Sperm Motility, Progression and Total Motile Cells

Sperm Motility, Progression and Total Motile Cells and how they are important in IUI (intrauterine insemination) procedures.

By: Stephen H. Pool, Ph.D.

Sperm motility is typically expressed as a percentage. It is the number of moving cells divided by the total concentration (number moving plus non-moving cells) of cells in the sample. For example; if you count 50 moving cells out of a total concentration of 100 cells you have a sample that has 50% motility.

In addition to motility, it is important to have sperm that swim in a linear direction. This is called the progression score. Progression scores range from not moving (0) to rapid linear movement (4). All fresh (non-processed) and frozen thawed semen samples generally have individual sperm that exhibit all progression scores. The average progression score for a fresh or frozen thawed semen sample is between 2 and 3.

Total Motile cells (TMC) is the number of moving cells, typically expressed in millions/ml (milliliter). The motile cells are the cells that are alive and moving in a semen sample and are critical to the fertilization process. Non-motile cells are unable to fertilize the egg on their own. It is the movement of sperm that allows them to swim through the reproductive tract and come in close proximity to the egg, attach and penetrate the egg to cause fertilization.

Therefore, when performing an insemination, physicians are primarily concerned with progression and TMC. You can have a sample with 20% of the cells that are motile and a sample with 30% of the cells that are motile but if the TMC is the same for each sample, the chance of achieving pregnancy from that sample is the same.

It is not so much the percentage of cells that are motile in the insemination dose as much as it is to have an adequate number of motile cells. Physicians prefer to inseminate with a minimum of 5 and 10 million TMC in order to achieve reasonable pregnancy rates with an IUI procedure.

The literature reports pregnancy rates of between 10 and 20% per insemination cycle when the insemination dose contains 5 to 10 million TMC. Another study reported that using between 200,000 and 200 million motile sperm per insemination had no significant relationship between sperm dose and pregnancy rate. Finally, one study reported 44% of the women in the study became pregnant after 3 insemination cycles and 69% of the women became pregnant after 6 insemination cycles.

Book Review and Coping Tips

A blog review of a recent book has some useful tips for overcoming the stigma of infertility. The book, out a few years ago is called "Tiny Toes: A Couple’s Journey Through Infertility, Prematurity, and Depression" by Kelly Damron. It is a personal story of a couple's struggles to start a family. The book not only tackles the subjects of infertility, premature birth, and post natal depression; it also takes a look at how relationships change when couples are faced with challenges. This book is a great resource for readers to prepare for and deal with the emotional issues of infertility. This blog article also includes 5 tips for overcoming the "stigma" of infertility. By learning how to talk about infertility couples can improve their emotional, mental and physical well being.

Door to Russian Adoption Slowly Closes

Similar to the country of South Korea, Russia is now trying to decrease the number of foreign adoptions. Seventeen years ago Russia starting allowing international adoptions and since then over 50,000 Russian children have been adopted by Americans. In 2008 1,800 Russian children were adopted by Americans which was down from a high of 6,000 a few years ago. According to this article the country is now encouraging Russians to adopt and is streamlining the internal adoption process while the adoption process for foreigners has become more and more difficult. Foster care was also recently introduced. It has become much harder for foreigners to adopt healthy children. Nadezhda Gertman, head of child welfare in Russia says 62 percent of children in orphanages suffer from serious psychological problems that are difficult to treat. Gertman claims that Russia cannot afford to lose its children. "We have more and more older people and fewer and fewer young ones because of the drop in the birth rate," she says. "The work force is shrinking. We need to keep our young people."

Tough Case? How To Find a Clinic

By: Kathleen

Women who have a high follicle stimulating hormone (FSH) level or have been diagnosed with diminished ovarian reserve (DOR) often have trouble finding an IVF clinic who will work with them if they want to use their own eggs. Sometimes these patients have already been labeled a "poor responder" by an IVF clinic. Some clinics refuse to work with these patients or advise them to consider egg donation or adoption. If you are not willing to give up yet it is worth the effort to get second or third opinions. There are clinics out there who have specific protocols for patients with DOR. And it is important that a physician considers your entire medical history. You may find that the experience and expertise of the doctors at one of these clinics can make the critical difference!

Polycystic Ovary Syndrome

By: Ervin E. Jones, MD, PhD, HCLD, FACOG
Genetics & IVF Institute

Polycystic ovary syndrome is the most common cause of infertility due to disorders of ovulation in reproductive age women. Abnormal menstrual cycle is often the earliest manifestation of ovulatory deficiency in these women. The fertility rate among women with polycystic ovary syndrome is approximately 2.5 fold less than that of normal reproductive age women. Polycystic ovary syndrome is also the most common endocrine disorder of the reproductive age woman and, therefore, carries considerable metabolic risk.

A syndrome is a constellation of symptoms and signs indicative of a disorder or disease. Polycystic ovary syndrome, as originally described by Stein and Leventhal in 1935, is a complex disorder of young women consisting of amenorrhea (lack of menstruation), hirsutism (increased hair growth) and obesity. There has been ongoing debate regarding the definition and diagnosis of polycystic ovary syndrome since it was originally described. The most widely used definition is the presence of excessive male hormones and irregular or complete absence of ovulation after exclusion of other known disorders. The Rotterdam consensus conference of 2003 characterized two types that are inclusive of the spectrum of this disorder. Type I polycystic ovary syndrome is described as the presence of excessive male hormones with polycystic ovaries and normal ovulation. Type II polycystic ovary syndrome is described as polycystic ovaries and irregular ovulation without evidence of excessive male hormones. Viewed differently, polycystic ovary syndrome can be defined as two subgroups of women with polycystic ovaries -- those with evidence of excessive male hormones who ovulate and those without evidence of excessive male hormones who do not ovulate. The presence of polycystic ovaries alone does not constitute polycystic ovary syndrome.

