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Chymotrypsin Wash
This wash procedure may reduce the amount of agglutinated or clumped sperm in the final preparation. It is especially useful for semen samples that appear to have many motile sperm clumped (agglutinated) together.

Isolation with Chymotrypsin Wash - A process that combines the features of the Isolation and Chymotrypsin washes.

Mini-Isolation with Chymotrypsin Wash - A wash that is designed to achieve the effects of isolation and chymotrypsin processing in semen sample of low density and/or motility.

Complete Semen Analysis
The Complete Semen Analysis is the primary test performed to inform and guide the clinician in the evaluation of male fertility.

Cryopreservation
Cryopreservation of semen, also known as freezing or banking, allows sperm to be preserved and stored at ultra-low temperatures for future fertility procedures. A complete semen analysis is performed to determine the quality of the specimen and the total number of motile sperm that are present. Based on the overall quality and number of motile sperm present, the semen sample is then mixed with specific volumes of media and preservant and divided into a calculated number of vials. These vials are then slowly cooled down to extremely low temperatures and stored in liquid nitrogen tanks. Cryopreserved semen can remain viable for use for many decades, thus preserving the fertility potential of the patient for many years.

Hormone Testing
The ICVR/AALC sends out all serum hormone testing to one of the top-of-the-line laboratories in Tucson to ensure the highest quality in test results and "turn around time" for results. This means you can have all your fertility work-up and testing done on a "one-stop" basis at our laboratory

IUI (Intrauterine Insemination)
An intrauterine insemination (IUI) is a procedure in which the sperm is "washed" and prepared then deposited into the upper portion of the uterus to help achieve a pregnancy. It is often an excellent option for couples prior to considering more complicated and very expensive procedures, such as in vitro fertilization (IVF). Most fertility centers will perform a sperm wash and IUI for $300 to $400, while the total cost of a single IVF procedure can cost $10,000 or more.

Isolation Wash
A density gradient wash that separates out many of the motile sperm from the non-motile sperm. It also "filters out" most of the clumps, aggregated sperm, round cells, seminal plasma, and debris. The final result is generally a "cleaner" preparation with an increased percentage of motile sperm of superior morphology as compared to the fresh sample.

Mini-Isolation Wash - A variation of the Isolation Wash that achieves similar results but may improve overall recovery for those semen specimens of low density and/or low motility.

IUI/IVF Support
The AALC offers full support for both Intrauterine Insemination (IUI) and In Vitro Fertilization sperm processing. We have a full range of wash (sperm processing) techniques that are "custom tailored" to optimize you and your physician's needs for an IUI prep. We also provide sperm freezing (cryopreservation) and storage for all your IVF needs. And we offer all these services 24 hours a day / 7 days a week for your convenience. Just call (520) 275-7502 for same day service and same day results!

Microscopic Epididymal Sperm Aspiration (MESA)
Microscopic epididymal sperm aspiration (MESA) is a technique for the procurement of sperm from the epididymis. Most commonly, MESA is indicated when there is an obstructed or non-existent ductal system for the epididymal sperm to exit. Couples who elect to not reverse a vasectomy either due to advanced maternal age or an extended duration since the vasectomy are best served by MESA to obtain the best quality sperm for Assisted Reproductive Technologies. Men with congenital absence of the Vas Deferens are born without an exit for the sperm produced in the epididymis. MESA and IVF complement each other and must be part of a coordinated program.

Pellet Count
With ART procedures such as ICSI requiring only a few sperm for potential fertility, it is often desirably to quantify as best as possible the number of sperm in a patient sample that presents itself as either severely oligozoospermic or possibly azoospermic under standard analysis techniques. A standard pellet is achieved by centrifugation of the specimen in the same manner as a Complete Semen Analysis. However, rather than examine a set number of HPF's, the entire pellet on the slide is methodically examined under high power and each sperm seen is recorded along with its motility. An average forward progression is recorded as well, if any motile sperm are present. The pellet count can be extremely useful for samples that have sperm densities too low to count or detect by normal methods. The Pellet Count can provide a good estimation of the number of sperm that can be recovered from the specimen for such advanced procedures as ICSI.

Peyronie's Disease
Peyronie's disease is the presence of scar tissue in the penis. The French surgeon Francois Peyronie first described it 250 years ago. The scar tissue, or Peyronie's Plaque, forms in the wall of the tissue that surrounds the corpus cavernosum. That is, a plaque forms in the "canvas" (tunica albuginea) that wraps the penis. These plaques can cause pain with erection and curvature of the penis.

How does a plaque form?
Peyronie's affects millions of men usually beginning in there 50's. The plaque forms from a lifetime of small injuries or tears. These injuries heal by forming exaggerated plaques, which result in the Peyronie's disease. Men who form abnormal scar tissue elsewhere in the body are more susceptible to develop a Peyronie's plaque.

