A laboratory study of male seminal fluid is called a spermogram. It is carried out in order to assess the ability of sperm to fertilize. Based on the results of the analysis, they talk about the presence or absence of problems with the reproductive function. How to decipher the results different options spermograms, what can they say?

This analysis is the main method for studying reproductive function in men different ages. Also, the results of the spermogram may indicate the presence of sexually transmitted or urological diseases. Is it possible to decipher the tests without the help of a doctor, what can the results of the study say?

Why do you need

By examining the seminal fluid with male germ cells, you can determine the cause of infertility, identify its degree, and make a prediction about the likelihood of conception in a natural way.

Additionally, it is possible to diagnose the presence sexually transmitted diseases, establish the probable cause of complete or partial infertility.

The composition of sperm is affected by consumption certain products nutrition, medicines, as well as stress and excessive physical exercise. For getting reliable results spermograms are recommended to be analyzed at least 3 times.

Varieties of analysis

Today, there are three main options for the study of male seminal fluid containing sperm germ cells. Depending on the tasks that the doctor sets for the laboratory, one or another variant of the microscopic study of the biomaterial is carried out. If a simultaneous study of three options is carried out, such an analysis is called extended.

Base

The study is carried out according to WHO standards. At least 2 ml of ejaculate is required for the study. When considering a fluid with sex cells, pay attention to the color, consistency, viscosity and number of active spermatozoa.

MAR test

It is carried out to study the seminal fluid for the presence of antisperm bodies in it that attack spermatozoa, thereby reducing the likelihood of conception naturally.

According to Kruger

The most detailed study of a man's semen, which is carried out on narrow-profile equipment. This type of spermogram is recommended before IVF. To study the ejaculate, at least 3 ml will be required; before analysis, a man must observe sexual abstinence for 3-5 days.

Features of the study

Comprehensive diagnostic study sperm is held in medical institution. The delivery of ejaculate occurs only by masturbation with clean hands in a separate office.

What influences the result

The composition of the semen includes not only active spermatozoa, but also the prostate fluid, their ratio may fluctuate. The quality of the ejaculate, and, accordingly, the result of the spermogram is affected by both internal factors(diseases, stresses), and external. List of the main reasons that can affect diagnostic result spermatograms:

• sexual contact before analysis (for a day, three, depending on the type of spermogram);
• ARVI, ARI, FLU;
• chronic kidney disease;
• inflammatory process of the genitourinary system (cystitis, prostatitis);
• physical activity before the test (a day or less);
• medications;
• reception hot bath, saunas;
• alcohol, smoking;
• taking antibacterial drugs;
• prostate massage;
• orchitis;
• temperature increase;
• venereal diseases.

Wash your hands with antiseptic soap before donating sperm. In the presence of eczema, wounds or suppuration on the hands, it is recommended to use sterile gloves.

Why does sperm count decrease?

The content of live sperm in the seminal fluid, necessary for the fertilization of the egg - 50%.

If this indicator is reduced, then conception is unlikely or impossible. Sperm, male germ cells, are contained in the seminal fluid in two forms: live active and already non-viable (necrotic). With a decrease in the number of live sperm, a diagnosis of necrospermia is made.

Necrospermia can be permanent or temporary. With a temporary option, there is a gradual restoration of active spermatozoa and fertilizing ability. This condition occurs after past illness, in diseases inflammatory nature. With constant necrospermia, conception is impossible.

Causes of decreased mobility

In addition to a low number of active sperm, there may also be a decrease motor function sex cells. Such a violation can be observed when wearing tight underwear, smoking, SARS or FLU. Dangerous Consequences can happen with mumps, or mumps. Frequent complication after "mumps" is infertility in men.

With reduced sperm motility during a fertilization attempt, a woman may develop ectopic pregnancy. This happens when a fertilized egg implants in the wall of the fallopian tube instead of the uterus.

How the analysis is carried out

The analysis is usually carried out in medical institution The patient is provided with a separate room. It is important that the collected biomaterial was obtained as a result of masturbation, and not coitus interruptus, not from a condom. The amount of seminal fluid examined is also important. 3-5 days before the analysis, it is necessary to refrain from sexual intercourse, otherwise the volume of the resulting ejaculate will be insufficient. For some research options, a large amount of sperm is needed.

Research accuracy

The accuracy of the result depends on the correctly delivered biomaterial, the quality of the equipment on which the study of the properties of the seminal fluid is carried out. To confirm the result, the analysis is carried out two or three times in a row. If these requirements are met, the reliability of the data obtained is very high.

Deciphering the results of indicators according to the table

Trying to decipher the result of the analysis on your own is not recommended, since the data obtained, which can be compared with the table, must be compared with each other and carefully studied. Need to know the features possible deviations, reasons, to be able to analyze all this for diagnostic purposes.

In table No. 1, you can view the boundaries of the norm for sperm indicators:

In table No. 2, the boundaries of the norm for assessing sperm:

What will be the normal analysis indicators for conception

The norm of the results of the analysis depends on the variant of the study. However, there are generally accepted standards.

Morphological norms

The results of the analysis indicate changes in the motor function of the sperm. Criteria for assessing the quality and quantity of germ cells are taken into account. Physiologically normal performance:

• spermogram shows 20-40 million sperm;
• volume - 2 ml and more;
• mobile spermatozoa not less than 25%;
• spermatozoa, which not only move randomly, but move along a straight path with high activity - at least half of the total.

Morphological norms of the sperm according to the Kruger variant:

• Head . Normally, one head, oval, 2.5-3.5 microns wide, 4-5.5 microns long. Half of the area of ​​the head is occupied by an acrosome - an organoid.
• Neck . Smooth, not exceeding a width of 1 micron, the length is equal to one and a half lengths of the head. Connection with a head at an angle of 90 degrees without distortion.
• Tail . Occupies 90% of the size of the sperm. The tail is even without tubercles and nodules. Narrowing is allowed, the tail is pointed at the end.

The rate of active sperm

The normal number of active spermatozoa per 1 ml of semen is more than 20 million. The decrease is observed when the testicles are inefficient, indicated by the diagnosis of oligozoospermia. A decrease in androgens, exposure to toxic and narcotic substances, or inflammation in the organ weakens the immune system, while affecting the spermatogenic epithelium.

