Semen analysis and infertility in men

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Semen analysis is a simple, non-invasive test that evaluates certain characteristics of semen and sperm. Also, it can verify the success of vasectomy. It is not a test of fertility but, it is the most important, single indicator of functional status of the male reproductive tract.

Three days’ abstinence before semen analysis is ideal. However, minimum of two days and maximum of seven days is accepted for more accurate test result. The sample is preferably collected by masturbation in a private room near the laboratory, in order to limit exposure of ejaculate to temperature fluctuations.

The time between production and analysis should not exceed one hour. Loss of all or part of sample should be reported to laboratory personnel. Assessed parameters include:

VOLUME: Low semen volume is characteristic of obstruction of ejaculatory duct or congenital bilateral absence of vas deferens. High semen volume may reflect active exudation in cases of active inflammation of accessory organs. The fifth edition of WHO laboratory manual for examination and processing of human semen indicates that normal semen volume is at least 1.5mL.

LIQUEFACTION: It usually occurs within 30 minutes of semen production and should not exceed one hour.

AGGLUTINATION: High concentrations of agglutination may indicate immunological infertility.

ROUND CELLS: High concentration of round cells may indicate reproductive tract infection or high density of immature sperm cells.

SPERM CONCENTRATION: According to the above-stated WHO manual, normal sperm count or density should be at least 15 Million per mL. Azoospermia is the absence of sperm cells in ejaculate. It may be genetic or caused by blockage due to incomplete or late treatment of infection or other factors. Depending on the serum level of FSH hormone and findings from testicular examination, sperm cells can be extracted by surgical sperm collection (a minor theatre procedure), which is then processed in the laboratory and used for Intracytoplasmic Sperm Injection with oocytes.

MORPHOLOGY: According to the fifth edition of WHO laboratory manual for examination and processing of human semen, percentage of sperm cells with normal morphology, should be 4% or more. A more detailed morphological assessment is obtained with Intracytoplasmic Morphologically Selected Sperm Injection procedure. Notwithstanding, men with suboptimal morphology have been reported to achieve conception.

MOTILITY: The fifth edition of WHO manual states that normal percentage motility should be 40% or more. Poor motility may be present in hypertensive patients. Poor motility may indicate hormonal deficiency, varicocele, infection, heavy smoking, alcohol abuse, use of antidepressants, anabolic steroids and cocaine use.

Semen parameters may be affected by medications, age, genetic factors, abnormal hormonal levels, antibodies, caffeine abuse, infections, lifestyle (smoking, alcohol abuse), regular exposure to radiations from workplace or residential area, varicocele, too little or too much abstinence prior to test, spillage of semen sample at collection, improper collection method, temperature of semen and timing between production and analysis.

Men with certain declining semen parameters, who are booked for testicular surgery, scheduled for radiotherapy or on medical treatments and prescription medications that may negatively affect their parameters, should consider cryopreserving their semen, if they desire to have children after recovery and completing their treatments.

Semen analysis is a guide to fertility and not an absolute proof of fertility. Men with poor semen parameters, with Assisted Reproductive Technology treatment options, can have a chance to conceive with their wives. Also, reproductive pathology in their female partners should be considered.

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