A spermogram or sperm analysis is one of the main methods for diagnosing the ability to conceive when examining a man in case of infertility.

In 2010, the World Health Organization published a Manual on the Laboratory Examination of Human Sperm (" WHOlaboratorymanualfortheexaminationandprocessingofhumansemen"). This guide covers all stages of sperm analysis - from collection techniques to disposal.

Synonyms: semen analysis, ejaculate analysis, sperm iog ramma, sper mato gram, semen analysis, spermatological examination.

Spermogram (sperm analysis) is

a standardized method for examining ejaculate, aimed at assessing the macroscopic and microscopic parameters of sperm.

The term “sperm analysis” is quite broad and includes several types of research (as defined by WHO), and a “spermogram” is aimed primarily at assessing the quantity and quality of sperm. In domestic urology and andrology, these terms are used as synonyms.

What is sperm and ejaculate?

Sperm is a concentrated suspension of sperm that is released during ejaculation.

Ejaculate is the fluid flowing from the male penis during orgasm, consisting of sperm and secretions from the prostate and seminal vesicles. The terms “ejaculate” and “sperm” are synonymous.

Sperm is 90% water, 6% organic matter and 4% .

Sperm composition

1. seminal plasma - a mixture of fluids produced by the testicles, cells of the seminiferous tubules, ducts of the epididymis, vas deferens, seminal vesicles, prostate, bulbourethral glands and paraurethral glands in the urethra itself;
2. formed elements, among which the first place is occupied by mature sperm, the amount in an adult man is about 15-100 million in 1 ml of ejaculate; other types of cells may be detected in sperm, but their total number should not exceed 2% of the total number of cells

• round degenerative cells from the germinal epithelium or from the lining of the straight tubules and rete testis
• columnar epithelium of the excretory genital ducts and urethra
• leukocytes
• fragments of spermatid cytoplasm (residual bodies)
• prostatic stones
• lipid grains
• protein granules
• pigment grains
• Bötcher crystals - prismatic crystals, a precipitate of salts of phosphoric acid and spermine, appear when water evaporates from sperm

Preparation

• sexual abstinence (including from masturbation) 2-7 days; in subsequent studies, the period of abstinence should be the same - if during the first study it was 4 days, then during the second, etc. - similar 4 days
• eliminate the influence of temperature - sauna, steam bath, hot bath or shower
• do not drink alcohol 14 days before the test
• Avoid taking medications that affect the urogenital tract

• You need to donate sperm in a special room at the laboratory (clinic) to minimize the time between receiving the material and its examination
• method of obtaining sperm - masturbation into a chemically clean, wide-necked glass or plastic cup (can be purchased at a pharmacy or in the laboratory itself)
• in some cases, you can use special condoms without spermicides
• You need to collect all the sperm; the most valuable is considered to be the first drop, which contains the maximum amount of sperm (its loss can lead to false test results)
• Sperm containers must be sterile if sperm culture, intrauterine insemination, or in vitro fertilization (IVF) is to be performed. in vitro fertilization)
• dish temperature 20-40°C (i.e. you can’t come in from the cold and start taking a sample)
• in exceptional cases, sperm can be collected at home, but the time of transport to the laboratory should be less than 60 minutes in a light-proof bag, temperature 20-40°C

Forbidden:

• sperm obtained during interrupted sexual intercourse is not suitable for analysis, since there is a high risk of losing the first drop; it is impossible to decipher the sperm analysis obtained in this way
• ordinary condoms cannot be used to collect sperm, since latex has a spermicidal effect (destroys sperm)

There are four important points in the process of semen analysis: preparation for analysis, transportation to the laboratory, performing the analysis itself, and decoding. Only the first two depend on the man.

Sperm

For a doctor assessing sperm quality, two parameters are most important:

• total sperm count - the ability of the testicles to produce sperm and the transport system to release them
• total volume of ejaculate - the ability of the glands to secrete a secret that ensures the viability of sperm

Bad spermogram

Men with spermogram results that are outside the normal range are less likely to conceive naturally, but this in no way means that the man cannot become a father.

Decoding

1. Sperm color and liquefaction time

Normal sperm is white-gray in color, slightly opalescent, homogeneous, and liquefies at room temperature in 15 minutes. If the liquefaction time is more than 60 minutes, special dissolution enzymes are added to make it suitable for further research. The semen should be free of fresh blood, brown hematin (indicates not previous bleeding), visible pus and mucus fibers. Yellow coloration of ejaculate occurs when taking multivitamins, antibiotics, or jaundice. Gel grains may be present that do not dissolve upon liquefaction.

2. Volume

The minimum amount of sperm required for research is 1 ml, the norm for fertilization is 1.5-5 ml. The amount of sperm depends on the volume of seminal plasma and does not depend on the number of sperm.

3. Consistency and viscosity

It is assessed after liquefaction along the length of the fiber formed when the glass rod touches the sperm. Increased sperm viscosity has a direct effect on sperm motility and indirectly indicates the presence of antisperm antibodies.

