Semen analysis, also known as a sperm count test, analyzes the health and viability of a man’s sperm. The World Health Organization estimates that the number of couples affected by infertility is currently 15 percent of all couples attempting to have children. The difficulties are attributable to a significant male factor alone in 30 percent of couples Semen is the fluid containing sperm (plus other sugar and protein substances) that’s released during ejaculation. A semen analysis measures three major factors of sperm health:
The number of sperm
The shape of the sperm
The movement of the sperm, also known as “sperm motility”
To get the best sample:
Avoid ejaculation for 24 to 72 hours before the test.
Avoid alcohol, caffeine, and drugs such as cocaine and marijuana two to five days before the test.
Avoid any hormone medications as instructed by your healthcare provider.
Discuss any medications you’re taking with your doctor.
Getting a good sample:
The semen must be kept at body temperature. If it gets too warm or too cold, the results will be inaccurate. Semen must be delivered to the testing facility within 30 to 60 minutes of leaving the body.
Sperm concentration 15 millions/ml
Total sperm count >39 million /ejaculate
Motility 32% progressive motility
Leucocytes < 1 million/ml
Round cells <5 million/ml
Sperm agglutination <10% spermatozoa
Sperm count: Measures the concentration of sperm in a man’s ejaculate, distinguished from total sperm count, which is the sperm count multiplied with volume
MOTILITY: The motility of sperm are divided into four different grades:
Grade a: Sperm with progressive motility. These are the strongest and swim fast in a straight line. Sometimes it is also denoted motility IV.
Grade b: (non-linear motility): These also move forward but tend to travel in a curved or crooked motion. Sometimes also denoted motility III.
Grade c: These have non-progressive motility because they do not move forward despite the fact that they move their tails. Sometimes also denoted motility II.
Grade d: These are immotile and fail to move at all. Sometimes also denoted motility I.
Sperm morphology, the WHO criteria state that a sample is normal if 4%.
Morphology is a predictor of success in fertilizing oocytes during in vitro fertilization.
Up to 10% of all spermatozoa have observable defects and as such are disadvantages
in fertilizing an oocyte. Sperm cells with tail-tip swelling patterns generally have lower frequency of aneuploidy.
A motile sperm organelle morphology examination (MSOME) is a particular morphologic investigation wherein an inverted light microscope equipped with high-power optics and enhanced by digital imaging is used to achieve a magnification above x 6000, which is much higher than the magnification used habitually by embryologists in spermatozoa selection for intra cytoplasmic sperm injection (x200 to x400). A potential finding on MSOME is the presence of sperm vacuoles, which are associated with sperm chromatin immaturity, particularly in the case of large vacuoles.
According to one lab test manual semen volumes between 2.0 mL and 5 mL are normal; WHO regards 1.5 ml as the lower reference limit. Low volume may indicate partial or complete blockage of the seminal vesicles, or that the man was born without seminal vesicles. Volume less than 2 mL in the setting of infertility and absent sperm should prompt an evaluation for obstructive azoospermia.
Sexually transmitted diseases also affect the production of semen. Men who are infected with the human immunodeficiency virus (HIV) produce lower semen volume.
Semen normally has a whitish-gray color. It tends to get a yellowish tint as a man ages. Semen color is also influenced by the food we eat: foods that are high in sulfur, such as garlic, may result in a man producing yellow semen. Presence of blood in semen (hematospermia) leads to a brownish or red colored ejaculate. Hematospermia is a rare condition.
Semen that has a deep yellow color or is greenish in appearance may be due to medication. Brown semen is mainly a result of infection and inflammation of the prostate gland, urethra, epididymis and seminal vesicles. Other causes of unusual semen color include sexually transmitted infections such as gonorrhea and chlamydia, genital surgery and injury to the male sex organs.
Fructose level in the semen may be analyzed to determine the amount of energy available to the semen for moving. WHO specifies a normal level of 13 μmol per sample. Absence of fructose may indicate a problem with the seminal vesicles.
According to one lab test manual normal pH range is 7.1-8.0; WHO criteria specify normal as 7.2-7.8. Acidic ejaculate (lower pH value) may indicate one or both of the seminal vesicles are blocked. A basic ejaculate (higher pH value) may indicate an infection. A pH value outside of the normal range is harmful to sperm and affect their ability to penetrate the egg.
The liquefaction is the process when the gel formed by proteins from the seminal vesicles is broken up and the semen becomes more liquid. It normally takes less than 20 minutes for the sample to change from a thick gel into a liquid. In the NICE guidelines, a liquefaction time within 60 minutes is regarded as within normal ranges.