Does Peyronie's cause Erectile Dysfunction?
Yes. Peyronie's disease will cause curvature but also prevent blood flow beyond the plaque resulting in erectile dysfunction. Correcting the plaque will improve potency. Often you will be prescribe Viagra™ or Trimix™ to treat the erectile dysfunction.

What will happen if I don't treat my Peyronie's disease?
Spontaneous improvement is rare. However, after one year, 2/3 of men does not get any worse and remain stable. However, 1/3 of men have worsening of their Peyronie's disease.

What are the current treatments for Peyronie's Disease?
Oral medication therapy is only effective in the early, or the acute phase, of Peyronie's. Thus, within the first year of developing a plaque, PABA, vitamin E and colchicine are effective first line treatments. However, after one year with a plaque, oral medications are rarely helpful. The next line of therapy is intralesional injections with verapamil. The penis is anesthetized initially and then the medication is injected into several sites within the Peyronie's Plaque. Following a series of 6 injections spaced at least every other week, 2/3 of men have improvement in their curvature, and 80% have improved erections.

If injections fail, surgical removal of the plaque and reconstruction can be performed. Surgery is very successful at correcting the curvature, but rarely improves the erectile dysfunction. Your doctor will discuss with you the need to possibly place a penile prosthesis during the plaque removal or attempt alternative treatments for erectile dysfunction.

Post Ejaculate Urine
A qualitative examination and screening for the presence of spermatozoa in the urine in patients where the semen ejaculate is retrogade and "backs up" into the bladder. Techniques can be used to "wash out" the bladder in patients with retrograde ejaculation. The retrieved sperm can then be utilized for intrauterine insemination, freezing, or other fertility treatment or testing.

Post Vasectomy Semen Analysis
Patients who have had a vasectomy should be checked for the presence of sperm in the ejaculate as part of their routine follow-up starting two weeks post surgery to verify the success of the procedure. A patient's semen is considered free and clear of sperm when they have two consecutive Post Vasectomy Semen Analysis (PVSA) that show no sperm, motile or non-motile, on the direct exam or centrifuged pellet. A follow up analysis is also encouraged at six months post surgery to rule out the possibility of a spontaneous reconnection. The principle function of the PVSA is to check for the presence or absence of sperm.

ProXEED
The dietary supplement proXEED® (sigma tau) has been introduced to the American market. ProXEED is a mixture of L-Carnitine, acetyl-carnitine and fructose.

L-Carnitine is found in high concentrations in the epididymis. Preliminary data from European studies indicate that the use of supplemental L-carnitine may improve epididymal function, thus improving sperm motility. In addition, there is evidence that sperm production may increase as seen by a greater amount of sperm in each ejaculate and a greater ejaculate volume.

Regular Sperm Wash
Sperm processing, or washing, is usually performed to prepare a fresh semen sample for IUI (Intrauterine Insemination) or other ART (Assisted Reproductive Technology) procedures. Sperm washing achieves two very important goals. First, it removes most of the seminal plasma from the semen that would otherwise not react well if directly inseminated into the uterus. Second, it concentrates the sperm density into a small volume that is suitable for intrauterine insemination. In some cases, sperm washing may also enhance the forward progression of the sperm or the percent motility.

Semen Fructose
The seminal vesicles contribute a significant amount of fluid to the total ejaculate volume via the ejaculatory duct. The vesicles are also a source of fructose. For patient's that have a semen specimen absent of sperm (azoospermia) the absence of fructose in their semen can be a strong indication of blockage distal to the seminal vesicles. The Semen Fructose Assay checks qualitatively for the presence or absence of fructose in the semen. Generally, the assay will only be clinically significant if the patient is azoospermic; therefore, a Complete Semen Analysis should accompany the Semen Fructose test.

Soft Wash
A variation of the Regular Wash that may reduce the "stress" on sperm during the centrifugation process.

Sperm Antibody Test
The presence of anti-sperm antibodies is associated with immunological fertility impairment. Semen specimens with anti-sperm antibodies (ASA) can often present themselves with motile sperm caught in clumps together (agglutinated). While there are several classes of ASA, only those of the IgG and IgA classes are clinically significant. IgA antibodies rarely if ever occur without IgG antibodies also being present. Therefore, testing for IgG is sufficient for routine screening of semen samples for anti-sperm antibodies. The ASA assay uses the direct method of testing by mixing fresh, untreated semen with latex particles that have been coated with human IgG. To this mixture is added a monospecific antihuman IgG antiserum. The formation of agglutinates between the particles and motile sperm indicates the presence of IgG antibodies on the sperm. A Complete Semen Analysis should be ordered along with the assay.

Sperm-Cervical Mucus Test
In some cases the semen may have normal parameters but interact poorly with the cervical mucus of the female partner, thus reducing the fertility potential of the couple. The Sperm-Cervical Mucus Test (SCMT) is an in vitro qualitative examination of this interaction based on the sperm penetration into the mucus and any observable effects on the sperm motility and forward progression. The interaction should be examined within one hour of collection of semen collection and combined with cervical mucus collected mid-cycle.

