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)
• the temperature of the dish is 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 in 15 minutes at room temperature. 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 spermatozoon 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 the ejaculate, in addition to spermatozoa, there may be other cells that 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 deviation 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 analysis 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.

Facts

• A spermogram is not an infertility test
• Each laboratory has its own norms and reference limits for sperm testing, so don’t be surprised when you see the norm one time being 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

Ejaculate, or sperm in other words, is a mixture of seminal fluid and prostate secretion. The consistency of sperm is viscous, cloudy-whitish in color. Released during sexual intercourse or stimulation of the male external genitalia.

The volume of ejaculate, the number of sperm and their motility make it possible to determine a man’s ability to fertilize female cells, that is, his fertility. The amount of sperm collected as a result of a single ejaculation is measured using a specially graduated serological pipette. Normally, this indicator varies within from 2 to 10 ml.

What determines the amount of sperm?

The volume of ejaculate is very individual and varies even for an individual man. This parameter is influenced by both the internal physiological characteristics of a man and environmental factors. The following factors affect sperm volume:

• male sexual activity;
• lifestyle;
• nature of nutrition;
• the presence of concomitant diseases of the urinary and reproductive systems;
• stress;
• age;
• hormonal levels (see).

There are a large number of other reasons, however, they are not so significant. Normally, the composition of the ejaculate is formed from two-thirds of seminal fluid and one-third of prostate secretion.

Small amount of ejaculate

If the ejaculate volume is less than 2 ml, then the urologist-andrologist diagnoses. Oligospermia is a pathological condition and occurs either with increased exposure to the above factors, or with pathologies associated with:

• abnormalities in the development of organs of the male reproductive system;
• imbalance of sex steroid hormones (testosterone);
• inflammatory and infectious diseases - testiculitis and prostatitis;
• use of drugs and alcohol.

In inflammatory and infectious diseases, in addition to a decrease in volume, sperm activity also decreases, and the percentage of sperm that are not capable of normal fertilization increases. All these factors significantly influence and can lead to infertility. Oligospermia is also observed in adolescence, when the reproductive system is just forming or during overly active sexual life.

Large amount of ejaculate

A large volume of ejaculate can be a natural phenomenon in two cases:

• with long-term abstinence (see). The accumulated seminal fluid in a large volume is detected in the ejaculate, and the percentage of young sperm decreases;
• with increased hormonal activity. It can also lead to increased sperm synthesis, thereby increasing the volume of ejaculate.

In the absence of the above reasons, the specialist needs to exclude pathology associated with the presence of tumors in the male reproductive system. Malignant tumors of testicular or prostate tissue can lead to a significant increase in the number of sperm in the seminal fluid or prostate secretion. In this case, the spermogram reveals altered immature sperm with reduced activity, which is often the cause of infertility.

Diagnostics

To clarify the cause of the pathology of ejaculate volume, an andrologist or urologist, in addition to interpreting the spermogram, conducts the following additional laboratory and instrumental studies:

1. , it is possible to use TRUS for a more detailed study of the prostate gland. Ultrasound diagnostics makes it possible to identify oncological diseases of the male reproductive system, as well as enlarged regional lymph nodes, which provides information about the stage of the oncological process.
2. Determination of oncological markers in blood serum is a mandatory study for oncological processes.
3. Determination of steroid sex hormones. The concentration of hormones helps in differential diagnosis and allows one to exclude or confirm diseases associated with hormonal imbalance (see).
4. Biopsy. Accurately determines the nature of the tumor process.

In addition to laboratory and instrumental studies, a history of the disease is collected and associated symptoms that may characterize a specific disease are clarified. Consultation and examination are the first stage of a diagnostic study and allow us to establish a preliminary diagnosis.

Sperm. Sperm analysis (Spermogram) :: what is it, explanation, results, meaning, reviews

What is a spermogram?

Spermogram(from ancient Greek σπέρμα - seed and γράμμα - record) - analysis of ejaculate (sperm), used in medicine to establish a man’s fertility and identify possible diseases of the reproductive system. A spermogram is prescribed when a couple complains of infertility; a spermogram is also indicated for sperm donors and people planning sperm cryopreservation.

Sperm analysis based on determining the properties of male germ cells. Their physical properties, chemical and cellular composition are determined, and the number of spermatozoa

Why does the doctor prescribe a spermogram?

The spermogram shows a man's ability to fertilization and, in addition, is the most important method diagnosis of urological diseases. Taking a spermogram is quick, simple and inexpensive. But the result of a semen analysis is often enough even to make a diagnosis.

