Spermogram

Spermogram is a laboratory analysis that is done to diagnose male infertility. In addition, semen testing is done after a vasectomy (birth control) operation to make sure there are no sperm in the seminal fluid.

The semen analysis test is different from a culture test, which is done to determine if there is an infection in the reproductive system.

A spermogram can be done for all men who have reached reproductive age. Early diagnosis is important for the treatment of male infertility. The analysis makes it possible to assess the structure and concentration of sperm, as well as the mobility of the spermatozoa themselves. The result can lead to one of the following diagnoses: asthenozoospermia (greatly reduced mobility), teratozoospermia (more than half of the spermatozoa have structural abnormalities) and oligozoospermia (very low concentration).

A reproductive medicine specialist advises patients about possible treatments. The most common infertility treatment in the cases mentioned above is artificial insemination using ICSI (injection of spermatozoa into the egg).

Types of changes in the spermogram

An ejaculate that has normal mobility, morphology and sperm count is called “normozoospermic”.

Types of changes in the analysis: reduced total number (oligozoospermia), impaired motility (asthenozoospermia) and changes in spermatozoa morphology (teratozoospermia).

However, most often in clinical practice there are combined pathologies and oligoasthenoteratozoospermia, which is most often the cause of male infertility. About 10-15% of men suffering from infertility have azoospermia – the absolute absence of sperm in the ejaculate. There are three types of azoospermia.

Obstructive (38%), arising from obstruction of the seminiferous tubules, congenital anomalies, or, more often, infection or trauma.

Ejaculative (2%), which is associated with ejaculate disorders.

Non-obstructive, manifested in connection with a violation of spermatogenesis (60%). The main causes of non-obstructive infertility are pituitary malformation (which leads to hormone deficiency), genetic abnormalities, varicocele, cryptorchidism, trauma, tumor, testicular torsion, testicular inflammation (orchitis). Also, the problem can develop due to drug use and exposure to harmful environmental factors.

Other changes in the spermogram: necrozoospermia – no live spermatozoa in the semen; cryptozoospermia – very few sperm in the semen; pyompermia – an increase in the number of leukocytes in the ejaculate due to the inflammatory process. Additional studies, such as ejaculate culture, can be used to search for the etiology of inflammation and select adequate therapy.

How to prepare for the analysis

It is very important to properly prepare the semen analysis for the most accurate and adequate examination and for the subsequent correct evaluation of the results, diagnosis and selection of the necessary medical treatment.

Basic rules to follow before analysis:

1. Refrain from minimal sexual activity for 3, but not more than 7 days. Sexual intercourse the day before the analysis usually leads to a decrease in the number and volume of spermatozoa in the ejaculate. More than seven days of abstinence leads to the death of mature spermatozoa that were capable of fertilization.
2. Refrain from drinking alcohol, drugs (including marijuana) in any form in order to avoid a decrease in the number of spermatozoa, changes in their shape, and death.
3. Refuse strong black tea, coffee and smoking the day before the start of the study.
4. Eliminate fat, fried foods, as they can help reduce the total volume of ejaculate and cell mobility.
5. To improve sperm parameters, it is useful to use plant foods with a high content of vitamins and fiber (vegetables and fruits); proteins (chicken, beef, lean meat, rabbit), dairy products, in addition, to improve the production of sperm in the testicles, it is important to consume enough vitamins (especially zinc and vitamin C).
6. General hyperthermia negatively affects the development of germ cells, since the optimal temperature for its maturation should be 1-2 degrees below normal body temperature (34-35°C). Therefore, it is not recommended to take a hot bath the day before the analysis.

It is not recommended to analyze:

• in the presence of a cold, acute respiratory viral infections with fever;
• inflammatory processes (urethritis, cystitis, prostatitis);
• sexually transmitted infections and diseases;
• with influenza, mumps, syphilis, tuberculosis and typhoid fever, can cause testicular atrophy and lead to low sperm motility and low sperm count. STDs such as chlamydia and gonorrhea can block the vas deferens, leading to infertility;
• when taking antibiotics or antidepressants;
• the use of anabolic steroids, which can disrupt the hormonal functions necessary for sperm production.

In all the cases described above, analysis can be done no earlier than after 2 weeks from complete recovery. Such terms are needed to normalize clinical and laboratory parameters, as well as to completely remove drugs from the body.

Normal spermogram values

For the analysis “Spermogram” determine the following indicators:

1. Volume: The volume of the semen sample must be greater than 1,5 ml. The preferred volume is 2 to 6 ml. A lower reading may be a sign of a blockage in the vas deferens. An excess volume of more than 10 ml is called polyspermy, and the spermatozoa are diluted.
2. Sperm count (other names are sperm concentration or density) is the amount of semen in the measured volume. The indicator should normally be more than 20 million. Sperm count/density is expressed as the number of sperm per ml.
3. The total number of spermatozoa in a semen sample. It is calculated by multiplying the volume of semen by the number of spermatozoa in 1 ml of ejaculate.
4. Movement: An indicator of normal moving spermatozoa. Should be over 50 percent one hour after ejaculation.
5. Morphology (shape of the spermatozoa): a semen sample is analyzed under a microscope. There may be irregularly shaped cells in the sample, but at least 30% of the sperm cells must have a normal parameter (according to WHO). More than 50% of the presence of abnormal sperm reduces fertility.
6. pH: The seminal fluid should have a level between 7.2-7.8. A score greater than 8 is usually associated with infection. A pH below 7 means an acidic sample and this may be caused by a blockage in the ejaculatory ducts.
7. Appearance and color: Normally, the liquid is blurred, opaque, and has a whitish-gray color.
8. White blood cell (WBC) count: Under normal conditions, white blood cells are not found in the ejaculate.

