples within 2 to 3 weeks. Since the number of sperm produced varies greatly, it is not objective or reasonable to make a judgment based on the result of only one semen analysis.
(3) The best time to collect semen is in the morning.
(4) Patients should collect the sample themselves by masturbation when they come to the laboratory. If this is difficult, the sample can also be collected at home by masturbation, but it must be delivered to the laboratory within 1 hour, preferably within 30 minutes. After ejaculation, the semen should be kept at around 37°C. In winter, the semen collection bottle should be kept warm in a pocket of an inner garment. In summer, avoid excessively high temperatures and direct sunlight.
(5) Do not use the interrupted intercourse method to collect semen. This is because this method often loses the small portion of semen at the beginning of ejaculation, which is the part with the highest sperm density.
(6) Condoms should not be used to collect semen. Both condoms and the talcum powder inside can affect sperm motility and test results. If a person cannot collect semen by masturbation and must use a condom, they must be instructed to thoroughly wash away the lubricant from the condom and allow it to dry completely before use. Special non-toxic silicone condoms are available for semen collection.
(7) All semen samples should be placed directly into a sterilized and clean glass bottle. The glass bottle should not be too large, but the mouth should be wide to prevent semen from being ejaculated outside the bottle. Before collecting semen, the bottle temperature should be brought to room temperature. If there are foreign objects in the bottle, they will contaminate the semen and affect the test results. If there is moisture in the bottle or the temperature is too low, it will affect sperm motility.
(8) If not all semen samples are collected, or if some samples are lost during transport, the samples are not meaningful for testing and should be collected again.
(9) After specimen collection, it should be sent for testing as soon as possible, and the time should not exceed 1 hour. The temperature should be kept at around 37℃, otherwise it will affect sperm motility, etc.
How to interpret a semen analysis report
Semen is composed of sperm produced by the testes and fluids secreted by the prostate gland, seminal vesicles, and bulbourethral glands. Semen is like water, and sperm are like tadpoles in the water. Sperm produced by the testes are stored in the epididymis. During ejaculation, semen is expelled from the body through the vas deferens. Semen provides favorable conditions for sperm survival and transport.
Whether semen is normal or not is best determined by the reference values of semen index variables in the World Health Organization's Manual of Standardized Examination and Treatment of Male Infertility:
Volume ≥ 2.0 ml
pH ≥ 7.2
Sperm density ≥20×10⁶/ml
Total sperm count 40 x 10⁶ per ejaculation
Vitality: Forward movement (Grade A + Grade B) ≥ 50% within 60 minutes after ejaculation, or rapid linear forward movement (Grade A) ≥ 25%.
Survival rate ≥75% (survival, staining exclusion)
White blood cell count ≤1×10⁶/ml