Western Fertility Instiutute employs a method of washing sperm that allows HIV positive men to have children safely using assisted reproductive technologies.
The following section offers insights into semen and sperm production, available collection processes, freezing/cryopreservation, and sperm washing.
The Physiology of Sperm Production
Hormones play a big part in regulating sperm production. The hypothalamus in the brain releases gonadotropin-releasing hormone (GnRH) that stimulates the anterior pituitary gland to release both luteinizing hormones (LH) and follicle-stimulation hormones (FSH). LH and FSH are the two gonadotropins (hormones that act on reproductive organs) crucial for reproductive function. FSH acts on the Sertoli cells in the testes to promote sperm production, and LH acts on Leydig cells in the testes to promote the release of testosterone, which also promotes sperm production. This whole system is regulated by a negative feedback loop that maintains testosterone, LH, and FSH at an optimal level.
Regulating a normal balance of these hormones is critical. Both lower and higher-than-normal testosterone levels can result in lower sperm counts. Low testosterone can limit sperm production, which is often the reason for lower fertility in older men, as testosterone tends to decrease with age. High testosterone, often due to uncontrolled supplemental testosterone, signals negative feedback to the brain to inhibit the production of FSH and LH, the other hormones critical for sperm production.
Spermatogenesis (sperm production) takes place in the testes. This process is where undifferentiated male germ cells, also known as spermatogonium, undergo cell growth and division, leading to the formation of sperm. This newly formed immotile sperm will undergo further maturation in the epididymis, a structure behind the testes. The sperm will develop the ability to move independently to reach the egg. This whole process of sperm creation and maturation takes around 74 days, with millions of sperm produced daily.
Mature sperm are stored in the epididymis until it is ejaculated. Ejaculation involves sperm from the epididymis entering the connected duct called the vas deferens, where the sperm is joined with secretions from three accessory glands: the seminal vesicles, the prostate, and the bulbourethral glands. These secretions aid in the transport and safety of the sperm and contribute to most of the semen volume.
As men age, sperm quality tends to decrease, and the abnormality of genetic material in sperm tends to increase. However, this trend is not as drastic compared to women with their eggs, allowing men to stay fertile even in later stages of life. Males dealing with infertility may have little to no sperm present in their ejaculate, which can be due to various factors. Semen analysis and further testing can be done to identify sperm quality and infertility-causing factors.
In most cases, we suggest ejaculating daily for the days leading up to a collection for semen analysis, sperm freezing, or IVF procedures. The longer sperm is stored in the body, the higher the chance of DNA damage to the sperm. Frequent ejaculation will filter out older, damaged, and dead sperm as much as possible, helping to maximize sperm quality, including motility, morphology, and genetic health of sperm. However, with a very low sperm count, more days of abstinence may be recommended.
Eating antioxidant-rich foods such as berries, dark chocolate, nuts, and colorful vegetables can benefit sperm quality as they help decrease oxidative stress. Oxidative stress harms sperm as it increases the likeliness of DNA fragmentation and can negatively affect sperm motility.
Sperm is temperature sensitive. The body naturally regulates the temperature of sperm through the descending and ascending of the testicles. If possible, limit wearing tight-fitting underwear as it can disrupt this temperature-regulating process. Specifically, heat can be damaging to sperm. Therefore, activities requiring long exposure to heat, such as hot tubs and extensive exercise, are not optimal.
A semen analysis is a lab test where semen is examined under the microscope to determine various quantitative and qualitative factors of the semen and sperm. This effectively determines the presence of male factor infertility or follow-up after a vasectomy. Below are the main characteristics that we look at in a semen analysis:
Volume (ml): Total volume of semen from one ejaculation.
Concentration (million sperm/ml): The concentration of sperm in the semen. It is measured by the number of sperm in one milliliter of semen.
Count: Total number of sperm present in the semen from one production. It is calculated by multiplying the volume by the concentration of the ejaculate.
Motility: Percentage of sperm that is moving in the sample.
Forward Progression: Percentage of sperm moving forward in the sample. We also note the quality of forward progression in terms of speed and direction.
Morphology: The percentage of normally shaped sperm. We use the Kruger strict morphology analysis.
White Blood Cells: The concentration of white blood cells in the semen. This can be indicative of infection or inflammation.
There is not much you will need to do to prepare for your semen collection. In most cases, frequent ejaculation is recommended leading up to your collection day. For more information on this and other ways to potentially improve sperm quality, please refer to the improving sperm quality section.
What to Expect
Once you arrive at WFI for your appointment, you will check in at the front desk and verify your identity. Lab personnel will lead you to a private collection room to discuss instructions and questions. You will be given a sterile cup labeled with your name to collect your sample. Once you have collected your sample, it is taken to the lab for analysis. You can expect the results to be ready in 1-2 business days.
Producing a sample on-site at WFI is recommended as it provides the freshest sample. However, we also offer an alternative option to collect a sample at home and bring it to WFI if that is what you prefer. This requires you to pick up a semen collection kit any time beforehand and bring the sample to WFI within 1 hour of production to ensure that the semen sample is still fresh.
What is Sperm Freezing?
Sperm freezing or sperm cryopreservation is the best way for men to preserve fertility. This procedure involves collecting and freezing sperm in vials to be stored for future use.
