Learn More About the Spermiogram

Information

Examining male fertility is an important step in reaching the correct diagnosis. Modern studies have shown that between 40 and 50% of infertility cases in the population are due to a male factor. However, very few fertility problems in men are visible. Examples include hypospadias, undescended testes, and impotence. In most cases, male fertility problems are not visible.

When experiencing difficulties conceiving, it is recommended that the necessary tests be performed on the man first, as they are not complex or invasive. Although many different tests can be performed in relation to male fertility, the most general and perhaps most important of them is the semen analysis.

What is a spermiogram?

A spermiogram, also known as a semen analysis, is a test that examines the structure and maturity of sperm cells, as well as their interactions with the seminal fluid. To perform a semen analysis, sperm must be collected into a sterile container designated for this purpose and provided to the laboratory within no more than half an hour.

Men who feel uncomfortable collecting a sperm sample in a hospital setting may collect the sample at home, but only if they are close enough to bring the sample to the laboratory within the specified time frame. The ejaculate must be collected exclusively through masturbation.

To ensure the best possible sample and therefore the most accurate result, the following is required:

• Sexual abstinence between three and five days before the date of the examination
• Use of a sterile container
• Avoid spilling or losing any portion of the ejaculate
• Do not use lubricants, as they can kill sperm cells
• Store the seminal fluid sample at room temperature

Tests

After your semen sample arrives at the laboratory, various factors will be assessed. First, the biologist analyses the semen.

• Ejaculate volume - the normal volume of ejaculate can range from 2 to 6 millilitres. If the volume is found to be outside normal limits, either too small or too large, a problem with the seminal vesicles and/or prostate is suspected. A small volume makes it difficult for sperm to travel to the cervix, while a large volume reduces sperm concentration by diluting them.
• Viscosity - this concerns the ability of the semen to liquefy shortly after ejaculation. If the semen does not liquefy or becomes too thick, an infection in the seminal vesicles and prostate is likely present.
• pH level - semen must have an alkaline pH in order to protect sperm from the acidic environment of the vagina. A more acidic pH of the ejaculate suggests a problem with the seminal vesicles.

After the analysis of the seminal fluid is complete, the biologist proceeds to examine the quantity and quality of the sperm cells.

Sperm cells

Sperm cells are often compared to tadpoles due to their shape. Sperm cells are not visible to the naked eye and therefore must be examined under a microscope. The semen analysis examines the concentration, motility, and morphology of the sperm cells, as well as the presence of clusters of sperm cells - agglutinates (motile) and aggregates (immotile).

• Sperm concentration - the number of sperm cells in your semen is an extremely important indicator, as too few sperm significantly reduces your chances of achieving pregnancy. Sperm concentration is considered low if the number of sperm cells per millilitre of ejaculate is less than 20 million, in which case a diagnosis of Oligozoospermia is made. In men in whom no sperm cells are found, the diagnosis is Azoospermia.
• Sperm motility - this indicator shows how well your sperm swim. The better the sperm swim, the greater the chance of completing the long journey to the egg through the uterus and fallopian tubes. According to their movement, sperm can be progressively and rapidly motile, slowly motile, or immotile. Normal semen should contain no less than 50% rapidly motile sperm.
• Morphology - the shape of the sperm cells is also an important factor in relation to conception. The ideal sperm cell should have an oval head connected to a midpiece (neck) and a long straight tail. An abnormal sperm cell will most likely be unable to fertilise the egg. If too many sperm cells with abnormal shapes are observed in the semen, the man is considered to have a sperm morphology problem. Various criteria exist for evaluating the morphology of human sperm cells.
• Clusters - the clumping of sperm cells together is also a problem, as it impedes their movement.

In addition to these criteria, the presence of white blood cells (or pus cells) is also examined. Since only a small number of white blood cells is normally found in semen, an abundance of such cells may indicate the presence of a seminal infection.

Results of the semen analysis

The results of the semen analysis are as accurate as they depend on the fertility specialists. However, if the ejaculate was not collected correctly, the examination was performed too late after collection, the abstinence requirement was not met, or the man had a general illness in the last three months, the results of the examination may be inaccurate.

If these conditions were met during collection and the results of the tested parameters are within reference ranges, there is no reason to repeat the examination. If, however, there is a deviation from normal values, it is recommended that additional tests of the seminal fluid be performed. And why not have a second spermiogram? It is quite simple, and it is normal for there to be fluctuations in sperm concentration and quality. Since sperm formation takes several months, it is recommended that the repeat examination be done after three to six months.

Once the correct diagnosis has been established, discussion of the ways to treat your infertility can begin. The exact form of treatment suitable for you depends on the cause of its occurrence.

Author: Gergana Ingilizova, embryologist, MBAL VITA and VITA In Vitro Centre