Semen Analysis
Prerequisites:
- Before providing the sample, one must have waited 3-5 days without ejaculation. If one ejaculates (at sexual intercourse, masturbation or wet dreams), one must wait again for another 3-5 days
- The sample must be provided by masturbation, AND NOT sexual intercourse, to avoid mixing the sample with the lady's secretions, possibly altering the results.
- Ejaculating the sample straight into the special container, without touching the container from inside, or using any foreign material such as gel, soap or water upon masturbation. The container must be immediately closed and transferred to the laboratory within 30 minutes at most, without exposing it to heat, vibration or direct sun light.
- All the ejaculate must reach the container (no spills).
Conventional Semen Analysis:
Interpretation: How to read a semen report:
Sperm concentration:
Sperm concentration should be 20-50 million sperm per cubic millimeter (ml) of ejaculate.
This is totally different from "total sperm count" which is the sperm concentration per ml, multiplied by the number of millimeters (volume) of the seminal fluid. The volume of fluid has no relation to the function of the testis. It is related to sexual desire and mental relaxation. The more one is relaxed and willing to have sex, the higher the volume is.
Therefore, specialists evaluate fertility potential by checking sperm concentration rather than the total count.
It must be noted that normally, sperm concentration fluctuates within narrow limits, day to day. Only severe permanent drops are considered abnormal. Temporary mild drops are not.
Sperm Motility:
Sperm has a tail that moves side to side to push the sperm forwards. The motility (motion) is necessary for sperm to reach the ovum, noting that sperm travel a long distance from the vagina to the fallopian tube to reach her. A special type of very fast motility (forward progressive) is necessary for the sperm to the ovum.
After one hour of ejaculation, examining the percentage of motile sperm under the microscope should reveal at least 60% of sperm being motile, and at least 25% showing "forward progressive motility".
For proper judgment of motility, the sample should be ejaculated after 3-5 days of abstinence (no ejaculation) no more and no less, since further delay decreases motility. In addition, the sample should not be contaminated with foreign materials such as gel, soap or water.
Sperm Morphology:
Normal semen contains a certain percentage of abnormal forms. Upto 40% is acceptable. Abnormal forms higher than 40% of sperm may result in infertility. Normal sperm form is described in here. Abnormal forms include round head, small head, double tail..etc.
Agglutination:
This is when sperm tails are entangled with each other. This may hinder their motility.
Pus cells / White blood cells:
These cells belong to the immune system and are normally present within a certain concentration to guard the testis. Normal values are less than one million cells per cc, or 305 per high power field (HPF).
When pus cells increase in concentration, this is a sign that the testis or its accessory glands are infected with a microbe.
Semen Volume:
This is the amount of fluid in which sperm are present. The fluid id not secreted by the testis, but rather secreted by a gland called "seminal vesicle". Normal volume is 2-5 cc.
Semen volume decreases in case of high obstruction of the seminal tract (ejaculatory duct obstruction), in congenital absence of the vas deferens, in atrophy of the seminal vesicles or in cases of retrograde ejaculation.
However, the reason for decreased semen volume may be much more trivial , such as spilling of part of the ejaculate outside the collection cup, or unfavorable psychological conditions, since semen volume is related to the power of ejaculation, which in turn is related to the emotional and psychological status. So, if a man is trying to ejaculate in a laboratory and is uncomfortable with that, his semen volume will be low, despite being normal when upon normal sexual intercourse.
Viscosity and Liquefaction Time:
Semen is ejaculated in a coagulated and thick. It should liquefy totally within 30 minutes following ejaculation. Upon liquefaction, its viscosity should be light. If liquefaction time or viscosity increase, this may lead to infertility. This may occur in diseases of the prostate or seminal vesicles.
On the contrary, absent ejaculation may be a sign of ejaculatory duct obstruction
Colour
Normally, semen is greyish white. It may turn yellow in infections or jaundice, red in cases of haemospermia (blood in semen).
2-Culture and Sensitivity
When infection occurs, antibiotics are necessary to cure it. However, in many instances, bacteria can escape the effect of some antibiotics but remain sensitive to others. Culture and sensitivity is when an infected sample (semen, prostate, urine..etc) are examined in the laboratory for the effect of various antibiotics on the bacteria within, to determine which antibiotic is more effective in treating the infection.
3-Computer Assisted Semen Analysis (CASA)
When semen is examined under the microscope, the results are vulnerable to human errors. This is where computer assisted analysis comes handy. CASA spots the sperm by comparing the cells in the sample to preset video images. CASA is very accurate in determining motility and morphology, more than it is at determining sperm concentration.
3-Swim up
This test examines the actual number of highly motile sperm by getting rid of the semen fluid, microbes and pus cells that may be a cause of weak motility, and placing the sperm concentrate underneath a motility compatible medium. The set is incubated in suitable conditions for one hour, after which the medium is examined for the number of sperm that has left the concentrate and invaded the medium. The number is proportional to the forward progressive motility. Swim up determines if the sample is suitable for normal conception, IUI or if IVF is necessary.
4-Sperm Function Tests
Sperm count, motility and morphology can be deducted from semen analysis. However, its actual capability for penetrating the ovum, the consistency of its content of genetic material and acrosomal enzymes can only be examined by sperm function tests such as "Hamster penetration assay" and "Acrosin test". In addition , if sperm are absolutely immotile (do not move), they are either dead or live static. Differentiation between the the states is via sperm function tests such as "hyper osmotic swelling test" or "eosin test"
5-Antisperm Antibody Test
Antisperm antibodies are normally absent. If present, they can decrease or prevent sperm movement, They can examined in semen, cervical mucous of the female and in blood samples in both partners. The latter is of no clinical significance. Examination is preferably by the indirect MAR test.
6-Sperm Freezing "Cryopreservation"
Whenever sperm concentration drops the great extent, it is advisable to store sperm by freezing just in case concentration drops to zero. Sperm preserved by cryopreservation can be used for IVF / ICSI within 3 years following storage.
For sperm to be stored, it is purified by getting rid of seminal fluid, microbes and pus cells. A nutrient and special preservative is added. The sample is mixed and inserted in a special tube on which the name and code of the owner is printed. The tube is preserved in 179°C, achieved by immersion in liquid nitrogen.
7-Markers of Obstruction
These are special chemicals secreted by the epididymis (alpha glucosidase) and seminal vesicles (fructose). Their absence in semen can denote obstruction of the vas deferens and help deduct its site.
