One of the major problems with couples who struggle with fertility issues is the male partner’s sperm. A semen analysis involves a thorough evaluation of the sperm and the function of the sperm. In our laboratory, our normal values are determined by closely watching the fertility course of many patients over the years. Approximately 60% of our male clients with sperm counts of 20 million/milliliter can achieve pregnancy.
The Fertility Institutes have Board Certified male reproductive medical and laboratory specialists available, including urologists, andrologists, and embryologists. We provide semen analysis in-house and use affiliated laboratories. The sperm is analyzed for sperm count, movement, shape, and appearance, as well as biochemical and chemical characteristics.
Sperm counts include the total density (actual count of sperm per milliliter) as well as the motile density (actual count of moving sperm). Normal values are 20 million sperm per ml, with around 8 million motile sperm per ml. The motile density predicts the number of sperm that are capable of progressing to fertilize the egg. This value is important for determining whether or not the semen analysis is “normal.” The motile density provides prognostic information so the reproductive specialist can determine if medical assistance is required or not.
The following are definitions of abnormal counts:
Polyzoospermia – Excessively high sperm concentration.
Oligozoospermia – Sperm count of less than 20 million/ml.
Hyperspermia – Semen volume of >5.5 ml.
Hypspermia – Semen volume of < 1.5 ml.
Aspermia – No sperm volume.
Pyospermia – Leukocytes present in semen.
Teratozoospermia – > 40% of sperm seen are abnormal form.
Asthenozoospermia – Sperm motility < 40%.
Hematospermia – Red blood cells in the semen.
Necrozoospermia – Nonviable or dead sperm.
Oligoasthenozoospermia – Motile density < 8 million sperm/ml.
Sperm Morphology (Shape and Appearance)
The evaluation of sperm shape and appearance is done by carefully observing a washed sperm sample under the microscope. The evaluator adds colored dye (stain) to the specimen, so the observer can distinguish important normal landmarks (characteristics) and certain abnormal findings.
Several different forms and shapes have be categorized. These include:
Normal forms – Have oval head, intact mid-section, and uncoiled single tail.
Abnormal heads – Many sperm head abnormalities seen, such as macrocephalic (large), microcephalic (small), absence of head, pyriform (teardrop shaped), tapering, and double/duplicate heads. Severe abnormalities in sperm appearances are termed as “amorphous” changes.
Abnormal tails – Several abnormal tails include coiling, bending, broken (less than half-normal length), double, triple, and quadruple. Cytoplasmic droplets along the tail are indicative of immature sperm.
Immature germ cells (IGCs) – The presence of white blood cells (WBCs) in the semen is a concern for infection.
Sperm Motility (Movement)
Sperm motility assessment identifies the percentage of moving sperm in the specimen. Many laboratories check motility as soon as the specimen is received and then again in hourly intervals for 4-24 hours. It is important that the sperm remain motile for several hours to reach the egg. In addition, 40% or greater sperm motility is considered to be normal.
Certain characteristics regarding sperm motility are documented. These include:
Asthenozoospermia – Term for decreased sperm motility, which is caused by abnormal spermatogenesis (development), transport abnormalities, epididymal sperm maturation issues, and varicocele.
Necrozoospermia – Term for the total absence of motile sperm. When sperm are seen, but are not moving, vital stain studies are used to see if the sperm are viable (alive). If alive, the sperm can be microinjected into the egg using intracytoplasmic sperm injection (ICSI).
Chemical and Biochemical Semen Characteristics
The four notable chemical and biochemical semen characteristics are:
Semen acid-base balance (pH) – The pH of semen is measured with a treated paper blot that changes color. The normal semen pH range is 7.2 to 7.8. Alterations of the pH reflect a dysfunction in the prostatic gland or other accessory glands.
Color and turbidity – Semen should be translucent or whitish-gray in color. Blood in the semen turns it pink, red, or brownish-red. The presence of mucus, debris, or blood is abnormal.
Liquefaction – Semen is produced as a coagulum, but liquefies within 30 minutes. Failure to turn to liquid is abnormal.
Viscosity – After complete liquefaction, viscosity is measure. A normal specimen can be poured from a beaker easily.