Mobility

The probability of natural fertilization depends on the mobility of the sperm. There are the following activity groups:

• A - active and mobile spermatozoa, which indicates the norm;
• B - sedentary spermatozoa, with rectilinear movement. This is a minor deviation, conception is possible;
• C - sedentary cells with oscillatory, rotational movements, fertilization is possible artificially;
• D - infertility, which does not allow to conceive artificially and naturally.

Reduced mobility is called asthenozoospermia. The causes are inflammatory processes, the use of narcotic and psychotropic substances. With damage to the testicles as a result of trauma and thermal effects, asthenozoospermia is observed very often.

Leukocytes

Leukocytes are cells of the body that are aimed at stopping and eliminating the inflammatory process in the body. The presence of leukocytes indicates that there is an inflammatory process. Normally, semen does not contain leukocytes, as well as erythrocytes (blood cells).

If a small number of leukocytes is found (2-4 in the field of view), we can talk about the beginning of the inflammatory process. Erythrocytes should not be visualized in seminal fluid at all.

Additional results of spermogram analysis within the physiological norm:

• agglutination (glued sperm) is absent;
• mucus is not visible;
• desquamated epithelial cells of the seminiferous tubules - up to 2%;
• sperm viscosity up to 0.5 cm;
• the time of semen liquefaction is not more than an hour;
• alkaline pH - 7.2-7.85.

How to improve sperm counts

There are situations when it is difficult to hope for an improvement in spermogram parameters.

For example, there are signs of low or absent sperm activity.

But if you are sure that the decrease in the analysis indicators is not permanent, you can try to influence the results.

Sperm values ​​can be improved if the following rules are observed:

• follow temperature regime, avoid saunas, baths with hot or cold water;
• reduce or eliminate the consumption of alcohol, tobacco;
• wear comfortable panties, comfortable underwear, use underpants in cold weather;
• regularly conduct sexual life with one sexual partner;
• avoid casual unprotected sexual contact;
• include fiber, proteins, vitamins of natural origin in the diet;
• exclude fatty foods;
• avoid stress and excessive exercise;
• stabilize weight indicators, bringing them closer to normal.

The above tips are as simple as possible, do not require a radical change in lifestyle. At the same time, when planning a natural conception, it is easy to improve sperm counts by such methods.

The decline in the reproductive capacity of the male population is a problem not sucked out of the finger by medical dealers who are trying to "cut down" money on gullible patients. No, it's all fair. Therefore, an article on how to read a spermogram correctly, i.e. quantitative and qualitative analysis ejaculate (that is, sperm) will be, as they say, "in the vein."

How to take a spermogram?

Preparing for the spermogram

A spermogram is a laboratory study of sperm (ejaculate). If a couple has any problems conceiving a child, then an in-depth examination is carried out as future mother, and a promising father. One of the items of the mandatory program for the latter is the delivery of a spermogram. Before this delicate procedure, the andrologist gives a memo with a small list of recommendations that must be followed for several days before taking the sperm (ejaculate) for analysis. In general terms, it prescribes to refrain from sexual intercourse and masturbation for 3-7 days before the procedure, not to drink alcohol (ideally - two weeks), not to take a steam bath or sauna, and not to urinate a few hours before the test. ejaculate.

Spermogram delivery

I, with your permission, will not describe the procedure of “getting fire by friction” itself. I will only note that the ejaculate is collected in a sterile plastic tube and transported to the study site, i.e. to the laboratory in a trouser pocket or in the hand (it is required to maintain body temperature).

Sperm is not something permanent: its composition depends on many factors, such as: the functional and psycho-emotional state of the body, intake medicines. In this regard, one analysis is far from an indicator. And if there is “no life” in your spermogram, then this is not a reason to sprinkle ashes on your head, because. it is necessary to make at least one more “control shot” into the test tube. Usually, 10 days are given to recharge the "batteries".

How to decipher a spermogram

Ejaculate volume

Example of semen analysis results Along with the concentration of spermatozoa, this is one of the key quantitative characteristics of semen. 2 ml or less is considered a possible criterion for infertility, even if normal concentration spermatozoa. Under such conditions, the chance of conception is reduced. Why? The fact is that acidic environment The vagina is extremely inhospitable to spermatozoa, and the lion's share of them does not live in it for even a couple of hours. That is how much time is given to the most mobile of them to get to their destination - to the uterus, where the conditions are quite comfortable. It is clear that the smaller the volume of ejaculate, the smaller the volume of seminal fluid that protects spermatozoa from the low pH of the vagina.

Another nuance: it is very important to collect the entire ejaculate in a test tube, especially its first batch, which is the richest in spermatozoa. If this did not work out, do not hide your failure from the doctor.

Liquefaction time

Here the decisive role is played by the viscosity of the ejaculate. Its liquefaction range lies between 10 and 40 minutes. If more, then there are problems with prostate.

Color

As for the color, you should not bother too much: this indicator is interpreted too vaguely. In this regard, it is not given such an important diagnostic role. Rather, it is a tribute to tradition. The only thing worth looking into close attention- pinkish shade of ejaculate, signaling the presence of erythrocytes in it.

Acidity

For sperm, a slightly alkaline reaction is normal when the pH is in the range of 7.2-7.4. The pH value helps to determine the presence and localization of inflammatory foci in the reproductive system. An elevated pH indicates inflammation of the prostate gland and seminal vesicles, and a lowered pH (up to 6.5) indicates a blockage excretory ducts the latter.

Sperm count

Determined in 1 ml of ejaculate. The account here is in the millions. The norm is 20-60 million per 1 ml of ejaculate. By the way, a low concentration of spermatozoa can be compensated by their increased motor activity.

Spermogram parameters: norm and pathologies

Sperm motility

Another key indicator sperm quality. Any quantitative abundance of spermatozoa will not matter at all if they are immobile. If you ever held a spermogram in your hands, then you probably already paid attention to 4 letters - A, B, C, D - each of which corresponds to its own percentage of spermatozoa. Yes, in total it is customary to distinguish 4 groups of sperm motility. Group A includes "elite" - spermatozoa that can move quickly and directionally. To group B - the same purposeful, but a little slower. Mobile, but "stupid" spermatozoa that move in an unclear way and in an incomprehensible direction (movement in a circle or in place) are classified as group C. Completely immobile spermatozoa constitute group D.

