Beyond the parameters that we look at in a normal semen analysis, there are other diagnostic tests that can provide more insights into sperm health. These tests include:
DNA fragmentation test
DNA fragmentation of sperm correlates to the integrity of the genetic material in sperm, and high DNA fragmentation can be an explanation for infertility, recurrent miscarriages and poor IVF outcomes. The major contributing factor for high DNA fragmentation is oxidative stress associated with advanced chronological age, alcohol, diet, increased testicular temperature, infection, occupational pollutants, smoking, stress and varicocele (an enlargement of the veins within the scrotum).
A DNA fragmentation test can provide a reliable sperm analysis at a molecular level by detecting abnormal genetic material within the sperm, which in turn helps to identify men who are at risk of subfertility.
Hyaluronan binding assay (HBA)
Hyaluronan binding assay (HBA) assesses the maturity of sperm. Hyaluronan (HA) is a sugar molecular surrounding the egg and only mature sperm can bind to it. Sperm that binds to HA have enhanced levels of developmental sperm maturity, including fewer chromosomal abnormalities and higher sperm DNA integrity.
The HBA test is another component of the sperm analysis that is reliable in the diagnosis of suspected male infertility, to predict sperm performance and fertilisation potential.
The Oxisperm test assesses the oxidative stress levels of sperm. High level of oxidative stress in sperm indicate an elevated level of reactive oxygen species (ROS), which have a direct negative impact on sperm DNA integrity and motility. Exposure to substances such as tobacco, alcohol, household appliances, radiation (from laptops, TV and UV rays), and heavy metals can lead to elevated levels of ROS.
Oxidative stress refers to an imbalance between the generation of ROS and the body’s ability to neutralise their harmful effects through antioxidants. Sperm is highly susceptible to oxidative stress and when in this state, peroxidative damage will be induced in sperm plasma membrane resulting in DNA fragmentation. High oxidative stress has been associated with poor sperm motility and function, leading to poor embryo formation, miscarriage, and infertility. Conditions such as varicoceles, infection, inflammation, and spinal cord injury, have also been associated with oxidative stress-induced infertility.
These pre-diagnostic tests provide information that can help in clinical diagnosis, management and treatment of male fertility, and increase favorable outcome for assisted reproduction procedures.
Patients who may benefit from these tests may have indicating factors such as:
- Advanced chronological age
- Multiple failed IVF/ICSI treatments
- Poor blastocyst development
- Recurrent miscarriage
- Unexplained infertility