Total motile spermatozoa:
Total motile spermatozoa (TMS) or total motile sperm count (TMSC) is a combination of sperm count, motility and volume, measuring how many million sperm cells in an entire ejaculate are motile.
Use of approximately 20 million sperm of motility grade c or d in ICSI, and 5 million ones in IUI may be an approximate recommendation.
ASPERMIA: Failure of emission of sperm
Oligospermia / oligozoospermia: Sperm count is 15mil/ml
Polyzoospermia: Count is .350mil/ml
AZOOSPERMIA: No spermatozoon in the semen
Asthenozoospermia: Reduced sperm motility
LEUCOCYTOSPERMIA: Increased white cells in semen
NECROZOOSPERMIA: Spermatozoa are dead
TERATOZOOSPERMIA: .70%Spermatozoa with abnormal morphology
OLIGOASTHENOTERATOZOOSPERMIA: Disturbance of all 3 variable
Other possible causes of male infertility tests can include:
Scrotal ultrasound: This test uses high-frequency sound waves to look at the testicles and supporting structures.
Hormone testing: Your doctor might recommend a blood test to determine the level of hormones produced by the pituitary gland and testicles, which play a key role in sexual development and sperm production.
Follicular stimulating hormone (FSH):
High-Testicular Failure (Small testicular volume).It may be genetic cause kleinfelters syndrome or Testicular atrophy.
Low-Hypogonadotropism (Kallmans syndrome).
Normal-Testicular biopsy to be done. If spermatogenesis normal there is obstruction to efferent ducts.
If spermatogenesis is absent then we have to go for donor sperms.
TESTOSTERONE: If testosterone is low and FSH is low then its hypogonadotopic hypogonadism. Hormonal therapy is required for that If testosterone is low and FSH is high then its testicular failure. We should go for donor sperms.
Post-ejaculation urinalysis: Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).
Genetic tests: When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome, signs of a genetic abnormality. Genetic testing might also be ordered to diagnose various congenital or inherited syndromes.
Testicular biopsy: This test involves removing samples from the testicle with a needle. The results of the testicular biopsy can tell if sperm production is normal. If it is, your problem is likely caused by a blockage or another problem with sperm transport. However, this test is typically only used in certain situations and is not commonly used to diagnose the cause of infertility.
Anti-sperm antibody tests: These tests, which are used to check for immune cells (antibodies) that attack sperm and affect their ability to function, are not common.
Specialized sperm function tests: A number of tests can be used to check how well your sperm survive after ejaculation, how well they can penetrate an egg and whether there’s any problem attaching to the egg. Generally, these tests are rarely performed and often do not significantly change treatment recommendations.
Transrectal ultrasound: A small lubricated wand is inserted into your rectum to check your prostate, and for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).
Surgery: For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
Treating infections: Antibiotics can cure an infection of the reproductive tract, but this doesn’t always restore fertility.
Treatments for sexual intercourse problems: Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
Hormone treatments and medications: Your doctor might recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
Assisted reproductive technology (ART): ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm are then inserted into the female genital tract, or used for in vitro fertilization or intracytoplasmic sperm injection.
When treatment doesn’t work:
In rare cases, male fertility problems can’t be treated, and it’s impossible for a man to father a child. If this is the case, you and your partner can consider either using sperm from a donor or adopting a child.
Lifestyle and home remedies:
There are steps to take at home to increase your chances of getting your partner pregnant, including:
Increasing the frequency of sex: Having sexual intercourse every day or every other day beginning at least four days before ovulation increases your chances of getting your partner pregnant.
Having sex when fertilization is possible. A woman is likely to become pregnant during ovulation which occurs in the middle of the menstrual cycle, between periods. This will ensure that sperm, which can live several days, are present when conception is possible.
Avoiding lubricants: Some products such as Astroglide or K-Y jelly, lotions, and saliva might impair sperm movement and function. Ask your doctor about sperm-safe lubricants.
Evidence is still limited on whether or how much herbs or supplements might help increase male fertility. None of these supplements treats a specific underlying cause of infertility, such as a sperm duct defect or chromosomal disorder. Some supplements might help only if you have a deficiency.
Supplements with studies showing potential benefits on improving sperm count or quality include:
Alpha-lipoic acid, Anthocyanins
Biotin, L-acetyl carnitine
Folic acid, Glutathione
Magnesium, N-acetyl cysteine
Pentoxifylline, Phosphodiesterase-5 inhibitors
Polyunsaturated fatty acids
Selenium, Vitamins A, C, D and E, Zinc