Androlog Mail
In response to Dr. Eliasson,s inquiry (regarding 2% astenoteratozoospermia)
Androlog 01/03/2001
1: Reproductive history: Male, 38 years of age, teacher, healthy with no
family history of infertility, no surgical procedures, no toxic habits, not
on medication. No high temperatures in the last three months. Physical
examination: normal build, right testicle 22 ml right, left testicle 20ml .
Vas deferens can be palpated, prostate flat, not painful, variocele no
observed. His wife is 35 years of age, sterility study normal (HSG, hormone
level determinations, biopsy of the endometrium, regular periods). The
couple came to the clinic after 23 months of primary sterility.
2-3.- (How many samples....) Five semen samples were analyzed with three
semen cultures over an eleven week period.
4.- (What was the degree of progressive motility?) The degree of progressive
motility has always been type ++ and only one sample showed some sperm with
a degree of motility type +++
5.- (How long...) The samples were always processed within one hour of being
obtained by the patient and were observed by myself personally on each
occasion.
6.- (What method....) The vitality test was run with Eosine/Negrosine.
7.- (% live?) I apologise for not having expressed myself clearly. I meant
to say 14% of sperm were live and the total morphology ranged between 28 and
37 % normal sperm (head, middle and tail) in the 5 semen samples (a count of
200 sperm). Rapid stain Dif-Quick technique following the WHO criteria.
8.- (What do you mean with proper collection?) The patient was instructed to
wash his hands and genitals before obtaining the sample and then to dry
properly. Whilst giving the sample the patient was told at all times to
avoid hand/semen contact. Once the sample had been collected, the patient
placed the sterile container in contact with the body and came into the
centre within the hour.
9.- (What do you mean with 'normal morphology'?) It is difficult to answer
the question regarding semen of normal morphology in fertile patients,
since, as in most cases, I have seen patients with between with 4-5% sperm
of normal morphology who are normally fertile, whilst others with sperm of
normal morphology were not. What I can say is that, 30% 'normal' forms is
what I consider normal. I can also state , that if the patient takes
recourse to ART and if the cause of the sterility is only in the male whose
spermatozoa morphology is below 15%, ICSI shall be carried out, and if it is
between 15-30%, AI or IVF are used. All the above if there are no other
conditioning factors
13.- (Quality control) Regarding quality control, I believe this is a most
important issue in the 'Reproduction Laboratories', and this is now being
developed in my country. All I can say for the time being unfortunately, is
that I have my 'own quality control', based on 16-years' experience in
Clinical and Laboratory andrology. (My teacher was Dr.Brassesco)
I apologise for not including these data in my query to Andro-mail, and you
are quite right in saying that most of the questions are based on the
quality of the semen and not on the andrological studies carried out, if
any. In my experience, these problems of sterility are being resolved more
and more frequently “short cut”, particularly among males and more
especially after ICSI has come into being. On top of this, in my country it
is more and more common for couples to marry in their thirties, and plan
their first child at around the age of 33 they then come to us when they are
having problems, around age 35, with immediate results. In my opinion all
this has a negative effect on Adrology as a Science.
Yours sincerely
Carlos Garcia-Ochoa, M.D.
Andrologist
Clinica CEFIVA
Santa Susana,31
33007-Oviedo. Spain
Phone: + 34 985259393
Fax +34 985347070
e-mail: andro@netcom.es
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