4. Acidity or pH

The pH of sperm is slightly alkaline, from 7.2 to 7.8. A pH above 7.8 indicates the presence of infection, and with obstruction of the vas deferens or congenital absence of the vas deferens, azoospermia (complete absence of sperm) and acidity below 7.0 develop.

Microscopic examination of sperm

Microscopic examination of sperm is carried out under a special microscope with phase contrast or an ordinary light microscope, unstained and stained smears are viewed.

1. Sperm count

The doctor counts the number of sperm in a special counting chamber (hemocytometer) under a microscope and calculates their total number in the sample and in 1 ml. Normally, the total number of sperm in the sample should be at least 15 * 10 6 / ml, and in the whole sample - more than 39 * 10 6 / ml

If there are very few sperm in the semen (oligospermia), then the sample is additionally centrifuged and only the sediment is examined (cryptozoospermia). If not a single sperm is detected in the semen sediment, then the conclusion will say “azoospermia”.

2. Sperm motility

To study sperm motility, the doctor examines 5 fields of view twice under a microscope and evaluates at least 200 sperm.

Sperm motility criteria:

a) rapid progressive movement (PR) - 25 microns/sec or more at 37°C or 20 microns/sec or more at 20°C; 25 microns is 5 sizes of sperm heads or half a flagellum, more than 32% of sperm move this way

b) slow progressive movement (“ sluggish" - like a snail)

c) non-progressive movement (NP) - less than 5 microns/sec

d) immotile sperm (IM)

Total mobility is the sum of categories a, b, c, normally more than 40%.

Progressively motile sperm – the sum of categories a and b must be at least 32%.

With a current infectious disease of the urogenital tract - prostatitis, urethritis, vesiculitis or the presence of sperm antibodies, the speed of sperm movement decreases.

3. Other cellular elements in sperm

In addition to spermatozoa, other cells may be present in the ejaculate, which are combined with the term “round cells”, since the magnification of the microscope does not always allow them to be differentiated. To identify them, preparations are stained with special dyes.

"Round cells" are:

• epithelial cells from the urogenital tract
• prostatic cells
• spermatogenic cells
• leukocytes

Normal ejaculate should contain less than 5 million round cells in 1 milliliter.

Leukocytes are predominantly present in small numbers in healthy ejaculate, but their increased number - leukocytospermia - can be caused by infection and inflammation.

If an increased number of leukocytes in semen is detected, additional studies need to be carried out - tank. urine culture, tank. culture of prostate secretion, bact. culture of urogenital secretions. The absence of leukocytes in semen does not exclude the presence of a genitourinary infection.

The presence of immature germ cells (spermatids, spermatocytes, spermatogonia) and epithelial cells in sperm is an indicator of impaired sperm maturation, delayed maturation (hypospermiogenesis), varicocele, Sertoli cell dysfunction, and is associated with a low probability of successful in vitro fertilization (IVF).

4. Sperm agglutination

Agglutination or gluing of living spermatozoa to each other by heads, necks, flagella or mixed (head + flagellum, neck + head, etc.) leads to their immobilization, this is an indirect indicator of immunological infertility. Normally, there is no sperm agglutination.

To diagnose immune infertility, it is carried outMAR test andimmunobead test.

5.% live sperm

The viability of spermatozoa is examined using “intravital” staining; the indicator is examined if the number of immobile sperm exceeds 50%. Dead sperm, with a destroyed cell membrane, are not stained. The test allows you to estimate the number of living but immobile sperm from dead ones. A large number of living but immobile sperm indicates structural defects of the flagella.

A significant number of dead sperm (necrospermia) indicates a disease of the testicles.

The lower limit of normal % of viable sperm is 58%.

6. Structure of sperm

The structure of the sperm is very variable and is not considered a mandatory study as part of a standard spermogram, but is mandatory when planning IVF. The shape of the sperm indirectly reflects the ability to conceive and determines the effectiveness of IVF. For low numbers of morphologically normal sperm, ICSI is recommended ( ICSI - IntraCytoplasmic Sperm Injection, injection of sperm into the cytoplasm of the egg, intracytoplasmic injection of sperm).

The doctor measures 200 sperm and compares them with the “ideal” sperm (read above in the section on the structure of sperm). The criteria for “correctness” (Kruger-Menkveld) are very strict, so the standards are quite low. The smear must contain at least 14% anatomically representative sperm for the sperm to be considered fertile (capable of fertilizing). An indicator of 5-14% has a good prognosis for conception, and 0-4 has a poor prognosis, this sperm is subfertile.

A spermatozoon is considered normal/typical if the head, neck and flagellum do not have any deviations from the norm or any anomaly.

The ejaculate contains a large number of sperm with various morphologically combined deformations, for example, a combination of an altered acrosome and a round head (). Therefore, doctors use special indices:

• TZI (teratozoospermiaindex)– teratospermia index - the average number of defects per 1 abnormal sperm, normally up to 1.6
• MAI (multiple anomalies index) - multiple anomalies index - the sum of all defects in the total number of abnormal sperm
• SDI (sperm deformity index) – sperm defect index – the sum of defects in the total number of all counted sperm

An increased percentage of abnormal sperm is caused by testicular diseases and impaired spermogenesis.

