Basic and special sperm examination
Spermiogram is the first examination in the evaluation of male fertility. This is a microscopic examination of the ejaculate sample. The number of sperm counts, their mobility and shape are evaluated.
Ejaculate is obtained by masturbation, it is a viscous opalescent liquid, white-yellowish coloured, which contains sperms and seminal plasma. It is produced by seminal and accessory sex glands. The sample is highly viscous after ejaculation and changes to fluid after about half an hour. The final analysis should only be determined after 2-3 samples that are examined within at least one-week time lapse.
Sample collection
Ejaculate is usually obtained by masturbation after a short 2 – 7-day long sexual abstinence; it is necessary to collect the whole amount of it. The man should not be taking any drugs, drinking alcohol, or smoking before the examination.
Sperms are collected by a man into a sterile plastic container (disposable), which must not contain residues of disinfectants that damage the sperms.
Evaluation of the ejaculate
Sperm analysis includes:
- volume and viscosity
- sperm concentration
- total sperm count
- sperm mobility
- the number of normal and damaged sperm
- pH
- the number of rounded forms (leukocytes and others) in the ejaculate
Appearance of the ejaculate
After the examination, the appearance is assessed. In the ejaculate, there should be no blood or flakes that indicate the presence of an infection in the sexual system.
Volume of the ejaculate
The ejaculate is left liquefying for 30 minutes at 37° C in a thermostat. Then its volume is measured.
pH
An ejaculate drop is applied to the pH paper strip and after 30 seconds the pH is read out according to the enclosed scale. The normal pH is slightly alkaline from 7.2 to 8.4.
Sperm concentration
We count the sperms by means of Makler, in a microscopic device with a special counting grid.
Sperm motility
According to the WHO, sperm motility is divided into the following four categories:
a – fast-moving sperms
b – slowly moving sperms
c – non-progressing sperms – on-site movement
d – immobile sperms
Morphology of the sperms
Morphology of the sperms is evaluated from the stained preparation.
The following are evaluated:
head – size, symmetry, shape, presence and size of the acrosome, presence of vacuoles, and others
cervix – thickness, attachment on the head, cytoplasmic drops, and others
tail – shape, length, double tail, tail twisting, and others
The larger the number of abnormal sperms or sperm abnormalities, the more likely a man is less fertile.
Leukocytes, bacteria, other …
Another parameter of the spermiogram is the presence of leukocytes, immature forms, bacteria, protozoa or other cellular elements.
The WHO baseline normal sperm count parameters is as follows:
Appearance – white-yellowish coloured ejaculate
Volume of the ejaculate – more than 1.5 ml
Sperm concentration – more than 15 million/ml
The total number of sperms in the ejaculate – more than 39 million
Total mobility – more than 40%
Progressive movement – more than 32%
Morphology – more than 4% morphologically normal sperms
Round shapes – less than 1 million/ml
Nomenclature
Normospermia – spermiogram parameters are within standards
Oligozoospermia – sperm concentration is less than 15 million/ml
Teratozoospermia – less than 4% of sperms have normal morphology
Astenozoospermia – less than 40% of moving sperm
Azoospermia – no sperms are present in the ejaculate
Aspermia – absence of the ejaculate
Necrozoospermia – presence of only non-living sperms
Cryptozoospermia – a small number of sperms, they are not present in a fresh sample, but only after centrifugation
Hypospermia – low ejaculate volume (≤ 1.5 ml)
Leukocytozoospermia – increased incidence of leukocytes
Factors affecting the sperm quality
– alcohol
– tobacco
– various medicines
– stress
– sample collection during influenza, another disease (antibiotics)
Ejaculate collection in the Sanatorium for the Treatment of Infertility – SPLN spol. s r. o.
The ejaculate is taken in a name-marked sterile, disposable container, at our workplace in a separate room (desiged for this purpose), if necessary with a female partner. The colelcted sample is then submitted to the authorized employee by the man, he fills-in and signs the spermiogram examination form.
The sperms from the frozen doses can be used for fertilization of the ova, in the absence of the partner on the day of ova collection or before chemotherapy of the partner. The sperms can also be obtained surgically – by the MESA or TESE methods, then they are frozen, and the required dose can be thawed on the day of the ova collection and used for fertilization. The ova collected can also be fertilized by the sperms of an anonymous donor whom the partners have chosen in advance.
Principles of the sperm collection outside the Sanatorium for the Treatment of Infertility – SPLN spol. s r. o.
Before the ejaculate collection, the patient shall be instructed to keep the period of sexual abstinence for 2 to 7 days.
If for any reason it is not possible to collect the ejaculate at this workplace, the client may, in agreement with the workplace, bring the ejaculate from his home. The client must follow these guidelines:
– collect the ejaculate into a sterile plastic bottle that he gets in our workplace
– keep the ejaculate at 20 – 37 degrees Celsius
– deliver the sample to the andrological laboratory within 30 minutes of collection (up to 1 hour max)
– label the bottle by the name
– fill-in and sign the application for the sperm examination form
Spermiograms shall not be reported by phone.