Decoding the spermogram

When studying spermogram data doctor draws attention to the following spermogram indicators:

• sperm volume Normally - 3-5 ml (about 1 teaspoon). A decrease in the amount of sperm released usually indicates decreased testicular functions And gonads. Similar spermogram results indicate the possibility male infertility.
• sperm count in 1 ml of sperm. The spermogram norm is 60-120 million/ml in 1 ml. A bad spermogram will show lack of sperm in sperm ( oligozoospermia) or their complete absence ( azoospermia).
• sperm motility. Normally, a spermogram will show 60-70% active, 10-15% weakly motile and 20-25% immobile sperm. The normal ratio would be 70-80% of live sperm and 20% dead, up to 20% of pathological sperm is also considered normal. The predominance of immobile spermatozoa in the sperm ( necrospermia) - an alarming signal indicating male infertility or the presence inflammatory diseases of the male genital area.
• sperm color should be milky white, without impurities.
• a normal spermogram shows the absence of any impurities, mucus in sperm. Blood in sperm(hemospermia), microflora, erythrocytes, leukocytes (more than 10), epithelial cells (more than 2-3) - this is a deviation from the norm, which means symptoms of urological diseases.
• The spermatogram also takes into account other indicators (acceptable norm in brackets): sperm viscosity(0-5 mm), pH(7,2-7,4), liquefaction time(20-30 min), fatigue(the percentage of mobile forms decreases by 10% after 1 hour, by 40% after 5 hours), travel speed sperm (3 mm/min) and many others.

Of course, spermogram results are individual for each person. But do not try to diagnose yourself based on the spermogram results, only doctor can comprehensively evaluate sperm analysis data and draw the correct conclusion about your health status.

Parameters of normal ejaculate

Ideas about the characteristics of the ejaculate of a fertile man have changed over time. With the increase in the quality and quantity of research in the section of male infertility, data on spermatogenesis is being reviewed and clarified. It is generally accepted that the general trend is towards a “loosening” of fertile ejaculate standards. Proposals from various authors regarding standards for ejaculate volume, sperm concentration and motility are presented in the table

Currently in Russia (as well as in the USSR in the past) there are no special documents from the Ministry of Health and Social Development establishing norms for fertile ejaculate. Medical institutions have the right to evaluate the fertility of ejaculate according to their own standards. The standards proposed by the World Health Organization are very popular among doctors. The prevalence of WHO standards is so great among doctors that WHO standards can be considered generally accepted at the present time, and the book “WHO Guidelines for the Laboratory Study of Human Ejaculate and the Interaction of Sperm with Cervical Mucus” is the most authoritative publication on the rules for conducting a spermogram.

In the latest edition " WHO guidelines for laboratory testing of human ejaculate and sperm-cervical mucus interactions"(Cambridge University Press, 1999) the following standard indicators of fertile ejaculate are proposed:

How to take a spermogram correctly?

In order to submit sperm for analysis and obtain reliable spermogram results, you must comply with some requirements:

• abstain from sex and masturbation for at least 3-4 days
• do not drink alcohol (even beer), medications
• You can’t take a steam bath or sauna, it is better to wash under shower.

Make a better spermogram in the laboratory specialized clinic through masturbation or interrupted coitus. Moreover, it is better to correctly submit sperm for analysis without using a condom, since when it comes into contact with latex and the substances with which the condom is impregnated, the sperm lose their mobility, and accordingly the results of the spermogram will be unreliable. If you decide to take a spermogram at home, avoid exposing the sperm to direct sunlight and overcooling the sperm. Try to save all semen released for analysis. The loss of some sperm, especially the first portion, makes the overall picture of the spermatogram inaccurate. To make a correct diagnosis, you will have to submit sperm for analysis 2-3 times.

Pathological conditions of sperm

The ejaculate that corresponds to the accepted standard values ​​is called normal and the state of this ejaculate is designated by the term “ normospermia", or " normozoospermia».

WHO proposes the following terms to describe pathological conditions of the ejaculate:

• Oligozoospermia- sperm concentration is below the standard value
• Asthenozoospermia- sperm motility is below the normative value
• Teratozoospermia- sperm morphology is below the normative value
• Azoospermia- absence of sperm in the ejaculate
• Aspermia- absence of ejaculate (in this sense it corresponds to the term “anejaculation”, but some experts use the term “aspermia” to describe ejaculate in which not only spermatozoa are absent, but also immature spermatogenic cells)

The terms “oligozoospermia”, “asthenozoospermia” and “teratozoospermia”, if there are corresponding abnormalities in the ejaculate, can be combined into one word, for example: “oligoasthenoteratozoospermia”, “asthenoteratozoospermia”, etc.