Conclusion of the doctor who examined the sperm

• normozoospermia – normal (completely “healthy”) ejaculate, according to the parameters written above
• oligozoospermia – total sperm count less than 20*10 6 /ml
• asthenozoospermia – less than 50% of sperm with progressive movements of categories A and B, or less than 25% with mobility A
• terotozoospermia – less than 15% of sperm with normal structure
• oligoasthenoteratospermia – a combination of all three conditions described above
• oligoasthenozoospermia - the most common combination of disorders in sperm - decreased motility and sperm count
• cryptozoospermia - sperm are detected only after centrifugation - sedimentation of sperm
• necrozoospermia – there are no live sperm in the preparation
• pyospermia – increased number of leukocytes in the ejaculate
• azoospermia/aspermia – there are no sperm in the ejaculate sample

Questions for the doctor

1. What determines the quality of sperm?

The quality of sperm depends on the condition of all organs involved in its formation and excretion, as well as the body as a whole. You cannot expect a normal spermogram result in the presence of severe, chronic illness or depression.

2. How to improve spermogram?

A healthy lifestyle (nutrition, work, sleep, rest), timely complete treatment of all diseases and sexual literacy.

3. Does a spermogram reveal sexually transmitted infections?

No. Only an increased number of leukocytes can indirectly indicate inflammation, but the spermogram itself will not reveal the pathogen.

4. Is it necessary to do a spermogram prophylactically, for example, at a certain age or early detection of the disease?

5. If the spermogram is normal, then the man does not need to be examined further?

No, a normal semen test result is the first step in diagnosing the disease. A normal semen test result does not exclude the presence of the disease.

6. I don’t have problems with erection, does that mean I don’t need a spermogram?

No, there is no connection between an erection and a spermogram. With normal erectile function, sperm can be “bad” and vice versa.

An erection is an increase in volume and hardening of the penis during sexual arousal for sexual intercourse.

7. Maybe for the reliability of the result, sperm analysis should be carried out in different laboratories?

No. Semen analysis must be carried out in the same laboratory, since the professionalism of the doctor performing the study greatly contributes to the correctness of the result.

8. At what spermogram parameters is conception guaranteed?

Conception is a complex process of fusion of male and female reproductive cells - sperm and egg. During natural sexual intercourse, no one can guarantee the success of conception, even with ideal sperm analysis results. Similarly, with a “bad spermogram,” spontaneous conception is possible.

Data

• A spermogram is not an infertility test
• Each laboratory has its own norms and reference limits for sperm testing, so you shouldn’t be surprised to see one time the norm is 2-6 and another 0-8
• the norm in the spermogram results is rather arbitrary and subjective, because the analysis is carried out by a person; due to the fact that individual analyzes within the spermogram are carried out twice, such distortion is leveled out
• it is necessary to decipher the spermogram in a comprehensive manner; a slight deviation does not always indicate the presence of a disease
• automatic analyzers have only a supporting role in sperm research
• so that the obtained spermogram results can be compared with each other, it is necessary to collect sperm under the same conditions, using the same technique, with the same time of abstinence; It is optimal for the results to be interpreted by the same specialist

Spermogram - sperm analysis, interpretation, results was last modified: October 29th, 2017 by Maria Bodyan

Spermogram is a fashionable study. Even those who are just planning to have children in the future consider it necessary to undergo such a test. Is such an act practical or is it just an ordinary tribute to a 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 man’s condition, but also his mood, mental state, and even the foods he ate 3-4 days before the analysis;
• Determining the “quality” of ejaculate is only half the journey. WHO believes that a spermogram is only 50% proof of a man’s fertility (fertility);
• In order to get the right conclusions, you need to be able to read the data received. But even an accurate decoding does not provide a complete guarantee that a man will be able to impregnate his partner.

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

Even based on this not the most serious example, one can understand 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 established that a sperm, penetrating an egg, fertilizes it. The amazing properties of sperm 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 ejaculate, which lasted more than 3 centuries. However, it was only in 1929 that specialists first thought of studying the probability of pregnancy depending on the concentration of sperm in the ejaculate. The spermogram appeared even later.

It was from this time that studies began to be carried out that made it possible to connect the concentration of sperm with the fertility of their owners, and to determine the upper and lower limits of this concentration. But these figures were 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 refinements were adopted by WHO in 2010. These are the ones that specialists take into account when deciphering the spermogram. What is considered the norm today?

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

It is clear from the indicators: in order for a man to impregnate 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 ejaculate. Under a microscope, experts study:

• blood cells;
• spermatogenesis cells;
• assess the motility, structure and concentration of sperm.

Macroscopic examination includes:

• estimation of ejaculate quantity;
• its color;
• smell;
• acidity level;
• consistency, etc.

Several sequential spermograms help not only to determine a man’s fertility at a particular moment, but to track changes in his spermatogenesis during treatment.