Spermagglutination

In a viscous, non-liquefying ejaculate, the phenomenon of gluing spermatozoa - agglutination - can occur. It is clear that it is difficult to talk about the possibility of fertilization if the spermatozoa stick together into a ball. This is observed, for example, in chronic or inflammation of the seminal vesicles - vesiculitis. There should be no agglutination in normal semen.

Presence of antisperm antibodies

With certain immune disorders in the body, the production of antibodies against its own spermatozoa can begin, which, when combined with them, prevent them from moving to the egg. Thus, the presence of such antibodies may explain the male infertility.

Microscopy of the ejaculate

What can be seen under a microscope in normal semen? Amyloid bodies, spermatogenic epithelial cells, lecithin drops, and a minimum of leukocytes (0-3). If there are more leukocytes than this value, plus mucus is found in the ejaculate, then this is a marker for the presence of an inflammatory process. Erythrocytes in the ejaculate should not be.

Abnormal spermatozoa

One should not think that all male spermatozoa are such “beauties”, everything is like a selection. This is not so: among them you can find many "tadpoles" with various defects. For example, with a curved head, or without a head at all. There are spermatozoa with two tails. There is nothing fatal here, in the sperm of any man there are such "freaks". The question is their number. The proportion of abnormal spermatozoa should not exceed 50% of their total number.

Spermogram results - doctor's diagnosis

• Normozoospermia - the ejaculate "with honor" passed all the tests.
• Oligozoospermia - few spermatozoa - less than 20 million in 1 ml.
• Teratozoospermia - a large number of spermatozoa with an abnormal head and tail (more than 50%).
• Asthenozoospermia - low mobility provided normal form and sperm count (below those two indicators that I wrote about a little higher in the chapter "").
• Oligoastenoteratozoospermia is a combination of the above three abnormalities.
• Azoospermia is the complete absence of sperm in the ejaculate.
• Aspermia is the complete absence of sperm itself.

And in conclusion, I note once again that passing the ejaculate is not a field to go over. The quality of sperm largely depends on the lifestyle of the individual. Smoking and especially alcohol are detrimental to her. The same can be said for the series medicines, for example, some antidepressants, tranquilizers, antihypertensives (especially clonidine),

Spermogram is a trendy study. Even those who are only going to have children in the future, consider it necessary to pass such a test. Is such an act practical or is it just a simple tribute to the new fashion? How does the analysis help fertilization?

There is no short answer for several reasons:

• the spermogram can change depending not only on the condition of the man, but also on his mood, mental attitude, and even those foods that he ate 3-4 days before the analysis;
• Determining the "quality" of ejaculate is only half the journey. WHO believes that the spermogram only 50% confirms the fertility (fertility) of a man;
• in order to get the right conclusions, you need to be able to read the data obtained. But even exact transcript does not give a full guarantee that a man will be able to fertilize a partner.

We will talk in more detail about the role a spermatogram plays in a man’s life, how to decipher it correctly and what to do in case of “bad” results below. For now, very interesting fact. If we translate genetic information into a “computer” language that is more understandable to today's generation, then we can draw up the following scheme:

Even based on this not the most serious example, it can be understood that the viscosity of sperm, its color, acidity and other indicators have a very limited effect on the occurrence of pregnancy.

A few words from history

Only 200 years later, Hertwig found that the sperm, penetrating the egg, fertilizes it. Amazing properties spermatozoa were discovered even later.

Everyone who is going to undergo a spermogram today should know:

Scientists acquired all this information in the process of studying the ejaculate, which lasted more than 3 centuries. However, only in 1929, for the first time, it occurred to specialists to study the probability of pregnancy depending on the concentration of spermatozoa in the ejaculate. Spermogram appeared even later.

It was from that time that studies began to be carried out that made it possible to link the concentration of spermatozoa with the fertility of their owners, to determine the upper and lower limits of this concentration. But these figures are constantly updated. So at first it was believed that if there are less than 60 million sperm in 1 ml of ejaculate, then a man is not able to make a woman a mother. Then this number dropped to 40 million.

The latest numerical revisions were adopted by WHO in 2010. It is they who are taken into account by specialists when deciphering the spermogram. What is considered normal today?

• ejaculate volume from 1.5 ml;
• at least 15 million spermatozoa in every milliliter of semen;
• 40% or more motile spermatozoa, of which at least 32% should actively move forward;
• at least 4% of sperm with a normal morphological structure.

From the indicators it is clear that in order for a man to fertilize a woman, even such low results are enough for him.

What is a spermogram?

Before undergoing a fertility test, a man must understand:

So what is a spermogram? This is a micro- and macroscopic study of the ejaculate. Under a microscope, experts study:

• blood cells;
• spermatogenesis cells;
• assess the mobility, structure and concentration of spermatozoa.

The macroscopic examination includes:

• assessment of the amount of ejaculate;
• its color;
• smell;
• acidity level;
• consistency, etc.

Several consecutive spermograms help not only to determine the fertility of a man at a particular moment, but to track the change in his spermatogenesis during treatment.

Spermogram indicators and their interpretation

Amount of ejaculate

A healthy average man should ejaculate at least 1.5 ml of semen. Sometimes the amount entering the study has a smaller volume, not because there was little of it, but because the patient lost part of the sample during the collection process. The loss of part of the sperm, especially its first portion, is also unacceptable because it is in it that the main amount of spermatozoa is concentrated. Therefore, an incompletely collected ejaculate can greatly distort the results of the analysis. If the liquid could not be completely collected, the patient must indicate this on a special form, which he will fill out before. If the ejaculate is completely collected, but its volume is less than 1.5 ml, this may indicate:

• the presence of infectious or inflammatory diseases;
• obstruction of the seminal ducts;
• insufficiently active functioning of the prostate gland;
• improper development or structure of vesicles (seminal);
• retrograde ("reverse") ejaculation, in which semen, instead of pouring out, enters the bladder4
• changes in the body due to: obesity, smoking, alcohol, lack of movement, etc.;
• an insufficiently long period of abstinence before collecting the ejaculate.

liquefaction

Sexual partners have noticed that as soon as the seed is erupted outward, it becomes gelatinous. This is a normal process, it is called coagulation. After a few minutes at room temperature, the ejaculate "melts", turning into a liquid. This process is called liquefaction and can last 15-60 minutes. It is this time that is considered normal for liquefaction.