In addition, the following terms are common:

• oligospermia- ejaculate volume is below the standard value
• leukocytospermia, also leukospermia, also pyospermia - the concentration of leukocytes is higher than the normative value

Sometimes you can come across the following terms:

• akinospermia(akinozoospermia) - complete immobility of sperm,
• necrospermia(necrozoospermia) - absence of live sperm in the ejaculate,
• cryptospermia(cryptozoospermia) - an extremely small number of sperm that can be detected in the ejaculate with great difficulty, after centrifugation of the sperm.
• hemospermia- presence of blood (erythrocytes) in the ejaculate.

Sperm motility

Based on motility, spermatozoa are divided into 4 categories: A, B, C and D.

It is assumed that category A and B sperm are able to reach the egg (category B sperm can sometimes increase their speed after capacitation occurs in the vagina and cervix). The proportion of sperm of different motility categories is determined either on a glass slide “by eye”, or in a counting chamber, or using a computerized sperm analyzer. According to the WHO proposal, the ejaculate is considered normal if at least one of two conditions is met: 1) if the proportion of sperm of mobility category A is not less than 25%, 2) or if the proportion of sperm of mobility categories A and B in total is not less than 50%. The state of the ejaculate that does not meet these conditions is characterized as “asthenozoospermia”.

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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, 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 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. It is these that specialists take into account when deciphering a 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) that are 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 sperm, you can almost accurately calculate how many sperm are in it and how much this quantity 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.

Spermogram is a study of ejaculate (sperm) in laboratory conditions. Using this analysis, the main parameters of a man’s fertility and possible inflammatory diseases in the genitourinary system are determined. A urologist or andrologist deciphers the results obtained. The final test data is influenced by the correct preparation of the man for this study. A spermogram includes the study of the physical and microscopic properties of the ejaculate.

Normal sperm count

Spermogram indicators and their fluctuations are important in finding the causes of male infertility. Before deciphering it, the doctor must collect information for anamnesis (for example, find out whether the man had mumps) and prescribe a comprehensive examination of the whole body.

When studying the physical properties of sperm, several indicators are examined. Spermogram standards according to WHO are not constant, but are constantly adjusted depending on changes in global statistics. Even for the same man, the test results will be different, so in case of any deviations it is necessary to take a spermogram several times after a month. Normal spermogram indicators according to WHO and Russian standards are located in the table.

Spermogram indicator	Meaning	WHO standards	Russian standards
Abstinence period	Number of days of abstinence before testing	2-7	3-5. Optimally 4
Volume	Total volume of sperm collected	20 ml or more	3-5 ml
Color	Ejaculate color	Grayish	White, grayish, yellowish
pH	Ratio of positive and negative ions	7.2 or more	7,2-7,8
Liquefaction time	Time during which sperm becomes viscous to certain standards	up to 60 min	up to 60 min
Viscosity (consistency)	The measurement is taken in centimeters of thread, at which the sperm is formed into a drop and separated from the pipette	Small individual drops up to 2 cm	0.1-0.5 cm

Quite a lot of indicators are studied using a microscope. Their standards are also indicated in the following table:

Spermogram indicator	Meaning	WHO standards	Russian standards
Sperm Density	Number of sperm in 1 ml of semen	20 million or more	20-120 million
Total sperm count	Sperm density * sperm volume	40 million or more	From 40 to 600 million
Sperm motility	Ability to move. Evaluated depending on the group: A, B, C and D.	type A more than 25% or A+B more than 50% 60 minutes after ejaculation	type A more than 50% type B, C and D - 10-20% 60 minutes after ejaculation
Sperm morphology	Number of sperm with normal structure capable of fertilization	more than 15%	more than 20%
Live sperm	Content of live sperm as a percentage	more than 50%	more than 50%
Smermatogenesis cells (immature germ cells)	Epithelial cells of the seminiferous tubules of the ovary	There are no interest rates	up to 2%
Sperm agglutination	Gluing of spermatozoa to each other, which interferes with forward movement	Normally absent	Normally absent
Leukocytes	White blood cells. Always available	1 *10x6 or 3-4 in the field of view	1*10x6 or 3-4 in sight
Red blood cells	Red blood cells	Normally no	Normally no
Amyloid bodies	They are formed due to stagnation of secretions in various parts of the prostate. Their number is not counted.		Indicates "present/absent"
Lecithin grains	They are produced by the prostate gland. The quantity is not counted.	Indicates "present/absent"	Indicates "present/absent"
Mucus	Presence of mucus in semen	No standards	No standards

It should be remembered that the results of the spermogram should be assessed comprehensively, and only a specialist can decipher them.

