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Answers to questions from urologist-andrologist Dmitry Alekseevich Kuznetsov

What prolactin should be taken macro or micro?

Macroprolactin, since it is an immune complex in which prolactin is associated with immunoglobulin G and an increase in its level may indicate a number of diseases, including hyperprolactinemia. This analysis makes sense to carry out only with an increase in the level of prolactin as an additional examination of the form of hyperprolactinemia.

Does my husband have teratozoospermia if there are chances for us to get pregnant or only IVF?

Morphologically abnormal cells have very little fertilizing capacity. Incorrectly moving and quickly dying, they increase the viscosity of the sperm and create significant difficulties for the movement of healthy sperm.

If the abnormal sperm manages to fertilize the egg, the onset of pregnancy often proceeds pathologically and is interrupted due to impaired development of the embryo.

What vitamins would you recommend to improve the quality of semen analysis before the IVF program?

There are a lot of complex vitamins containing antioxidants and trace elements that help improve spermogram indicators, we use different ones depending on the situation.

What is the informative Kruger morphology? Is it carried out in your clinic?

The structure is assessed in accordance with the strict Kruger criteria according to 16 parameters: For the normal (reference) structure of the sperm, an oval head with a clearly defined acrosome, tail and neck is characteristic. Acrosome is called enlightenment, which occupies about 50-70% of the upper part of the cell. The neck should be thin, the tail is not curled, of the same thickness along the entire length with a slight tapering in the middle of the cage. Ideal morphometric parameters are:

  • head 4.5–5 µm long, 2.5–3 µm wide;
  • neck 1.5 times the length of the head and less than 1 μm wide;
  • the ratio of the length of the tail to the head is 1: 10–1: 9.

Defects in the head prevent the penetration of the oocyte, defects in the tail affect sperm motility.

For the study of Kruger morphology and prices, check with the information center of the clinic.

Is it relevant for a man to take drugs to improve spermogram before IVF?

Relevant if it is necessary to improve spermogram indicators.

Does Empty Turkish Saddle Syndrome Affect Semen Analysis?

Empty Turkish saddle syndrome is a rare, asymptomatic anomaly that occurs in 10% of the population and is considered a pathological form of hyperprolactinemia, which in turn can affect sperm counts.

Husband’s history of mumps, what is the percentage of infertility?

Male infertility after suffering from mumps occurs in 17% of cases. The older a man who has had mumps, the greater the risk of consequences such as infertility. Boys with bilateral orchitis are at increased risk.

With normozoospermia, a man needs preparation before IVF? Which one?

  1. Blood test for HIV (human immunodeficiency virus), hepatitis B (HBsAg) and hepatitis C (anti-HCV).
  2. Serological blood test for syphilis.
  3. Microbiological examination of a smear from the urethra to detect other STDs (mycoplasmosis, ureaplasmosis, chlamydia, cytomegalovirus infection, herpes types 1 and 2).
  4. Serological blood test with the determination of antibodies of classes M and G to the herpes simplex virus type 1.2, cytomegalovirus.
  5. Consultation with an andrologist to obtain an opinion on joining the IVF protocol, the advisability of additional use of other assisted reproductive techniques or the use of donor material

Is frozen sperm or fresh sperm important for fertilization of the egg?

The use of fresh sperm from the testicle improves the rate of implantation compared to frozen sperm from the ejaculate or testicle.

Based on this, for patients with virtual azoospermia or cryptozoospermia, it is preferable to use fresh sperm from the testicle for ICSI, in view of their increased fertilizing ability.

Some clinics have abandoned IMSI, others from PIXI. How to do IVF + ICSI + PIXI + IMSI at the same time?

It makes sense to do IMSI in case of severe disorders of sperm morphology and when they are obtained by surgery. IMSI can increase the pregnancy rate by 5%. However, with other disorders of spermatogenesis or relatively normal spermogram parameters, IMSI does not have significant advantages over ICSI. Also, in turn, it should be noted that clinically significant indicators of morphology (large vacuoles, change in the shape of the head, absence of acrosome) are also distinguishable with standard ICSI when using objectives with a magnification of 40x.

During PIXI, mature spermatozoa have receptors for the main component of the egg membrane – hyaluronic acid. To select spermatozoa carrying such receptors, special cups are used, the bottom of which is covered with hyaluronic acid. Mature sperm bind to the bottom of the cup, while immature ones remain motile. The bound sperm are collected for ICSI.

As you can see, these techniques are used in various situations.

Do you perform operations at the Lada clinic?

Yes, you need to look at what specifically interests you.

What are the consequences after the operated varicocele?

If you are asking about complications, how are the rules for relapses of varicocele, the occurrence of dropsy of the testicle. There may also be a lack of positive dynamics on the part of spermogram indicators after the operation.

In turn, there are cases of improvement in spermogram indicators after elimination of varicocele, as a rule, it depends on the age of the operated patient, the earlier the patient turns, the better the result.

Is hyaluronic acid binding test informative? It is no longer held abroad

With the help of the GST test, it is possible to determine the degree of maturity of the spermatozoa, which can significantly increase the likelihood of successful fertilization and choose the course of treatment and the ART program that is optimal in terms of price and efficiency,

I have a question for the doctor on a different topic. What should be the indications for passing the DNA analysis of sperm fermentation and is it carried out in your clinic?

The indications for DNA fragmentation are:

  • Idiopathic infertility (for an unknown reason).
  • After repeated unsuccessful attempts at artificial insemination.
  • If a low quality embryo is detected.
  • In patients with repeated miscarriages.
  • Men over the age of 45.
  • In the event of semen freezing (to ensure that the frozen sample has an acceptable level of β-fragmentation).
  • Increased body temperature in the last 3 months.

For DNA fragmentation and research prices, check with the clinic’s information center.

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Клиника репродуктивного здоровья "Лада"
ул. Среднефонтанская, 19В, ЖК «Чудо-город» 65039 Украина, г.Одесса
(0482) 373747, [email protected]