The analysis is carried out by picking up a drop of the test material on the tip of a glass rod or needle. The needle is then lowered vertically and the drop is observed to expand.

The analysis can show that "unmelted" jelly-like granules remain in the ejaculate under study. This is also considered normal and does not affect the general clinical picture and diagnosis. If the liquefaction process exceeds 60 minutes, this may indicate a lack of enzymes or inflammation of the organs responsible for the production of ejaculate.

Viscosity, color and volume

Some self-taught, trying to read the spermogram on their own, confuse viscosity and liquefaction.

Viscosity is the "thickness" of semen. The thicker environment, the more difficult it is for any organism to move in it. The higher the viscosity of the sperm, the more it makes it difficult for the sperm to move towards the desired goal. How is viscosity determined? A drop of ejaculate brought for examination is released from a pipette or dispenser. The drop does not fall freely (normal viscosity) or stretch to become a thread. The latter indicates that an inflammatory process occurs in the body of a man.

The normal color of semen is familiar to anyone who makes love. It is cloudy or milky white, yellowish gray. Color change says a lot.

• if the sperm is stained in pinkish color, this means that red blood cells (blood) are present in the semen. This happens with some forms of prostatitis, trauma, vesiculitis;
• the presence of yellow or brown shades in the semen makes one think about the presence of pus in it or the excessive consumption of products containing dyes by a man.

What is included in the ejaculate? Secrets (substances) that produce different male glands. Most of all in the semen is a “product” that is produced by the prostate and vesicles (vesicles). Even in the "cocktail" there is a derivative of the bulbous urethral glands, epididymis. By calculating the content of each element in a given volume of semen, one can almost accurately calculate how many spermatozoa are in it and how much this amount corresponds to the generally accepted norm.

Sperm acidity and other indicators

Acidity (hydrogen index) - very important indicator. It is known that in an acidic environment, spermatozoa quickly lose their viability. In order to neutralize the "acidic" surface of the vagina, into which the ejaculate enters and allow the spermatozoa to reach the egg, nature placed them in a slightly alkaline environment. An indicator of 7.2-8 is considered normal. It is he who allows the sperm to neutralize the acidity of the vagina and ensure normal fertilization. If the acidity index is higher than the indicated figures, then this means that:

• in a man there is an obstruction of the paths along which the seed moves;
• urine is present in the ejaculate;
• seminal vesicles are underdeveloped, etc.

A value greater than 8 indicates a high alkalinity of the sperm due to infections or inflammation in the seminal ducts.

Agglutination - good or bad?

Agglutination is bonding. Sometimes spermatozoa stick together with heads, tails, or the heads of some stick to the tails of others ( mixed type). This should not normally be the case. If the spermatozoa stick together, this indicates that antibodies have “stuck” on them or the person is infertile for other reasons. Agglutination can be:

• true, in which the sperm stick together;
• false when they stick together with other cells contained in the sperm.

The cause of agglutination, in addition to diseases, can be surgery, trauma.

What else is in semen and how much should it be?

In semen that meets the standard indicators, there may be:

• leukocytes (1×106 million/ml). If there are more white blood cells, this may mean the presence of the most various inflammations in organism;
• products of spermatogenesis: round immature cells. There should be about 4 of them in the field of view of the researcher. If there are fewer of them, the testicles may be damaged or poorly functioning in a man;
• pieces of the epidermis.

Sperm concentration

It should not be confused with the total number of these elements.

The number of spermatozoa that is included in the delivered ejaculate is called the quantity and is normally about 15 million / ml and above.

Only a specialist is able to understand the intricacies of these ratios, so ordinary patients are better off just remembering these numbers. More low rates significantly reduce the likelihood of fertilization (pregnancy).

A few words about sperm motility. They are divided into 3 groups, each of which has its own characteristics.

• motionless. Complete absence movement indicates that these organisms are dead. Pregnancy cannot occur;
• non-progressive-mobile. These are spermatozoa, which, actively “moving” in one place, do not move forward. They are in the sperm of every man;
• progressively mobile. These are moving fast and hard. It is their entry into the egg that leads to the desired (or unwanted) pregnancy. In semen, 32% should be exactly them. "Progressive" and "non-progressive" spermatozoa together should add up to 40%.

It is important to know: it is this indicator that most of all depends on the mental and nervous state of the patient.

The structure of spermatozoa

In order to understand how the shape (morphology) of "tailed creatures" corresponds to the norm, they are examined under a microscope, magnified 1000 times. In this case, the drug is first stained. What does a complete spermatozoon look like?

Its head is oval, smooth, distinct. It has 2 parts. In one - enzymes, without which fertilization is impossible. The size of this part occupies 40-70% of the volume of the entire head. The other part contains the genetic material. The neck and flagellum (it is 10 times longer than the head) also have a clear shape. Any deviation can lead to difficult fertilization.

What to look for when doing research?

How to prepare yourself for a spermogram?

Preparation begins at least 4-5 days before going to the laboratory. At this time, the man must:

• exclude any alcohol from your life;
• refrain from masturbation and sexual intercourse;
• completely refuse to take any drugs (except for vital ones). The presence of the latter should be reported to the doctor;
• do not visit baths, steam rooms, etc.

How to collect and donate ejaculate?

• it is best to do this not at home, but in the laboratory. Any temperature effects on sperm affect its characteristics;
• condoms are strictly forbidden to use: their lubrication greatly affects the acidity of sperm. Only sterile laboratory glassware may be used;
• you need to collect all the sperm, especially its first drops;
• if semen for analysis is to be obtained during masturbation, the cleanliness of the hands and penis should be carefully monitored and no lubricants should be used.

Spermogram is a sentence?

No, this is not a sentence.

Medicine knows cases when a man with unfavorable spermogram parameters became a father. And this was not always preceded by medical treatment.

Male infertility may depend on the activity of the brain. If the representative of the stronger sex is afraid or does not want the partner to become pregnant, the brain begins to block the production of full-fledged spermatozoa. Their number may decrease under the influence of other intrusive thoughts or fears. It only takes a man to normalize his state of mind, get rid of aggravating emotions, as the number of spermatozoa and their quality become normal.