Spermogram indicators and their interpretation

Ejaculate quantity

A healthy average man should ejaculate at least 1.5 ml of sperm. Sometimes the quantity received for testing is smaller, not because little of it was released, 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 sperm is concentrated. Therefore, incompletely collected ejaculate can greatly distort the analysis results. If it was not possible to collect the liquid completely, the patient must indicate this in 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 vas deferens;
• insufficiently active functioning of the prostate gland;
• improper development or structure of vesicles (seminal);
• retrograde (“reverse”) ejaculation, in which sperm, instead of being ejected, enters the bladder4
• changes in the body due to: obesity, smoking, alcohol, lack of exercise, etc.;
• insufficiently long period of abstinence before collecting ejaculate.

Liquefaction

Partners who have sex have noticed that as soon as the semen is ejaculated, it becomes gelatinous. This is a normal process, it is called coagulation. After just a few minutes at room temperature, the ejaculate “melts”, turning into liquid. This process is called liquefaction and can last 15-60 minutes. This is the 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. Then the needle is lowered vertically and watch how the drop stretches.

The analysis may show that “unmelted” jelly-like granules remain in the ejaculate being tested. This is also considered normal and does not in any way affect the overall 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 producing ejaculate.

Viscosity, color and volume

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

Viscosity is the “thickness” of the sperm. The denser the environment, the more difficult it is for any organism to move in it. The higher the viscosity of the sperm, the more it hinders the progress of sperm to 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 stretches into a thread. The latter indicates that an inflammatory process is occurring in the man’s body.

The normal color of sperm is familiar to everyone who makes love. It is cloudy or milky white, yellowish-gray. The change in color speaks volumes.

• If the semen turns pinkish, this means that there are red blood cells (red blood) in the semen. This happens with some forms of prostatitis, injuries, vesiculitis;
• the presence of yellow or brown tints in the semen makes one think about the presence of pus in it or the man’s excessive consumption of products containing dyes.

What's in the ejaculate? Secretions (substances) produced by different male glands. Most of the “product” in sperm is produced by the prostate and vesicles (vesicles). The “cocktail” also contains a derivative of the bulbous-urethral glands, epididymis. By calculating the content of each element in the donated volume of semen, you can almost accurately calculate how many sperm are in it and how much this amount corresponds to the generally accepted norm.

Sperm acidity and other indicators

Acidity (hydrogen value) is a very important indicator. It is known that in an acidic environment, sperm quickly lose their viability. To neutralize the “acidic” surface of the vagina into which the ejaculate enters and allow the sperm to reach the egg, nature placed them in a slightly alkaline environment. The normal indicator is 7.2-8. It is this that allows sperm to neutralize the acidity of the vagina and ensure normal fertilization. If the acidity level is higher than the indicated figures, this means that:

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

An indicator greater than 8 indicates high alkalinity of sperm due to infections or inflammation in the spermatic ducts.

Agglutination - good or bad?

Agglutination is sticking together. Sometimes spermatozoa are stuck together with their heads, tails, or the heads of some stick to the tails of others (mixed type). This should not normally happen. If the sperm are stuck together, this indicates that antibodies have “sticked” to them or that 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 disease, can be surgery or trauma.

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

Sperm that meets standard parameters may contain:

• leukocytes (1×106 million/ml). If there are more white blood cells, this can mean the presence of a variety of inflammations in the body;
• products of spermatogenesis: round immature cells. There should be approximately 4 of them in the field of view of the researcher. If there are fewer of them, the man may have damaged or poorly functioning testicles;
• epidermal particles.

Sperm concentration

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

The number of sperm that is included in the donated ejaculate is called the count and is normally about 15 million/ml and above.

Only a specialist can understand the intricacies of these ratios, so it is better for ordinary patients to simply remember these numbers. Lower 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. A complete lack of movement indicates that these organisms are dead. Pregnancy cannot occur;
• non-progressively mobile. These are sperm that, while actively “moving” in one place, do not move forward. They are in the sperm of every man;
• progressively mobile. These are moving forward quickly and persistently. It is their entry into the egg that leads to a desired (or unwanted) pregnancy. They should make up 32% of sperm. “Progressive” and “non-progressive” sperm together should give a total of 40%.

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

Structure of sperm

In order to understand how well the shape (morphology) of “tailed creatures” corresponds to the norm, they are examined under a microscope, magnified 1000 times. In this case, the preparation is first colored. What does a full-fledged sperm look like?

Its head is oval, smooth, clear. It has 2 parts. One contains 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 should you pay attention to when taking the test?

How to properly prepare yourself for a spermogram?

Preparation begins no less than 4-5 days before going to the laboratory. At this time, the man must:

• eliminate any alcohol from your life;
• abstain from masturbation and sexual intercourse;
• Completely stop taking any medications (except vital ones). The presence of the latter should be reported to the doctor;
• do not visit baths, steam rooms, etc.

How to properly 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;
• You should absolutely not use condoms: their lubrication greatly affects the acidity of the sperm. Only sterile laboratory glassware can be used;
• you need to collect all the sperm, especially its first drops;
• If sperm for analysis must be obtained during masturbation, you should carefully monitor the cleanliness of your hands and penis and do not use any lubricants.

