Basic sperm examination:

This examination includes a cell count; examination of the motility and its quality; morphological examination of the sperm cells using a regular light microscope; presence of agglutinations, examination of the semen's viscosity and pH.
Example of an answers sheet for this examination

           Special sperm examinations

High magnification (x6000) motile sperm organellar morphology examination (MSOME)

This examination is recommended in the following cases:
For couples with unexplained infertility who in the past failed in IVF using the micromanipulation (ICSI) technique.

For couples who in the past failed in IVF using the micromanipulation (ICSI) technique on a background of a morphological problem in the sperm cells.

For men in whose semen no sperm cells were observed in a routine sperm examination or in whose semen sperm cells were observed but they were immotile.

The aim of this examination is to clarify whether the failure stemmed from an impaired quality of the sperm cell head that cannot be observed using regular microscopy. In this case it may be assumed that micromanipulation will be more successful after individual selection of sperm cells with a normal nucleus (IMSI).
However, if the examination reveals that the rate of sperm cells with a normal nucleus in these men is high (>10%), then the cause for the previous failure in ICSI may stem from the quality of the eggs. In this case selection of the sperm cells will not afford a relative advantage for routine ICSI.

The examination itself is carried out on 150 random motile cells that would usually have been chosen by an embryologist for injection using the routine micromanipulation technique. These cells are used to determine the rate of sperm cells in the population with a normal nucleus. The results of this examination will sometimes indicate 0 sperm cells with a normal nucleus. In these cases great effort will be made on the IVF day in order to scan several thousands of cells, and then a good chance exists that isolated cells with a normal nucleus will indeed be found. Example of an answers sheet for this examination.

Search for sperm cells

This examination is recommended in the following cases:
For men who were found to be azoospermic.
For men who were found to have complete asthenozoospermia (0% motility).
For men who underwent testicular sperm extraction or aspiration (TESE/TESA, respectively) or testicular fine needle aspiration (TFNA).

In this examination we concentrate the semen and scan the entire precipitate under a special light microscope with a magnification power of x6000, thus increasing its search ability . A high magnification also enables viewing the single cells whose tails are vibrating. These cells are viable and can be used in IVF using the micromanipulation technique .

Summary of results
Summary of results performed lately in our lab reveled that in 113 men who where found to be azoospermic using regular examinations, when high power magnification was used sperm cells were found in the ejaculate of 22% of the cases. In those men an overage of 10 sperm cells per men were found. Following selection of these sperm cells according to their quality and using the selected sperm cells in IVF, resulted in 47% pregnancy rate. In 30 men to whom sperm cells were found in testis tissues (TESE, TESA, TNFA), sperm cells selection prior to IVF resulted in 53% pregnancy rate.

Sperm search in the ejaculate of non obstructive Azoospermic patients using MSOME
(2.2005-8.2008)

Patient number	Sperm cells
88 (77.8%)	Not found
25 (22.1%)	Found 10.8±13.1 sperm cells in average (range 1-65)

IMSI pregnancy outcome in non obstructive Azoospermic patients

	Men age	Woman age	Best sperm cells	Second best sperm cells	Clinical pregnancy rate
Ejaculate sperm cells	34.3±6.5	31.4±5.6	3.0±4.8	2.8±3.5	46.7%
Testicular sperm cells	35.9±4.8	32.1±4.4	3.6±3.7	6.6±6.5	53.3%

Treatment of the sperm

In our laboratory, treatment of the sperm is carried out on a density gradient. These treatments are qualitative and their goal is to increase the pregnancy rate. For the convenience of the patient and the physician, we carry out this treatment every day of the week and at all hours of the day (except for on the Sabbath). After 30-40 minutes of treatment of the semen, the treated fraction of cells is transported by the couple to the treating physician's office for intra-uterine insemination.
Example of an answers sheet for this examination.