That is why, having received a spermogram with “bad” indicators, you should not be upset, but undergo a course of treatment or psychological support.

An accurate analysis of the spermogram and a prognosis for future paternity can be obtained at the same place where the tests were taken. A urologist-andrologist deals with male fertility.

The main purpose of the study of the ejaculate is to determine the ability of sperm to fertilize and identify diseases and / or pathological processes that caused the corresponding damage. Sperm examination is an integral part of infertility diagnosis. In about 47% of cases, the cause of childlessness couples is a man. The cause of infertility in men can be diseases of the testicles, prostate, conduction disorders of the seminiferous tract, diseases and malformations of the urethra. The study of seminal fluid is also one of the tests in the diagnosis of hormonal disorders, diseases of the genital organs or their malformations.

Normally, the ejaculate is a suspension of spermatozoa in the secretion of the testicles and their appendages, which by the time of ejaculation is mixed with the secretion of the prostate gland, seminal vesicles and bulbous urethral glands.

Spermatozoa make up about 5% of the volume of semen and are produced in the testicles. Approximately 60% of the volume of semen is produced in the seminal vesicles. It is a viscous, neutral or slightly alkaline liquid, often yellow or even highly pigmented due to high content riboflavin.

The prostate produces approximately 20% of the volume of seminal fluid. This milk-like liquid has a slightly acid reaction (pH about 6.5), mainly due to the high content citric acid. The prostatic secretion is also rich in acid phosphatase and proteolytic enzymes, it is believed that proteolytic enzymes are responsible for coagulation and liquefaction of seminal fluid.

Less than 10-15% of semen volume is produced in the epididymis, vas deferens, bulbourethral and urethral glands.

The standard spermogram assesses the physical (macroscopic) and microscopic parameters of the ejaculate (Table, Fig. 1-3).

Indicator	Characteristic	Interpretation
Color	Grayish-whitish, slightly opalescent	Norm
	Almost transparent	Sperm concentration is very low
	reddish brownish	The presence of red blood cells
	Greenish	pyospermia
	Yellowish	Jaundice, taking certain vitamins, with prolonged abstinence
pH reaction	7.2–7.8, slightly alkaline	Norm
	Below 7.0	In the azoospermic specimen, the presence of obstruction or congenital bilateral absence of the vas deferens
	9.0–10.0 alkaline	Pathology of the prostate
Volume	2–6 ml	Norm
	Less than 1 ml	Androgen deficiency, endocrine diseases, narrowing and deformation of the vesicles, vas deferens

Sample collection and storage conditions

The ejaculate must be obtained after at least 48 hours, but no more than 7 days of sexual abstinence.

The ejaculate obtained by masturbation must be collected completely and kept warm (20–40 ° C). The sample is stable for one hour, however, if sperm motility is pathologically low (less than 25% of sperm with fast linear translation), the time between sample collection and analysis should be kept to a minimum.

Research method

Macroscopic examination - determination of the consistency, volume, odor, color, viscosity and pH of the ejaculate.

The semen obtained during ejaculation is thick and viscous, which is due to the coagulation of the secretion of the seminal vesicles. Normally, at room temperature, the ejaculate sample should liquefy within 60 minutes. If ejaculate long time remains viscous, semi-viscous, or does not liquefy at all, then inflammation of the prostate gland can be assumed. Normal ejaculate volume is 2-6 ml. The amount of less than 1.0 ml is typical for androgen deficiency, endocrine diseases, narrowing and deformation of the vesicles, vas deferens. The maximum volume can reach 15 ml. The volume of ejaculate does not affect fertility. The smell of normal ejaculate is specific and is due to spermine (reminiscent of the smell of “fresh chestnuts”). The specific smell becomes weak or absent when the prostate excretory ducts are blocked. In purulent-inflammatory processes, the smell of semen is due to the waste products of the bacteria that caused the inflammatory process.

microscopic examination– study of sperm motility and the presence of agglutination in the native preparation, counting the number of spermatozoa in the Goryaev chamber, studying the morphology of spermatozoa, spermatogenesis cells and differential diagnosis live and dead spermatozoa in stained preparations.

Microscopic examination of the ejaculate is carried out after its complete liquefaction.

The motility of each sperm cell is classified into categories using the following criteria:

a) fast forward movement;

b) slow and sluggish movement;

c) relentless movement;

d) immobile spermatozoa.

First, all spermatozoa of categories a and b are counted in a limited area of ​​the field of view or, if the concentration of spermatozoa is low, in the entire field of view (%). Further, in the same area, spermatozoa with non-translational movement (category c) (%) and immobile spermatozoa (category d) (%) are counted.

Mobility can be determined by counting in the Goryaev chamber. Sperm is bred 20 times saline, only immobile and inactive spermatozoa look in the camera.

The calculation is carried out according to the formula:

X \u003d A - (B + C), where,

A is the total number of spermatozoa;

B - quantity sedentary spermatozoa;

C is the number of immobile spermatozoa.

From here, the number of actively motile spermatozoa in percent is (Y):

Y \u003d X * 100 / A.

Sperm motility depends on the time of year and day. There is evidence that in the spring there is a decrease in sperm motility (seasonal fluctuations). When monitoring the number of active-motile spermatozoa during the day, an increase in their number in the second half of the day (daily rhythms) was noted.

A decrease in sperm motility below normal is asthenozoospermia. A slight degree of asthenozoospermia - the number of actively and inactive spermatozoa with forward movement in total is less than 50%, but more than 30%.

Evaluation of sperm agglutination. Sperm agglutination refers to the gluing of motile spermatozoa together by heads, tails or heads with tails. Bonding of immobile spermatozoa to each other or of motile spermatozoa to filaments of mucus, other cells or cell debris should be considered and recorded not as agglutination, but as non-specific aggregation. During the study, the type of agglutination is recorded (heads, tails, mixed variant). A semi-quantitative method can be used to assess the degree of agglutination from "-" (no agglutination) to "+++" (severe degree, in which all motile spermatozoa are susceptible to agglutination). Normally, no more than 3-5% stick together. If the number of agglutinated spermatozoa is 10-15%, we can talk about a decrease in their fertilizing ability.