Is a spermogram a death sentence?

No, this is not a sentence.

Medicine knows of cases where a man with unfavorable spermograms became a father. And this was not always preceded by drug treatment.

Male infertility may depend on brain activity. If a representative of the stronger sex is afraid or does not want his partner to become pregnant, the brain begins to block the production of full-fledged sperm. Their number may also decrease under the influence of other obsessive thoughts or fears. As soon as a man normalizes his state of mind and gets rid of aggravating emotions, the number of sperm and their quality become normal.

That is why, when you receive 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 carried out. A urologist-andrologist specializes in male fertility.

The study of ejaculate consists of several stages, or rather, evaluation spermogram indicators– morphological, quantitative and physical properties, the presence of mucus, erythrocytes and leukocytes in the seminal fluid, as well as the presence of spermatogenesis cells and their agglutination (adhesion with erythrocytes, bacteria and other cells carrying antibodies).

Morphological parameters of the analysis include the number of spermatozoa that are normal in structure and cells with pathology. Quantitative parameters are sperm motility and their number in 1 ml of ejaculate and in the entire ejaculate. Physical parameters are color, volume, acidity (pH), viscosity of sperm and the rate of its liquefaction.

Ejaculate volume

The spermogram indicator measured with a special serological graduated pipette. At the same time, the viscosity of the seminal fluid is measured.

If the volume of sperm provided for research is less than 2 ml, then this amount is considered abnormal and is called oligospermia. Such insufficiency can be caused by hypoplasia and dysfunction of the seminal vesicles, retrograde ejaculation, obstruction of the ejaculatory ducts, dysfunction of the prostate gland, and hypogonadism. This is due to the fact that 2/3 of the volume of ejaculate consists of the juice of the seminal vesicles, and 1/3 of the juice of the prostate gland, therefore, dysfunction of one of these organs reduces the total amount of sperm released. Another factor that can lead to a decrease in sperm volume is insufficiently long abstinence from sexual intercourse on the eve of donating ejaculate for examination.

Ejaculate color

In principle, the color of the seminal fluid is not particularly important for diagnosis, but this indicator is still recorded. The color of normal semen ranges from grayish white to cloudy white. If the seminal fluid is clear, then this is an indication that the ejaculate has a low sperm count. The appearance of a pinkish or yellow tint in the sperm indicates hemospermia - the appearance of blood (red blood cells) in the ejaculate.

Also, some diagnostic laboratories determine the smell of semen. It is usually characterized as “specific”. Seminal fluid gets its smell thanks to a special substance it contains – spermine. Spermine is produced by the prostate, and its functions have not been studied to date.

Acidity (pH level) of ejaculate

The acidity of seminal fluid is determined after its liquefaction. For this, a pH meter or special indicator paper is used. The normal pH level of ejaculate is considered to be no lower than 7.2. On average, sperm acidity in healthy men ranges between 7.5 and 8.0.

Ejaculate viscosity and liquefaction time

If the seminal fluid does not have deviations in its composition, then immediately after ejaculation (ejaculation) it is a viscous liquid - a coagulum. After some time (the so-called liquefaction time), it liquefies. This usually occurs within 15-30 minutes, but liquefaction within one hour is also considered normal. If liquefaction does not occur within 60 minutes, then, most likely, the sperm will remain thick.

Determination of the dilution of seminal fluid is carried out using the “length of thread” method, that is, using a pipette or a special stick (plastic or glass), touch the ejaculate and slowly lift the pipette. If there is a “string” of sperm more than 2 cm long behind it, then such ejaculate is considered not liquefied, that is, viscous. The most common cause of non-liquefaction of the ejaculate is prostate dysfunction.

Sperm owes its viscosity to a specific substance – the glycoprotein semenogelin. This substance is produced by the seminal vesicles. Its functions are not exactly known, but scientists agree that semenogelin keeps sperm in an inactive state. At the moment of ejaculation, prostate juice is also added to the juice of the seminal vesicles and sperm, which contains an enzyme that destroys semenogelin - “a specific antigen of the prostate gland.” Thanks to this, the sperm liquefies and the sperm enter an active state.

Number of sperm in ejaculate

Determining the total number of sperm in the resulting ejaculate is another one of the most important spermogram indicators. This value is expressed in two values ​​- absolute (the total number of all sperm in a portion of ejaculate) and relative (the number of sperm in 1 ml of semen).

To count the number of spermatozoa, special counting chambers are used (Makler, Neubauer, Goryaev chambers, etc.), which allow laboratory technicians, while observing spermatozoa through a microscope eyepiece, to count their number in 1 ml of ejaculate, that is, to determine their concentration.

In addition to this method, which is quite long and labor-intensive, there are simpler and faster ways to determine the concentration of sperm, for example counting them on a glass slide. There are also computer programs that count the number of sperm - sperm analyzers, which are a microscope in which a video camera and a system for analyzing and evaluating the resulting image are installed.

