Seminal Analysis
Spermogram and seminal analysis are terms that are usually used interchangeably. Androscience agreed to call the exam that assesses minimum parameters of the ejaculated semen as spermogram, while it calls manual seminal analysis and manual seminal analysis completes the exam that assesses, in addition to the minimum parameters required by the World Health Organization (WHO), some important additional parameters when seeking a male diagnosis.
It is important to know that neither a sperm analysis nor a seminal analysis is able to determine a man's fertility or infertility. For a deeper evaluation, there are sperm function tests. The investigation of semen works as a marker of testicular function and, for this reason, it is important in the assessment of human health in a more global way.
HOW THE TEST IS CARRIED OUT
Semen evaluation must be done carefully, as it provides important information about spermatogenesis and the permeability of the reproductive tract. Traditionally, the diagnosis of male infertility depends on a descriptive assessment of the parameters of the ejaculate, with an emphasis on sperm concentration, motility and morphology. The fundamental philosophy of this approach is that male fertility can be defined in terms of a minimum number of morphologically normal and progressively moving sperm, which must be exceeded for a given individual to be diagnosed with normal spermatogenesis and greater chances of pregnancy.
STEP 1: SAMPLE COLLECTION
The collection of the semen sample usually used, suggested by the World Health Organization and which guarantees the effectiveness of the result of the effective seminal analysis, is the collection by self-masturbation. For this collection, a period of ejaculatory abstinence of 2 to 7 days is suggested. The Androscience laboratory has a secret collection room, prepared for the comfort of the patient during the procedure.
In exceptional cases, such as patients who are in a hospital bed, Androscience provides the service validated by the Sanitary Surveillance for transporting biological material.
Another option offered, however, not recommended because it does not guarantee the quality of the sample during the analysis, is the collection of samples at home using specific sterile condoms and without spermicides.
STEP 2: SAMPLE LIQUEFACTION AND MACROSCOPIC ANALYSIS
Immediately upon receipt of the sample by the laboratory staff, the sample is kept warm.
When ejaculated, the semen is quite viscous, due to the presence of special proteins, which change their structure when exposed to room temperature, in such a way that the semen normally completely liquefies within 60 minutes.
Liquefaction, however, typically takes 15 minutes. In some cases complete liquefaction does not occur within 60 minutes and this may indicate prostate dysfunction.
The evaluated macroscopic parameters are:
Seminal volume: Seminal fluid or fluid is the means of transport and nutrient source for sperm to remain alive within the female reproductive tract. Normal ejaculate volume is ≥ 1.5 ml. Changes in seminal volume may suggest infection, inflammation or abnormalities in the male reproductive tract organs, long periods of abstinence, use of antibiotics, retrograde ejaculation, ejaculatory duct obstruction, or agenesis/hypoplasia of seminal vesicles.
Appearance/Color: A normal specimen has a homogeneous appearance and an opalescent gray color. The sample may also appear reddish, suggesting the presence of blood in the semen, prostate cancer or prostatitis, or yellowish, suggesting infection.
Viscosity: Increased viscosity of the seminal sample may be related to prostatic dysfunction due to chronic inflammation or dysfunction of the seminal vesicles. Abnormal consistency may also impair the assessment of other semen characteristics, such as motility, concentration or determination of antisperm antibodies.
pH: It is important that the semen pH is basic (above 7.0) to neutralize the acidic vaginal pH, keeping sperm alive. It is suggested that samples with a pH greater than 7.8 should be evaluated for the presence of infection or prostatitis. In cases where the pH is lower than 7.2, agenesis or occlusion of the seminal vesicles and ejaculatory duct obstruction may be suspected.
STEP 3: MICROSCOPIC ANALYSIS (CONCENTRATION AND SPERM MOTILITY, ROUND CELLS AND LEUKOCYTES)
During the initial microscopic investigation of the sample, concentration, motility, sperm agglutination and the presence of other cellular elements in the semen in addition to sperm are determined.
Concentration: It is the estimate of the amount of sperm in the seminal fluid, either per ml or in the total ejaculated volume.