The calculation of the total number of spermatozoa is carried out in the Goryaev chamber. Total spermatozoa in the ejaculate is calculated by multiplying the number of spermatozoa in 1 ml of semen by the volume of semen extracted.

normospermia- at healthy man 1 ml of ejaculate contains more than 20 million spermatozoa.

Polyzoospermia- the number of spermatozoa in 1 ml of ejaculate exceeds 150 million.

Oligozoospermia- 1 ml of ejaculate contains less than 20 million spermatozoa.

Azoospermia- absence of spermatozoa in the ejaculate.

Aspermia– in the delivered liquid there are no spermatozoa and spermatogenesis cells.

Assessment of viability of spermatozoa. To assess the viability of spermatozoa, one drop of fresh ejaculate is mixed on a glass slide with a drop of standard eosin dye. Live spermatozoa in such preparations are not stained (white); dead spermatozoa are stained red, because. their plasma membranes are damaged. By viability is meant the proportion (in percent) of "live" spermatozoa. Viability should be assessed if the percentage of immotile spermatozoa exceeds 50%.

Viability assessment can serve as a control for the accuracy of sperm motility assessment, since the percentage of dead cells should not exceed (taking into account the counting error) the percentage of immotile spermatozoa. The presence of a large number of live but immobile spermatozoa may indicate structural defects in the flagella. The sum of dead and live sperm should not exceed 100%.

Characteristics of the cellular elements of the ejaculate. Usually, the ejaculate contains not only spermatozoa, but also other cells, which are collectively referred to as "round cells". These include epithelial cells of the urethra, prostate cells, immature germ cells and leukocytes. Normally, the ejaculate should not contain more than 5 * 106 round cells / ml.

In most cases, human ejaculate contains leukocytes, mainly neutrophils. Increased content These cells (leukospermia) may indicate an infection and poor sperm quality. The number of leukocytes should not exceed 1106/ml. Counting is carried out in the Goryaev chamber in the same way as sperm counting.

In addition to leukocytes, the ejaculate may contain immature sex cells (spermatogenesis cells) for different stages maturation: spermatogonium, spermatocyte of the 1st order, spermatocyte of the 2nd order, spermatids. (Fig. 2)

Presence in the ejaculate various types immature cells of spermatogenesis usually indicates its violation. The excess of these cells is a consequence of dysfunction of the seminiferous tubules, in particular, with reduced spermatogenesis, varicocele and pathology of Sertoli cells.

Assessment of sperm morphology. For analysis, a smear stained with histological dyes (hematoxylin, Romanovsky-Giemsa, etc.) is used, in which a sequential count of 200 spermatozoa is performed (a single count of 200 spermatozoa is preferable to a double count of 100 spermatozoa) and the number of normal and pathological forms is expressed as a percentage (Fig. 3 ).

The head of the sperm should be oval. The ratio of the length of the head to its width should be between 1.5 and 1.75. A well-defined acrosomal region should be visible, accounting for 40–70% of the head area. The neck of the sperm must be thin, 1.5 times the length of the sperm head and attached to the head along its axis. The size of the cytoplasmic droplets should not exceed 1/2 the size of the head of a normal spermatozoon. The tail should be straight, of the same thickness throughout and somewhat narrower in the middle part, not twisted and about 45 microns long. The ratio of the length of the head to the length of the tail in normal spermatozoa is 1:9 or 1:10.

Head defects: large, small, conical, pear-shaped, round, amorphous, with vacuoles in the chromatin region; heads with a small acrosomal region, a vacuolated acrosome, with an asymmetrically located acrosome; double and multiple heads, heads with a compact chromatin structure, etc.

Neck and midsection defects: “slant” neck (neck and tail forming a 90° angle to the long axis of the head), asymmetrical attachment of the midsection to the head, thickened or irregular midsection, pathologically thin midsection (lack of mitochondrial sheath), and any combination of these .

Tail Defects: Tails short, multiple, hairpin, broken, sloping (greater than 90°), uneven tail thickness, thin mid-section, twisted end, fully curled, and any combination of these. With a differentiated morphological count, only spermatozoa with tails are taken into account.

Teratozoospermia- an increase in the number of pathological forms of spermatozoa above the reference values. Severe teratozoospermia dramatically reduces the chances of fertilization and increases the likelihood of fetal malformations if fertilization occurs. Teratozoospermia is usually associated with oligozoospermia and asthenozoospermia.

Spermatozoa, in which the head is enclosed in a cytoplasmic drop, and those in which the cytoplasmic drop is located on the neck in the form of a scarf and, in relation to the size of the head, is more than 1/3, are distinguished as immature or young. In a normal spermogram, they make up about 1%.

Reference intervals

• Volume - 2.0 ml or more;
• pH - 7.2 or more;
• concentration - 20 *106 sperm / ml or more;
• total number - 40 *106 spermatozoa or more in the ejaculate;
• mobility - 50% or more mobile (category a+b); 25% or more with forward movement (category a) within 60 minutes after ejaculation;
• viability - 50% or more alive, i.e. not painted;
• leukocytes - less than 1 *106 / ml.

Classification of indicators of ejaculate

• Normozoospermia - normal ejaculate;
• oligozoospermia - the concentration of spermatozoa is below the normative values;
• asthenozoospermia - mobility below the standard values;
• teratozoospermia - morphology below the normative values;
• oligoastenoteratozoospermia - the presence of violations of all three indicators;
• azoospermia - no sperm in the ejaculate;
• aspermia - no ejaculate.

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Spermogram- a method for studying ejaculate to assess the fertilizing ability of male sperm. The analysis of the spermogram shows the quantitative, qualitative, morphological parameters of the sperm.

Semen analysis is performed in case of:

1. Barren marriage (identification male factor, spermogram - male infertility). Infertile is a marriage in which pregnancy does not occur within 1 year of regular sexual activity without the use of contraceptives.
2. Infertility in men (prostatitis, varicocele, infections, injuries, hormonal disorders).
3. Preparation for artificial insemination.
4. Planning for pregnancy.
5. A man's desire to test his fertility (fertility).

How is a spermogram given?