The normal percentage of sperm morphology is 14% according to the Kruger criteria, this is called Kruger morphology. Dr. Thinus Kruger developed normative indicators, they are also called strict criteria.

Morphology scores (Kruger criteria):

• more than 14% normal cells: high fertility potential leads to normal results;
• 4-14% normal cells: average fertilization potential, impaired fertility;
• 0-3% normal cells: severe impairment, potential infertility; fertility treatment may be required.

Semen analysis and male infertility

A semen analysis is done to assess the likelihood of a man being infertile. According to statistics, 15% of couples who have not been able to conceive a child for some time have no health problems, but there are deviations in the spermogram. Some causes of male infertility can be caused by problems with the morphology, motility and number of male germ cells. Other factors are associated with hormonal problems and genetic characteristics.

Common causes of male infertility: hypogonadism (the body cannot produce enough testosterone), side effects of certain types of medications, chemotherapy, testicular tumors, idiopathic oligospermia (an unexplained low sperm count), cryptorchidism (absence of one or both testicles), testicular hydrocele (accumulation and swelling of fluid in the testicle), traumatic injury, infection, obstruction in the vas deferens, systemic diseases, erectile dysfunction, cystic fibrosis, retrograde ejaculation (sperm enters the bladder rather than exits the body). These infertility problems are diagnosed using semen analysis, other laboratory tests, and imaging techniques.

Interesting Sperm Facts

The seminal fluid is analyzed in a semen analysis, where the characteristics of semen and spermatozoa are assessed. A spermogram is performed to detect male infertility. Semen volume, morphology, motility, sperm count and concentration are examined in semen analysis. Some interesting facts:

1. Sperm cells are produced in the testicles and take about 10 weeks (72 days) to mature.
2. Mature cells can wait 2 weeks for fertilization.
3. If sperm cells do not ejaculate, they are destroyed and reabsorbed by the body.
4. Only 1% of ejaculate fluid is spermatozoa, part contains minerals or vitamins, and all these components help sperm cells to survive.
5. Healthy men produce 70-150 million sperm per day. They can ejaculate up to 3 times this amount.
6. The average man can ejaculate a teaspoon of semen at once.
7. Men produce millions of sperm cells, but it takes 2-3 months for sperm to mature.
8. Spermatozoa can live 72 hours in the vagina, this period can be 5-7 days in suitable conditions.
9. All cells are not the same, there are abnormal ones, they can be two-headed, with short tails, small, large or tailless.
10. According to the distribution of chromosomes, spermatozoa also have a sex, females are slower but stronger than males, and they live longer.

Male fertility depends on certain factors, and one of them is the quality of the sperm, which is assessed through analysis. There are some characteristics of seminal fluid and spermatozoa that affect sperm quality. These are semen volume, cell concentration, total cell count, pH, sperm motility and morphology (shape). All of these functions affect sperm quality and male fertility, and they are evaluated and measured using a semen analysis.

False beliefs about semen analysis

The spermogram is an important study for the diagnosis of male infertility, but there are many false beliefs about this analysis.

Many men believe that if there was one semen analysis and no sperm was found, then there is no need to repeat the study. This is a false belief, you need to repeat the spermogram at least 2-3 times to be sure before starting treatment.

The volume of ejaculated fluid is low, which means that the man has a problem in the production of sperm. This is also not the case, since the number of spermatozoa depends on various factors and fluctuates over time.

Higher or lower values ​​should be evaluated by an andrologist.

It is also a common misconception that if the patient could not collect the entire semen sample in the sample dish for analysis, then this value is not important for the test, since most of the sample is in the container. But it’s not. It is necessary to collect every drop of liquid for spermogram. There may be some cells in the missing part of the sample, and this part may change the result of the test.

Also, many men believe that if a spermogram was performed in different laboratories at different times, and there was a different result, then the results are erroneous. The production of sperm cells is a process that takes 70 days. Various factors such as lifestyle changes, fever, infectious diseases can lead to different results in the analysis. Also, different laboratories may have different assessment methods, but this does not cause a significant difference in test results. The best way is to have a semen test done in a specialized andrology laboratory or reproductive medicine center.

Some men are convinced that if they can ejaculate during intercourse, and if there is sperm, it means that they have no problem producing it. The seminal fluid contains not only spermatozoa, in addition to them, there are various secrets that are produced by the glands. The presence of spermatozoa, sperm quality or cell count can be assessed under a microscope during a semen analysis. The presence of seminal fluid does not mean that there are enough sperm in it.

Also, many couples mistakenly believe that if there is a history of pregnancy in the past with a partner, then there can be no problems in sperm production now. But infertility can occur over time.

Some men mistakenly assume that if there were no sperm in past semen tests, then they have no chance of becoming a father. The absence of spermatozoa can be determined in the analysis, but there may be some production in the testicles.

An andrology specialist can collect pieces of tissue from the testicles using microsurgery, can find sperm cells inside and use them in IVF (in vitro fertilization); so even in such cases there may be a child.