If we talk about the normal number of sperm in 1 ml of ejaculate, then it should be no less than 20 million sperm. In the entire volume of ejaculate, this number should not be lower than 40 million sperm. If the sperm count is below these numbers, then the man is diagnosed with “oligozoospermia”.

Sperm motility

According to the degree of their motility, sperm are divided into four categories:

• Spermatozoa of category A - active, progressively mobile - the nature of their movement is rectilinear, the speed of movement is no less than 25 microns per second, and in 2 seconds they cover a distance that is equal to their length;
• Spermatozoa of category B – progressively weakly mobile – the nature of the movement is linear, but the speed of movement is less than 25 microns per second;
• Spermatozoa of category C are non-progressively motile - they can either move non-linearly or generally move in one place;
• Category D sperm are immobile – such sperm have no movement.

Only sperm of the first two categories, that is, A and B, are considered capable of reaching the egg and fertilizing it.

According to WHO, indicators of sperm motility in the ejaculate are considered normal if the spermogram parameters that determine this motility meet the following conditions:

• The number of sperm whose motility falls into category A is no less than 25% of the total number of all sperm;
• The total number of sperm of categories A and B must be at least half (50%) of all sperm.

If these conditions are not met, then this condition of the ejaculate is called “asthenozoospermia”.

Assessment of morphological properties of spermatozoa

The morphological properties of sperm are examined using a microscope. The laboratory technician conducting the study counts the number of sperm that are normal in appearance and structure, and the number of sperm with any abnormalities. To detect abnormal sperm, special staining agents (most often hematoxylin) are used, which are applied to the sperm smear. Such histological tests are called tests according to the Schorr, Romanovsky-Giemsa and Papanicolaou methods.

In general, any man, even a healthy one, has a lot of sperm in his sperm with various anomalies in its structure. These deviations can be in the structure of any of its parts - in the head, neck, middle part and flagellum. Most often, anomalies occur in the shape, size, curvature of the sperm, as well as in the absence of a flagellum. The concept of absolute norm in a given spermogram indicator no, but according to WHO, the number of abnormal sperm should not be more than 70% of the total number of sperm. If the ejaculate has a larger number of abnormal sperm, then this condition is called “teratozoospermia”.

Sperm viability

The viability of sperm is actually called their motility, that is, sperm that have motility are considered viable. A sperm that lacks motility is either damaged or dead.

The norm of viability is considered to be the presence of no less than 50% of living sperm in the ejaculate, that is, if sperm with mobility categories A and B predominate in the sperm, then there is no particular point in checking them for viability.

Typically one of two methods is used to test sperm viability:

• Hypoosmatic test - placing sperm in a special hypotonic solution. Living sperm swell in it (visually this can be seen as the curvature of their tails - they form loops), but dead ones do not (their shape remains unchanged).
• Supravital eosin staining is the application of eosin to spermatozoa. Eosin will not be able to penetrate into a living sperm, so it will not change its color (the sperm membrane prevents this). In dead sperm, the membrane is broken and allows eosin to enter, so they acquire a pink color.

Checking the number of leukocytes in the obtained ejaculate sample is another spermogram indicator. If an increased number of leukocytes is found in the ejaculate, this indicates that the man has diseases or inflammation in the gonads - seminal vesicles, prostate.

In normal ejaculate, the level of leukocytes does not exceed 1 million units per 1 ml of sperm. If the number of leukocytes exceeds the norm, then this condition is called “leukocytospermia”.

Typically, to count white blood cells, they are stained using any dye that can stain their nucleus. The most commonly used are hematoxylin and peroxidase.

Presence of antisperm antibodies (ASAT) in the ejaculate

As we have already said, AsAt are antibodies directed against antigens of male germ cells - sperm. The male body can react to its own sperm, leading to. AsAt, in the case of attachment to the tail of the sperm, slow down its movement, and in the case of binding to antigens on its head, they do not allow the sperm to connect with the membrane of the egg.

If there are antisperm antibodies in the sperm, this will be visible from the results of spermagglutination - the process of sperm gluing together. At the same time, motile sperm stick to each other, sticking together with their heads, necks or tails. Such groups of glued sperm are called rosettes.

There are also chemical methods for determining this spermogram indicator. The most common of these methods is the MAR test (MAR-test, Mixed Antiglobulin Reaction). During the study, a drop of a special suspension consisting of silicone microparticles that bind to human antibodies is added to a drop of ejaculate applied to a glass slide. In the case when a man has AsAt in his sperm, these silicone particles will stick to the sperm. If the number of such sperm exceeds 50% of the total number of sperm, then it is said that the man has antisperm antibodies in the ejaculate, and we are talking about immunological infertility.

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

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

Why is it needed?

By examining seminal fluid with male reproductive cells, it is possible to establish the cause of infertility, identify its degree, and make a prediction about the likelihood of conception occurring naturally.

Additionally, you can diagnose the presence of sexually transmitted diseases and establish the probable cause of complete or partial infertility.