Material for research is collected by masturbation. You can bring the ejaculate in a sterile, hermetically sealed container, warm (in the armpit or in a thermostat at body temperature), within an hour after the test. Prior to the test, abstinence for at least 4 days, but not more than a week. During this period, the rejection of thermal procedures, alcohol. After taking antibiotics, at least 2 weeks should pass.
Methods for the study of sperm: phase-contrast microscopy, special staining to assess the morphology of spermatozoa.

Spermogram norm

Volume - more than 2 ml;
Consistency - viscous;
Liquefaction after 10-30 minutes;
Viscosity up to 2 cm;
Color - white-grayish;
The smell is specific;
pH 7.2-8.0;
Turbidity - cloudy;
Mucus - absent;
The number of spermatozoa in 1 ml - 20 million - 200 million;
The total number of spermatozoa in the ejaculate is more than 40 million;
The number of active spermatozoa - more than 25%;
The total number of active and sedentary - more than 50%;
Immobile spermatozoa - less than 50%;
Lack of agglutination and aggregation;
The number of leukocytes up to 1 million;
Normal spermatozoa - more than 50%;
Spermatozoa with normal head morphology - more than 30%;
Spermatogenesis cells - 2-4.

Interpretation of spermogram, classification of ejaculate indicators:

Aspermia - absence of ejaculate
oligozoospermia - a decrease in the number of spermatozoa in the ejaculate (less than 20 million in 1 ml),
azoospermia - the absence of sperm in the ejaculate,
cryptozoospermia - the presence of single spermatozoa in the ejaculate after centrifugation,
asthenozoospermia - decreased sperm motility,
teratozoospermia - a decrease in the content of spermatozoa of normal morphology.

Spermogram results

With results that are different from the norm, it is necessary to donate sperm again in 1-2 weeks and contact an andrologist with the results obtained to search for the causes of the pathology that has arisen. An exception is the suspicion of genital infections, in which case treatment should be started immediately. For example, the effect of prostatitis on the spermogram is manifested in sperm motility. Infectious prostatitis (especially those caused by sexually transmitted infections) has a great influence on the quality of sperm. The inflammatory process in the prostate reduces the mobility of spermatozoa, contributes to their agglutination (gluing due to the presence of bacterial bodies or their metabolic products on the surface of the spermatozoa) and the formation of inferior forms (for example, poor spermogram as a result of ureaplasmosis).

How to improve spermogram?

Sometimes it is possible to improve the quality of sperm by eliminating industrial and domestic harmful factors having established a normal rhythm of work and rest, it is also necessary to ensure good nutrition, the correct rhythm of sexual life. It is useful to do physical gymnastics daily with an emphasis on exercises that improve the functioning of the pelvic and abdominal muscles.

The most effective for improving the quality of spermogram is the treatment of urological, endocrine diseases, as well as taking some medications. What drugs and the duration of their administration are prescribed by a urologist-andrologist.

The state of spermatogenesis is assessed by spermogram (spermogram).

To obtain a correct spermiological diagnosis, the following conditions must be met during ejaculate delivery:

• abstaining from ejaculation for 2-7 days ( optimal time 4 days);
• abstaining from taking alcoholic beverages, including beer, potent drugs (hypnotics and sedatives) during this period;
• abstinence from visiting saunas, baths, as well as from taking hot baths for 2-7 days;

Often, andrologists tell patients a spermiological diagnosis and hand out a spermogram without a detailed explanation. Patients have a huge number of questions: which of the indicators does not correspond to the norm, what does this discrepancy mean, how are the spermogram indicators related to each other?

We have tried to compile for you a table of the main indicators of spermogram with brief comments. The table shows the norms of spermiological indicators of WHO (4th edition, Cambridge University Press, 1999 (MedPress, 2001)), as well as recommended norms.

We hope that this table will help you better navigate the spermogram, but we note that the results of the spermogram are evaluated comprehensively and only a professional can interpret them correctly.

Spermogram indicators, their norms and commentary on deviations:

Spermogram index	What does the indicator mean	WHO standards	A comment
		Our recommended norms
Term of abstinence	Number of days of sexual abstinence before analysis	2-7 days	If the terms of abstinence are not observed, the result of the analysis cannot be compared with the standard, and the spermiological diagnosis in this case should be considered incorrect. Average periods of abstinence are optimal for the study of ejaculate. Reanalysis should be taken with the same abstinence period as the first.
		3-5 days, optimal - 4 days
Volume	The total volume of ejaculate.	2 ml or more	An ejaculate volume of less than 2 ml qualifies as microspermia, which in most cases is associated with insufficient function of the accessory gonads*. The upper limit of ejaculate volume is not limited by the WHO Guidelines. However, according to our observations, an increase in the volume of ejaculate is more than 5 ml. often indicates an inflammatory process in the accessory sex glands.
		3-5 ml
Color	ejaculate color.	Grayish	Red or brown color indicates the presence of blood, which may be caused by the presence of a tumor, stones in the prostate gland, or trauma. A yellowish tint may be a variant of the norm or indicate a disease of jaundice or the intake of certain vitamins.
		White, grayish or yellowish
PH	The ratio of negative and positive ions.	7.2 or more	Only the lower pH value is limited by WHO experts. However, according to our observations, not only a decrease in pH below 7.2, but also its increase above 7.8 in most cases indicates the presence of an inflammatory process in the accessory sex glands.
		7,2-7,8
Liquefaction time	The time of semen liquefaction to viscosity standards.	Up to 60 min	An increase in the liquefaction period is usually the result of long-term inflammatory processes in the accessory gonads, such as in the prostate (prostatitis), seminal vesicles (vesiculitis), or enzyme deficiency. We consider the liquefaction time to be one of the most important spermiological parameters. It is very important that spermatozoa get the opportunity to actively move as quickly as possible. With prolonged liquefaction, spermatozoa, moving in a viscous medium, lose biologically available energy (ATP) faster, stay longer in the vagina, the acidic environment of which significantly reduces their mobility, and hence their ability to fertilize.
		Up to 60 min
Viscosity (consistency)	viscosity of the ejaculate. It is measured in centimeters of a thread at which it is formed into a drop and separated from a pipette or a special needle.	Small individual drops (up to 2 cm.)	The reasons for the increase in viscosity are the same as for increasing the thinning time. The WHO Guidelines do not have a clear standard for semen viscosity. Only the following is said: "Normal, the ejaculate, flowing from the pipette, forms small separate drops, and a sample with pathological viscosity forms a thread of more than 2 cm." We believe that a drop of normal liquefied semen should not stretch more than 0.5 cm, since, according to our observations, the fertility of patients whose sperm viscosity exceeds 0.5 cm, and even more so 2 cm, is significantly reduced.
		0.1-0.5 cm
Sperm Density	The number of spermatozoa in 1 ml. ejaculate.	20 million or more	An increase or decrease in sperm density is defined as polyzoospermia or oligozoospermia, respectively. The upper limit of normal for sperm density is not limited by WHO experts. However, according to our observations, an increase in the density of spermatozoa above 120 million/ml, in most cases, is combined with their low fertility and in many patients is subsequently replaced by oligozoospermia. Therefore, we are convinced that patients with polyzoospermia need dynamic monitoring. The reasons for the change in sperm density are not fully understood. It is believed that they are the result of endocrine disorders, blood flow disorders in the organs of the scrotum, toxic or radiation effects on the testicle (increasing or inhibiting spermatogenesis), inflammatory processes, and less often - immunity disorders.
		20-120 million
Total sperm count	Sperm density multiplied by volume.	40 million or more	The reasons for possible non-compliance with the standards are the same as in the previous paragraph.
		40 to 600 million
Sperm motility	The ability to move. It is assessed in 4 main groups: 1. Active-moving with rectilinear movement (A) 2. Sedentary with rectilinear movement (B) 3. Sedentary with oscillatory or rotational movement (C) 4. Fixed (D)	type A > 25%, or A+B > 50% after 60 min. after ejaculation	Reduced sperm motility is called asthenozoospermia. The causes of asthenozoospermia are not fully understood. It is known that asthenozoospermia can be a consequence of toxic or radiation effects, inflammatory processes or immunological factors. Also, the environment matters. Asthenozoospermia is often observed in people working under elevated temperature(cook, bath attendant, hot shop worker, etc.).
		type A > 50%, type B - 10-20% type C - 10-20% type D - 10-20% after 60 min. after ejaculation
Morphology	The content in the ejaculate of spermatozoa with normal structure and capable of fertilization.	Over 15%	There is no consensus among specialists both on the issue of assessing the morphology of spermatozoa and on the normative values ​​for the content of normal spermatozoa in the ejaculate. Therefore, the evaluation of sperm morphology is one of the most subjective and controversial sections in spermiological research. Usually morphologically normal spermatozoa make up 40-60%. In Russia, the diagnosis is teratospermia, i.e. "ugly sperm", is put in cases where the number of spermatozoa with a normal structure is less than 20%. The deterioration of morphological parameters is often temporary and occurs during stress, toxic effects, etc. Also, the morphological picture of the ejaculate largely depends on the environmental situation in the patient's region of residence. As a rule, the number of pathological forms increases in residents of industrial zones.
		Over 20%
Live spermatozoa (sometimes dead spermatozoa)	Percentage of live spermatozoa in the ejaculate.	Over 50%
		Over 50%
Spermatogenesis cells (immature sex cells)	Spermatogenesis cells are epithelial cells of the seminiferous tubules of the testis.	There are no percentages	Found in every ejaculate. A significant number of spermatogenesis cells (desquamation of the epithelium) occurs in the secretory form of infertility.
		Up to 2%
Sperm agglutination	Sperm agglutination is the adhesion of spermatozoa to each other, which prevents their forward movement.	Should not be normal	True agglutination is rare and indicates abnormalities in immune system. It is necessary to distinguish true agglutination from aggregation of spermatozoa. Unlike aggregates, in true agglutination, only spermatozoa stick together and their "rosettes" do not contain cellular elements.
		Should not be normal
Leukocytes	White blood cells. There are always.	1*10 6 (3-4 in standard field of view)	Exceeding the norm indicates the presence of inflammation in the genital organs (prostatitis, vesiculitis, orchitis, urethritis, etc.).
		1*10 6 (3-4 in standard field of view)
red blood cells	Red blood cells.	Should not be normal	The presence of red blood cells in semen may be associated with tumors, genital trauma, the presence of stones in the prostate, vesiculitis. anxiety symptom requiring serious attention!
		Should not be normal
amyloid bodies	They are formed as a result of stagnation of the secretion of the prostate in its various parts. The number is not counted.	no WHO standards	Designated as "Present/absent (+/-)". Amyloid bodies are currently absent in many patients, which indicates some decrease in prostate function.
		There are no standards
Lecithin grains	Produced by the prostate gland. The number is not counted.	no WHO standards	Designated as "Present/absent (+/-)". A small amount of lecithin grains indicates a decrease in the functions of the prostate gland.
		There are no standards
Slime	The mucus contained in the ejaculate.	no WHO standards	May be present in the norm. A large number of mucus indicates a possible inflammation of the accessory sex glands.
		There are no standards

* Accessory sex glands include the prostate gland, seminal vesicles, Cooper glands, etc.

The norms of spermogram indicators indicated in the WHO Guidelines and recommended by us are different in some cases.

Let's try to justify our position.

1. Suggested World Organization Health care norms for spermogram indicators were developed by averaging statistical data collected from various countries of the world. At the same time, in different regions, as a rule, the average spermiological indicators of male ejaculate are different. Moreover, these differences can be significant.
2. Authors of the WHO Guidelines "consider it preferable for each laboratory to define its own standard values for each spermogram indicator".
3. The norms of ejaculate indicators proposed by us were obtained as a result of studies conducted at the Clinical Center for Andrology and Transplantation endocrine glands under the guidance of Professor I.D. Kirpatovsky, published works of Russian specialists and our laboratory and clinical experience.

The study of ejaculate is one of the most subjective laboratory research, and its result - spermogram largely depends on the skill level of the spermiologist.

In some organizations, special devices - sperm analyzers - are widely used to study ejaculate. We are convinced that the spermogram performed on the device must necessarily be duplicated by a spermiologist's study, since the devices can "confuse" some morphological structures with each other. For example, sperm heads and small white blood cells.

In conclusion, it should be noted that neither of normative indicators ejaculate does not indicate the minimum values ​​at which pregnancy is possible.

You can get a free consultation of an andrologist on spermogram interpretation at our website.