Why Should I Freeze Sperm?
Medical Treatments: If you are undergoing a medical treatment known to affect sperm quality, production, or ejaculation, you may be recommended to freeze your sperm to preserve your chances of having children. These treatments include cancer treatments, vasectomies, gender confirmation, testosterone treatments, and more.
IVF Treatment: If you are currently undergoing or planning to undergo IVF treatment, you may choose to freeze your sperm to have it readily available for the time of fertilization. Having frozen sperm can be a convenient option if it is difficult for you to produce a fresh sample at our clinic at the time of fertilization. Having sperm frozen as backup may also be recommended if you are concerned about your sperm quality during fertilization.
The Process: Preparation and what you can expect for your semen collection for cryopreservation appointment will be the same as a semen analysis. Depending on your situation, you may also need to get additional labs done following your semen collection via a blood draw and/or urine analysis. Collected samples will be sent to the lab to be analyzed and then frozen into vials. The number of vials frozen will depend on the volume and quality of your semen sample. Generally, one vial will be good for one IVF cycle, but having additional vials for backup is recommended.
Sperm Preparation for ICSI/IUI
Semen intended for ICSI or IUI use is washed using sperm wash media and centrifugation to separate it from the other unneeded contents of the semen, concentrating just the sperm. Depending on the semen sample, different approaches may be taken to prepare sperm. Below are some of the techniques involved in sperm preparation.
Density Gradient: If you are undergoing a medical treatment known to affect sperm quality, production, or ejaculation, you may be recommended to freeze your sperm to preserve your chances of having children. These treatments include cancer treatments, vasectomies, gender confirmation, testosterone treatments, and more.
Swim-Up: If you are currently undergoing or planning to undergo IVF treatment, you may choose to freeze your sperm to have it readily available for the time of fertilization. Having frozen sperm can be a convenient option if it is difficult for you to produce a fresh sample at our clinic at the time of fertilization. Having sperm frozen as backup may also be recommended if you are concerned about your sperm quality during fertilization.
Zymot: Preparation and what you can expect for your semen collection for cryopreservation appointment will be the same as a semen analysis. Depending on your situation, you may also need to get additional labs done following your semen collection via a blood draw and/or urine analysis. Collected samples will be sent to the lab to be analyzed and then frozen into vials. The number of vials frozen will depend on the volume and quality of your semen sample. Generally, one vial will be good for one IVF cycle, but having additional vials for backup is recommended.
HIV Sperm Wash
We offer specialized semen preparation for males with HIV wanting to undergo assisted reproduction. HIV is in bodily fluids, including semen but does not affect the sperm. This semen preparation process will allow sperm to be washed, stored, and ready to use for IVF with ICSI to create embryos.
Requirements: This process requires the patient to have an undetectable HIV viral load. The patient will need to travel to Los Angeles for three days for multiple semen collections at our clinic. The patient cannot be azoospermic, meaning sperm must be present in their ejaculate to proceed with the sperm wash.
Advantages: There is no wait time to get started. Once the sample is collected, it will be ready for fertilization in 2 to 3 weeks. This process allows sperm to be safely used without compromising embryo quality or pregnancy outcomes.
Risks: There is a theoretical risk of transmittance to the gestational carrier. However, there have been no reports of a gestational carrier testing positive after proper semen preparation.
- Consultation with an infectious disease specialist for FDA ID screening
- Blood draw for additional HIV-specific testing
- Semen production and analysis
- Semen preparation followed by cryopreservation
- HIV PCR to detect viral load in the prepared sample
In the case where a man has little to no sperm present in their ejaculate, a potential option is to retrieve sperm directly from the testicle or epididymis:
Testicular Sperm Extraction (TESE): The testicle is surgically opened, and a tissue sample is extracted. The lab then examines the sample for sperm.
Percutaneous Epididymal Sperm Aspiration (PESA): Fluid is aspirated using a small needle from the epididymis. The lab then examines the sample for sperm.
These procedures are performed by a urologist. The sperm retrieved can be used for fertilization on the same day or frozen for later use. Any leftover sperm after fertilization can also be frozen.
Frequently Asked Questions
In most cases, the doctor recommends frequent ejaculation before semen collection (0 days abstinence). However, depending on your situation, the doctor may recommend more days of abstinence.
Although the in-house collection is recommended, bringing a sample from home is a good alternative. You will need to visit our clinic before your sample collection to pick up a kit with all the things you need for a viable collection.
IUI-ready sperm has been pre-washed and purified. ICI-ready sperm is unwashed. Both are good viable options.
Only one vial is needed for each cycle. However, we do recommend purchasing one extra as a backup.
This specially engineered device can be used as an effective alternative way to prepare sperm that does not involve centrifugation. It filters sperm based on their natural swimming ability by using a membrane that only progressively motile sperm can pass. This approach may be recommended for certain patients depending on their sperm quality.
Both fresh and frozen sperm can be used to fertilize eggs. Frozen sperm can be a convenient option if you cannot produce a fresh sample on the day of fertilization. However, the freezing and thawing process will kill around half of the sperm in your sample. Therefore, for patients with poor-quality sperm or a low sperm count, using fresh sperm may be recommended.