The composition of sperm is affected by the consumption of certain foods, medications, as well as stress and excessive exercise. To obtain reliable spermogram results, it is recommended to take the test at least 3 times.

Types of analysis

Today, there are three main options for studying male seminal fluid containing spermatozoa. Depending on the tasks that the doctor sets for the laboratory, one or another version of microscopic examination of the biomaterial is carried out. If three options are studied simultaneously, such an analysis is called extended.

Base

The study is carried out according to WHO standards. For the study, at least 2 ml of ejaculate is required. When examining fluid with germ cells, pay attention to color, consistency, viscosity and the number of active sperm.

MAR test

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

According to Kruger

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

Features of the study

A comprehensive diagnostic test of sperm is carried out in a medical institution. The delivery of ejaculate occurs only through masturbation with clean hands in a separate room.

What influences the result

The composition of semen includes not only active sperm, but also prostate fluid; their ratio may fluctuate. The quality of the ejaculate, and, accordingly, the result of the spermogram, is influenced by both internal factors (diseases, stress) and external ones. List of the main reasons that can influence the diagnostic result of a spermatogram:

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

Before donating sperm, you must wash your hands with antiseptic soap. If you have eczema, wounds or suppuration on your hands, it is recommended to use sterile gloves.

Why does sperm count decrease?

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

If this indicator is reduced, then conception is unlikely or impossible. Sperm, the sex cells of a man, are contained in the seminal fluid in two forms: living, active and no longer viable (necrotic). When the number of living sperm decreases, a diagnosis of necrospermia is made.

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

Reasons for decreased mobility

In addition to a low number of active sperm, a decrease in the motor function of germ cells may also be observed. Such a violation can be observed when wearing tight underwear, smoking, acute respiratory viral infection or influenza. Dangerous consequences can occur with mumps, or mumps. A common complication after mumps is infertility in men.

If sperm motility is reduced during an attempt at fertilization, a woman may develop an ectopic pregnancy. This occurs if the fertilized egg implants in the wall of the fallopian tube rather than the uterus.

How the analysis is carried out

The analysis is usually carried out in a medical institution, and the patient is provided with a separate room. It is important that the collected biomaterial was obtained as a result of masturbation, and not interrupted sexual intercourse, or from a condom. The amount of semen tested is also important. 3-5 days before the test, you must abstain from sexual intercourse, otherwise the volume of ejaculate obtained will be insufficient. Some research options require a large amount of sperm.

Accuracy of the study

The accuracy of the result depends on the correct biomaterial and the quality of the equipment used to study the properties of seminal fluid. To confirm the result obtained, 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.

Decoding the results of indicators according to the table

Trying to decipher the analysis result yourself is not recommended, since the data obtained, which can be checked against the table, must be compared with each other and carefully studied. You need to know the features, possible deviations, causes, and be able to analyze all this for diagnostic purposes.

In table No. 1 you can view the normal limits of sperm parameters:

In table No. 2, the limits of the norm for sperm assessment:

What are the normal test results for conception?

The standard of analysis results depends on the type of study performed. However, there are generally accepted standard norms.

Morphological norms

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

• spermogram shows 20-40 million sperm;
• volume - 2 ml or more;
• motile sperm not less than 25%;
• sperm that not only move chaotically, but also move along a straight path with high activity - no less than half of the total number.

Morphological norms of sperm according to the Kruger variant:

• Head . Normally, there is one head, oval in shape, 2.5-3.5 microns wide, 4-5.5 microns long. Half the area of ​​the head is occupied by the acrosome, an organelle.
• Neck . Smooth, not exceeding 1 micron in width, length equal to one and a half lengths of the head. Connection to the head at a 90 degree angle without bending.
• Tail . Occupies 90% of the sperm size. The tail is smooth without tubercles or knots. Narrowing is allowed, the tail becomes sharper at the end.

Norm of active sperm

The normal number of active sperm per 1 ml of sperm is more than 20 million. A decrease is observed when the testicles are not functioning effectively, and is 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, thereby affecting the spermatogenic epithelium.

Mobility

The probability of natural fertilization depends on sperm motility. The following activity groups are distinguished:

• A – active and mobile sperm, which indicates normality;
• B – sedentary sperm, with linear 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 conception through artificial or natural means.

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

Leukocytes

Leukocytes are body cells 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, sperm does not contain leukocytes, nor red blood cells (blood cells).

If a small number of leukocytes is detected (2-4 in the field of view), we can talk about the beginning of an inflammatory process. Red blood cells should not be visible in the 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;
• sperm liquefaction time is no more than an hour;
• Alkaline pH - 7.2-7.85.

How to improve your sperm count

There are situations when it is difficult to hope for improvement in sperm count.

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

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

Sperm levels can be improved if the following rules are followed:

• observe the temperature regime, avoid saunas, baths with hot or cold water;
• reduce or eliminate the consumption of alcohol and tobacco;
• wear comfortable-sized panties, comfortable underwear, use underpants in cold weather;
• regularly have sex with one sexual partner;
• avoid casual unprotected sexual contacts;
• include fiber, proteins, and 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 and do not require a radical lifestyle change. At the same time, when planning natural conception, it is easy to improve sperm parameters using such methods.