Sperm Storage
Once your sperm is frozen, we can store your specimens at our Sperm Bank for as long as needed. It will last and remain viable for use to help you have a child for as long as you need it. All sperm specimens are catalogued and recorded in a unique "quadruple" format to ensure the highest quality in storage documentation.

We can also ship your stored sperm samples to almost any place in the world, so matter where you may end up living after freezing your specimens they will still remain available to you, with next day shipping delivery available?

Other storage questions? Just give us a call at (520) 885-2689 for all your sperm storage options. We are here to help and answer all your questions.

The following groups, TESE is mandatory for obtaining sperm for IVF/ICSI:

Men whose epididymis is unavailable because of previous surgery or congenital bilateral absence of the Vas Deferens have a sperm reservoir available in the testes. In patients with obstructive azoospermia, TESE is close to 100% at retrieving sperm. Men with obstructed epididymis have about 42% clinical pregnancy rate with TESE/ICSI.

Men with Sertoli Cell Only (SCO) pattern, maturation arrest, or severe hypospermatogenesis represent another group of patients with successful testicular sperm retrieval. This group of men were, until recently, felt to be untreatable, however, now sperm can be retrieved in up to 60%, with pregnancy achieved through IVF/ICSI in 28-50%.

TESE may be performed with testicular mapping. Mapping is typically necessary for men with reduced sperm production such as post chemotherapy. During testicular mapping, several sites throughout the testes are sampled under the microscope. Only a very small amount of tissue is sampled, even if four or more sites are sampled.

Testosterone Fertility
Testosterone is the hormone that causes men to be "male". Testosterone is almost single handedly responsible for a boys development of muscle strength, bone density, deepened voice, body hair, competitiveness, sex drive and sperm production.

It makes intuitive sense that when a man has impaired fertility because of a low sperm count, giving him extra testosterone would benefit his fertility. This is a critical mistake many doctors continue to make.

Approximately 150,000 men every year are evaluated for impaired fertility. Oftentimes a low sperm count and low testosterone are found. Such men are even more susceptible to the toxic effects of extra testosterone on their sperm production. Extra testosterone will stop a man's sperm production and make his chances for fertility impossible! Even giving testosterone in replacement doses, so that blood levels never are higher than normal, will halt sperm production. Testosterone has actually been administered to healthy men in low doses for the purpose of a male birth control. There are medical conditions when testosterone replacement is highly beneficial-but restoring sperm production is never one of them. Fortunately, the impaired sperm production that extra testosterone causes is often reversible, but can take anywhere from 3 months to years.

Urine Culture
Our lab sends out all urine culture testing to one of the top-of-the-line laboratories in Tucson to ensure the highest quality in test results and "turn around time" for results. This means you can have all your fertility work-up and testing done on a "one-stop" basis.

Varicocele
Varicoceles, which are an abnormal collection of dilated veins above the testicles, are present in 15% of men. Men with varicoceles have a progressive injury to the cells in the testes that produce sperm and testosterone. Varicocele repair not only stops the testicular injury, but also can reverse the cellular changes, thus improving both male fertility and increasing testosterone.

Vital Stain
Sperm that are non-motile are not necessarily "dead". Many of these non-motile sperm are still alive and viable, and can be used for ART (Assisted Reproductive Technology) procedures such as ICSI (Intracytoplasmic Sperm Injection). In addition, the percentage of sperm that are viable but non-motile may indicate other clinical evidence of partial blockage or other factors that may render the sperm immotile, but still alive. The vital stain also provides an accurate check of the motile percentage of the specimen, since the percentage "alive" should equal or exceed the percentage motile. The vital stain is based on the principle that dead cells will take up an eosin dye, and as a result stain red. Live sperm do not take up the dye and remain colorless. The nigrosin provides a dark background which makes it easier to asses the slide.

White Blood Cell Count
The White Blood Cell Assay (WBC) is useful in quantifying the number of certain leukocytes (WBC's) in a semen sample. The test can distinguish these WBC's from the general population of Round Cells (RC) typically reported out in a semen analysis assay. Most human ejaculates contain some leukocytes, with the predominant cell type being the neutrophil. A high concentration of WBC's (leucocytospermia) may indicate the presence of an infection in the reproductive tract. Furthermore, high concentrations of these cells can have detrimental effects on the semen, including reduction in volume, sperm density, motility, and forward progression. WBC's can also impair sperm function as a result of the various reactive oxygen species they may release, along with possible secretions of cytotoxic cytokines.

The impact of WBC's can depend on the site at which they enter the semen, the type involved, and their state of activation. The granules in neutrophilic polymorphic WBC's contain peroxidase, which together with hydrogen peroxide form free water and oxygen ions. The oxygen ions oxidize benzidine which then colors brown, thus staining the cells brown. The WBC stain also contains a red contrast reagent to differentiate peroxidase positive round cells from peroxidase negative round cells. Since the WBC concentration is based on the sperm density, a Complete Semen Analysis assay should be ordered along with this assay.

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