Polycystic ovary syndrome may also be an early manifestation of excessive insulin secretion that may cause cardiovascular and metabolic complications later in life. Polycystic ovaries can be detected in up to 70.4% of women reporting both abnormal growth of hair and abnormal or a complete lack of menstruation.

The diagnosis of polycystic ovary syndrome is primarily achieved through clinical history and physical findings. The principal features are increased hair growth or other biochemical evidence of excess male hormone production, which also includes acne, male pattern baldness and male pattern hair growth. Irregular menstrual bleeding is a key presentation in the infertile women with polycystic ovary syndrome.

Associated findings include insulin resistance, increased insulin secretion and obesity. On ultrasound, the ovaries may be enlarged and contain numerous small follicles arranged either in a chain bead pattern just beneath the surface or distributed throughout the substance of the ovary. Some investigators have also described abnormal blood flow to the ovaries in women with polycystic ovarian syndrome. Hormone tests will assist the physician in making the diagnosis. Over secretion of the pituitary hormones LH and FSH, which tell the ovary how to work, is a key finding in some, but not all, patients with polycystic ovary syndrome. Increased production of male hormones produced by the ovary is another cardinal finding in patients with polycystic ovarian syndrome. Measurements of glucose and insulin levels, as well as a lipid profile, are highly recommended in obese individuals.

Treatment must, obviously, depend on the desires of the individual patient. Women with polycystic ovary syndrome exhibit exaggerated responses to ovarian stimulation, abnormal egg development, implantation failure, and pregnancy loss. If the patient is concerned about menstrual irregularity and wishes to become pregnant, controlled ovarian stimulation with ovulation inducing drugs including clomiphene citrate, gonadotrophin or a combination of these combined with intrauterine insemination should be first line options for treatment. Clinical strategies that improve pregnancy outcome and minimize pregnancy loss in women with polycystic ovary syndrome must be sought. Correction of follicle growth to improve fertility, optimization of follicular responsiveness to gonadotropin therapy, and enhancement of pregnancy outcome either by controlled ovarian stimulation or in vitro fertilization must be the clinician's first goal.

With proper diagnosis and treatment, women with polycystic ovary syndrome may enjoy more regular menstrual cycles, overcome the troubling symptoms of the condition and become pregnant if they wish to have a baby.

Frontiers in Preimplantation Genetic Diagnosis and Screening (PGD/S)

By: Gary L. Harton, BS, TS(ABB) and Shelby Duffer, MS, CGC

Preimplantation genetic diagnosis (PGD) was first developed in 1990. Dr. Alan Handyside's lab in London was the first to be able to take a single cell from a three-day old embryo and use the genetic material inside that cell to run a genetic test. This allowed him to choose embryos that would not have the specific genetic disease carried by the biological parents. Since the embryos were screened before implantation, there were fewer worries about the health of an ongoing pregnancy and increased chances that any required prenatal testing would be normal. PGD was a revolution in genetic testing and was quickly adopted by a number of assisted reproductive technology (ART) centers around the world. Today, PGD is available for a large variety of genetic diseases. In recent years, it has been proposed that preimplantation information about embryos might be helpful for many couples experiencing infertility. Abnormalities in the chromosomes (the genetic material inside the cell) are responsible for a large percentage of pregnancy losses. Preimplantation genetic screening (PGS) is the testing of a single cell from an embryo for these common chromosomal anomalies. Our expectation is that finding and eliminating chromosomally abnormal embryos during an IVF cycle will increase pregnancy rates and help patients deliver more healthy children. Currently PGD only examines a few of the 24 human chromosomes. This detects common abnormalities, but leaves many untested. New technologies are emerging that will allow testing of all 24 chromosomes for errors as well as the ability to combine general chromosome screening with specific genetic disease diagnosis. Genetics & IVF Institute (GIVF) is collaborating with the father of PGD, Dr. Alan Handyside (The London Bridge Fertility, Gynecology and Genetics Centre, London) on a new PGD technology called Karyomapping. Our collaboration presented data this year describing this technique at the prestigious American Society for Reproductive Medicine (ASRM) meeting. It allows the simultaneous detection of anomalies in all 24 chromosomes and virtually any genetic disease in embryos. The ASRM meeting also included presentations on another new PGD technique called comparative genomic hybridization (CGH). An American/English partnership showed initial information confirming very good pregnancy rates into the third trimester following testing of all 24 chromosomes. GIVF continues to be a leader in the development of new technologies and new applications of science to assisted reproduction and infertility treatment. These new techniques may be the next step in allowing doctors and scientists to choose the best embryos for transfer in IVF cycles.

Molecular Testing May Transform Medicine

For the last 20 years PCR technology has been at the forefront of molecular testing. According to a recent report new technologies are entering the marketplace and will change the medical field as we know it today. The report predicts that physicians will come to rely on them for early detection of disease and prediction of a patient's response to specific therapies. By making molecular testing cheaper, better, and faster; a future can be imagined in which these technologies will be found in every doctors office, offering simple and accurate results instantly. It is predicted that the molecular testing market (valued at 3.7 billion in 2007) will expand by double-digit growth through 2012.

A New Window Into Early Life

A recent breakthrough in medical imaging is shedding light on the first days of life. As this article describes, researchers used a technique called Digital Scanned Laser Light-Sheet Fluorescence Microscopy to obtain some truly miraculous footage. By taking a picture every 10 minutes over the course of a day, the video shows thousands of cells organizing into structures in the early embryo. It has already led to some new understanding of these early development processes.