A new twist to the traditional career choice.
Artificial insemination, with sperm provided by either the husband or a donor, has become a popular option for many infertile couples. Laboratory testing in this area has also grown, thereby creating an exciting new career opportunity for medical technologists.
Andrology, which deals with male fertility problems, was once dominated at the laboratory bench by technicians holding a bachelor's degree in biology. Physicians are now considering MTs for the job because of their clinical background and expertise in the necessary techniques.
I became the first medical technologist to work in the andrology laboratory at the University of Pennsylvania Hospital. The lab is operated by the division of human reproduction and reproductive biology in the department of obstetrics and gynecology.
A newspaper ad for a sperm bank coordinator drew me into the field. After three years as a rotating technologist and diener at another Philadelphia hospital, I was ready to move on. True, I had no cell culturing experience--one reason that some technologists may not apply--but I mastered every technique I would need in two weeks. The only other major adjustment was getting used to constantly working under a sterile hood.
Besides a supervisor and me, the andrology testing staff consists of two technicians in separate sections handling RIA and the hamster assays (the latter evaluate sperm penetration into a hamster egg). I rarely see another medical technologist during my workday and have nothing to do with the clinical laboratory.
The andrology lab operates from 8:30 a.m. to 4:30 p.m., Monday through Saturday. On an average day, we may do sperm washings for about six patients. The workload is typical of obstetrics and gynecology in that much depends on ovulation. Some days are fairly relaxed, and we are able to take a leisurely look at the slides. However, when several women ovulate at once, we become busy processing the husbands or tracking down donors, and preparing the specimens for insemination. Although we do store frozen sperm, we prefer if possible to bring in a donor for a fresh specimen on the recipient's ovulation date; this improves the chances for pregnancy.
The routine andrology workup employs several basic tests to assess sperm function. To start, the patient abstains from sexual activity for 48 hours, then collects a semen specimen in a sterile container. Abstinence insures maximal test results.
The specimen, allowed to liquefy at 37 C, is delivered to the laboratory for immediate analysis. It is transferred to a graduated centrifuge tube, and volume, viscosity, and pH are recorded. A morphology slide is prepared in the same way as a white blood cell differential. The slide is left to dry for later microscopic examination, and a wet mount prep is made and stained with a 5 per cent eosin solution. The technologist evaluates motility, progression, and viability of the sperm and reports the results as a percentile.
Next, a 1:20 dilution of semen to distilled water is prepared using an automatic pipettor, and a Nuebauer ruled hemocytometer is charged and counted using the same ruled area as in a manual white blood cell count. The specimen is maintained at 37 C throughout the entire workup to insure valid test results. When testing is completed, the physician evaluates the parameters of the semen analysis, arrives at a diagnosis, and chooses a course a therpay if necessary.
When a patient demonstrates oligospermia (decreased sperm count) or antisperm antibodies are found in either blood plasma or seminal plasma, sperm washing is one promising treatment. This simple procedure begins with an abbreviated semen analysis on a fresh specimen. An enriched media is then used to wash the sperm by gentle mixing and centrifugation. The resulting concentrated sperm pellet is overlaid with media supplemented with human serum albumin and placed at a 45-degree angle in a 37 C, 5 per cent CO2 incubator.
Sperm cell capacitation, which involves shedding the outer layer of the sperm head, can be accomplished in vitro during the washing and incubation period. Afterward, the specimen is analyzed to evaluate motility and progression and to get a count. This fraction-- into which the most viable sperm have "swum up'--is delivered to the physician for intrauterine insemination.
Another type of testing that andrology and clinical laboratories have in common is radioimmunoassay. We now know that many cases of male inferility stem from immunological factors. Antisperm antibodies can cause sperm agglutination, which results in poor motlity and progression.
The direct antibody test detects the presence of IgG and/or IgA immunoglobulins on the human sperm cell membrane. Washed sperm is incubated with radiolabeled antibodies, and specific binding higher than the normal control is reported as positive for the particular antibody.
The indirect antibody test detects the presence of IgG immunoglobulins directed against sperm in blood plasma and seminal plasma. In this assay, donor sperm known to be negative for antisperm antibodies is preincubated with the patient's plasma, and radiolabeled goat antihuman IgG is then added. Increased specific binding in the previously negative donor sperm indicates the plasma specimen is positive for IgG antibodies.
We have about as many husband inseminations as donor inseminations. In cases where the husband's semen can be used, we are usually dealing with a correctable mucous or antibody problem as opposed to oligospermia.
Occasionally, a husband's sphincter abnormality causes retrograde ejaculation, and the sperm goes into the bladder. We can spin down urine specimens and immediately pour off the urine to salvage the sperm. Although we will try to spin down and combine multiple semen specimens when the husband is oligospermic, in severe cases our physicians generally recommend that the couples consider donor insemination.
The hospital's AID (artificial insemination by donor) program offers a glimmer of hope to couples when a severe male fertility problem cannot be corrected. It is the only choice in cases of azospermia, or complete absence of sperm.
A donor pool of approximately 25 medical and dental students is maintained. One of the advantages of using students is that they generally live nearby and can almost always come in on short notice if necessary.
The donors are carefully selected. Compatible blood type is the first priority, but the AID program also tries to match the donor's physical characteristics with those of the husband or even the wife. To this end, photos of the prospective parents are attached to the medical chart.
All potential donors undergo extensive screening. Besides determining their blood type, karyotype, and fertility status, we test for hepatitis, syphilis, gonorrhea, human immunodeficiency virus antibodies, Tay-Sachs disease, and sperm-associated antibodies. Once accepted in the program, donors are tested periodically for exposure to HIV.
Donor specimens are frozen at --180 C in liquid nitrogen by the cryopreservation method. Glycerol serves as the cryoprotectant and helps prevent the cell membrane damage that can occur with rapid temperature changes during freezing and thawing.
If they consistently provide good specimens, donors may give every other day. They are paid $25 for specimens collected for insemination--$35 if called in on a weekend--and $15 for research specimens. The program does not advertise. Most donors are referred by other participants.
All donor information remains strictly confidential to protect the donor, recipient, and possible off-spring, and all participants sign consent forms prohibiting future contact. Some donors worry that a child might someday come looking for his "real' father, while some recipients are concerned about subsequent paternity claims. Records are sealed and locked in the lab. However, we make sure that donors understand that a court could reverse the program's guarantee of anonymity-- say, if the child needed a kidney transplant.
Andrology is a fascinating speciality, offering a combination of clinical and research responsibilities. Certified medical technologists who have mastered such skills as pipetting, centrifugation, and serial dilution may be pleasantly surprised at how easily they can adjust to an andrology lab. However, technologists may have to take the initiative and search out opportunities in this field, since many times these jobs are advertised under "nursing' or "technician.'
I may have been the first medical technologist to work in our andrology laboratory, but I won't be the last. It pleases me to report that my performance led to a change in the job requirements. Only medical technologists will be hired in the future.
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|Title Annotation:||andrology testing|
|Author:||Goldsmith, Gail E.|
|Publication:||Medical Laboratory Observer|
|Date:||Jun 1, 1987|
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