Sperm Motility: The presence and quality of sperm motility in seminal fluid is an important factor in determining male fertility. Only a mobile, progressive sperm is able to penetrate the cervical mucus, migrate through the female reproductive system, penetrate the egg and achieve fertilization.
Vitality: When a patient has a large amount of immobile sperm, it becomes necessary to check that the sperm are alive. For that there are vitality tests.
Round cells: Semen also has other cellular elements other than sperm, such as spermatocytes and spermatids (precursor cells to sperm) and leukocytes (defence cells). It is important to differentiate leukocytes from sperm precursor cells, both very similar and called round cells. To differentiate round cells it is necessary to carry out the Leukocyte Research.
STEP 4: SPERMATIC MORPHOLOGY
Morphology investigates sperm shape and is considered a sensitive parameter of sperm quality. Are evaluated: head, neck, midpiece and tail.
Morphology Classification Criteria
Sperm morphology by World Health Organization criteria: human sperm is classified using an optical microscope, after special staining. In this system, sperm are classified as normal (oval), amorphous, bicephalic, megalocephalic, tapered, mid-piece defects, tail defects, etc. It is a system that accepts small irregularities in the sperm. It is a less stringent criterion, but no less important. It can help identify defects in spermatogenesis that are typical of some diseases.
Sperm morphology by Kruger's strict criteria: Consists of a strict classification criterion, where 200 sperm are analyzed and those potentially normal are measured with a ruler (micrometer) built into the microscope. Several measurements are taken on each sperm, which is classified as normal (oval) or abnormal.
UNDERSTAND THE SEMINAL ANALYSIS
The values of a seminal analysis must always be compared to reference values, and normality ranges. For semen, the most recent reference values were established in 2010 by the World Health Organization (WHO), based on a large number of men studied in 8 countries on 3 continents, all fertile, with recent paternity (less than 1 year ago). ), and who were able to get their partners pregnant within 12 months after they stopped using contraceptives. The 2010 values replace those previously established by the WHO in 1987, 1992 and 1999; each proposes advances in relation to the previous ones, but introduces new questionable points.
The objective of a reference value is not only to allow an adequate interpretation of the results, minimizing diagnostic errors and preventing potentially fertile men from being investigated for infertility or unnecessarily referred to Assisted Reproduction. The reference values aim to place the seminal parameters within a category (or percentile) and estimate the chances of pregnancy, always understood as the ability to get the partner pregnant in a period of ONE YEAR.
The reference values established by the WHO, 2010 establish the minimum values necessary and sufficient to obtain a pregnancy, below which it is acceptable for men to start a more detailed investigation of their fertility.
The shaded column indicates the 5th category or percentile, and contains the minimum values below which a male can be considered to have little chance of pregnancy. In other words, of the entire fertile population studied, 5% have these values in their seminal parameters and still managed to get their partners pregnant within 1 year with frequent intercourse and without contraceptives. Another way to interpret it is that 95% of fertile men have semen with parameters above the 5th percentile parameters.
Of course, a man with seminal parameters in the 97.5th percentile, although he has a high chance of getting his partner pregnant, may still not get a pregnancy, since fertility depends on numerous other clinical factors, including female factors.
According to this information, the seminal analysis can be interpreted by generating the following graph, which contains 4 quadrants, one for each of the four basic parameters considered the most important: 1) total number of sperm present in the total ejaculated volume; 2) total motility in percentage (grades A+B+C); 3) progressive motility in percentage (grades A+B); 4) morphology, in percentage of normal forms.
The values plotted on the graph indicate the percentile in which your semen parameter is, according to the WHO table, 2010. The percentiles grow towards the center of the graph, so the closer your results are to the center, the greater the quality of the parameter and the greater the chance of pregnancy. As all four parameters are important, it is critical that they all be in acceptable percentiles.
Summary of the main terms associated with semen evaluation.
References:
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WHO Laboratory Manual for the Examination and Processing of Human Semen, sixth edition, Geneva: World Health Organization, 2021.
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Kruger TF, Menkveld R, Stander FS, Lombard CJ, Van der Merwe JP, van Zyl JA, Smith K. Sperm morphologic features as a prognostic factor in in vitro fertilization. Fertile Sterile. 1986;46(6):1118-23.