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.
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.
SEMEN MICROBIOLOGY
The microbiological analysis of semen is important in the early identification of infections in the reproductive tract, in order to avoid the emergence of a more serious problem, such as infertility. It is recommended that, in suspected infection, semen be collected after performing prostate massage by a physician. It is also important that it be performed in conjunction with microbiological analysis of urethral secretions and urine.
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.