To conceive a woman during IVF, only high-quality sperm is used. For this reason, a man undergoes appropriate tests to determine his ability to conceive. If the spermogram standards are met, the chances of a successful union of the sperm with the egg increase, artificial insemination is carried out.

Basic information

In each case, the standard for sperm analysis is based on the quality of the seminal fluid, leukocytes and red blood cells. Any disturbances may indicate the presence of an inflammatory process, which must be treated.

An important condition is that a normal spermogram proves the absence of red blood cells in the seminal fluid. If a deviation is noted, there is still no significant threat and fertilization can occur. The presence of red blood cells indicates the consequences of injuries, the presence of stones in the prostate gland, and oncology.

A normal semen analysis result additionally evaluates leukocytes. Elevated levels indicate inflammatory processes in the genitourinary organs (most often we are talking about the prostate gland, testicles and their appendages).

If there is an excessively large number of leukocytes and red blood cells in the seminal fluid, inflammation of the seminal vesicles can be suspected.

Ideal sperm is almost never observed, so the doctor conducts research individually and determines his diagnosis. The specialist remembers: a spermogram should normally have a certain composition and with the required quantities and characteristics of leukocytes and erythrocytes. In most cases, if the spermogram is not normal, the man is treated before further stages of IVF.

Danger signs

Recently, serious problems with a man’s intimate health have been indicated by blood in the semen. If such a deviation did not affect the other parameters and it was still possible to obtain a normal one for fertilization, additional treatment is required.

The presence of blood in semen may indicate the following problems:

1. chronic kidney inflammation;
2. bladder problems;
3. urinary tract diseases.

Experts note that in men under 40 years of age the phenomenon is periodic, but consultation with a urologist-andrologist becomes mandatory. It is recommended to be especially vigilant if blood was detected three or more times.

Knowing that, it is best to prepare for the potential continuation of diagnostic activities. Only after a complete examination is a final opinion made regarding the possibility of a woman being impregnated by a man.

Only a good spermogram result increases the chances of pregnancy, because artificial insemination is carried out using strong sperm and good eggs.

Analysis data

After the procedure, the doctor evaluates the resulting sperm, which should correspond to normal spermogram parameters.

What does the spermogram result look like? A guy’s ability to fertilize a girl depends on the quality of seminal fluid, red blood cells, and sperm. in the laboratory. The analysis includes a microscopic examination of ejaculate and sperm. After diagnostic measures are carried out, a document is presented with all the results, which are interpreted individually.

What should be the spermogram analysis:

• ejaculate volume is one of the most important characteristics of sperm, since 2 milliliters or less is considered a potential sign of infertility;
• liquefaction time depends on the viscosity of the seminal fluid (the optimal duration is about 10 - 40 minutes);
• color is interpreted vaguely, so it is not given an important diagnostic role;
• acidity – 7.2 – 8.0 (an increase indicates inflammation of the prostate gland, seminal vesicles, a decrease indicates blockage of the excretory ducts);
• sperm count: per milliliter – 20 – 60 million;
• mobility is one of the key characteristics (50% of motile sperm are required);
• glued spermatozoa are undesirable, since otherwise the spermogram standards cease to play their previous role, and the risk of infertility increases;
• the presence of antisperm antibodies indicates the production of antibodies against sperm and the impossibility of fertilization of the egg;
• composition of the ejaculate: spermatogenic epithelial cells, lecithin drops and a minimal number of leukocytes;
• abnormal sperm no more than 50%.

Only if the spermogram shows normal values, a man can become a father.

Every married couple dreaming of a child should know: normokinesis is a diagnostic assessment of the number of motile sperm. If a minimum percentage is fixed (for example, 2%), the guy must undergo the treatment prescribed to him.

Factors for making a reliable diagnosis

When carrying out IVF, an important role is played by the true characteristics of the sperm and the results of the examination of the girl. In order for the parameters when donating sperm to be reliable, the patient should follow the doctor’s recommendations.

The great importance of indicators implies responsibility when conducting research.

The procedure is carried out according to a certain scheme:

• the ejaculate must be collected in a timely manner in a special plastic tube for further transportation to the laboratory;
• To maintain true characteristics, it is necessary to maintain the appropriate temperature.

The doctor provides a special leaflet with tips that it is advisable to follow for several days before donating sperm for analysis:

1. abstaining from intimate contacts and masturbation for three days;
2. avoidance of alcohol abuse, which reduces sperm quality;
3. excluding visits to baths and saunas, which negatively affect the ability to conceive.

If you ignore the advice, there is a serious risk of changing the quality of sperm and receiving false information that will not help in the successful implementation of artificial insemination.

Every guy should remember: the example of other men’s sperm indicators is not important, since only an individual interpretation by a specialist allows one to understand the chances of becoming a dad.

After checking the spermogram standard, doctors determine the possibility of IVF with the participation of a man. If necessary, additional examinations are carried out in advance. The success of in vitro fertilization largely depends on the quality of sperm.