What do deviations from the norm mean?

The following deviations from the norm are possible:

1. 1. A small volume of sperm is called oligospermia. In this situation, the number of sperm in the semen decreases. This is due to the inflammatory process in the accessory sex glands, which causes infertility. A small amount of sperm is not able to penetrate the uterus due to the acidic environment of the vagina. If the first analysis showed oligospermia, then there is no need to worry yet. To confirm this diagnosis, the test will have to be taken several times. If the sperm volume exceeds 5 ml, then this does not affect the ability to conceive. The fact is that only 5 ml fits into the vagina, and the excess flows out. A large volume of semen indicates an infection in the prostate or chronic vesiculitis.
2. 2. Most often, the color of sperm is whitish-grayish. Slightly yellowish, milky or white is also considered normal by WHO standards. But in Russian laboratories this is sometimes indicated. Sperm with a pinkish tint indicates the presence of red blood cells (hemospermia). Sometimes there is even a brownish tint. Transparent sperm indicates the presence of azoospermia, i.e. the absence of sperm. A yellowish tint indicates jaundice; this also happens when taking multivitamin complexes.
3. 3. pH indicator. After ejaculation, male reproductive cells may die in the acidic environment of the vagina. In order for sperm to reach the egg, they need to overcome this barrier. This is what seminal fluid exists for. It is this that reduces acidity, while sperm become able to reach the uterus. If other indicators are normal, pH deviations do not mean anything, but in combination with others they indicate various diseases. For example, in the absence of sperm, a decreased pH level indicates that the ducts from which sperm arise are clogged. Also, a decrease in this indicator in combination with other signs indicates inflammation in the prostate and testicles.
4. 4. During ejaculation, sperm is viscous. After some time, the secretion of the prostate gland, located in the ejaculate, liquefies it. If this does not happen, then this indicates disturbances in the functioning of the prostate gland, which has a negative effect on the chemical parameters of sperm. This causes sperm immobility, making fertilization of the egg impossible.
5. 5. An increase in sperm density is called polyzoospermia, a decrease is called oligozoospermia. The reasons for the change in density are still not fully understood. According to some versions, this occurs due to endocrine disorders, improper blood flow in the scrotum, and is also the result of radiation exposure.
6. 6. If the number of sperm is less than normal, then this negatively affects the ability to conceive. This condition is characterized by the term oligozoospermia, there are quite a few causes - damage to testicular tissue due to various diseases, urological problems, liver and kidney failure, smoking, alcohol abuse, frequent ejaculation.
7. 7. Sperm motility is one of the important criteria for assessing the possibility of conception. Depending on the ability to move, male reproductive cells are divided into 4 groups, a description of which is presented in the table:

Group name	Motion characteristics
A - progressively active	Sperm move straight at a speed of 25 microns per second. These are young sperm that have recently formed in the testicles.
B - progressively weakly mobile	Sperm move straight at a speed of less than 25 microns per second. These are male reproductive cells that age or have an abnormal structure. This condition is associated with prolonged abstinence.
C - non-progressively mobile	The speed of movement of male reproductive cells is high, but they move in one place. Their number ranges from 5 to 15%
D - motionless	There is no movement. These are old sperm that are dying or have already died

Features of spermogram

Only sperm from categories A and B are capable of fertilizing an egg. Even if a man is completely healthy, all groups will be present in his analysis. In this case, pathological forms of sperm should not exceed 20%. Static sperm is called akinozoospermia. It is necessary to find out the cause of this pathology. Eosin is used for these purposes. This drug turns dead cells red, their membrane easily bursts, and eosin penetrates into the cell. The drug is unable to penetrate into a living sperm. If the cell does not move and does not stain, this indicates a violation of morphology. A condition in which all sperm are dead is called necrozoospermia. The cause of true necrozoospermia is unknown, and this condition cannot be treated. If this diagnosis is made several times in a row, the couple will be recommended IVF with donor sperm or adoption.

To determine infertility, it is necessary to find out what structure (morphology) male reproductive cells have. Sperm with irregular morphology move slowly and have a smaller tail. In addition, fertilization of an egg with a pathology of the head negatively affects the health of the unborn child. To identify them, a stained smear and raw sperm are used. Deterioration in morphology may be temporary due to stress. This indicator is also influenced by the environmental situation in the region where the man lives. A large number of pathologies occur in people living in industrial areas.

Sperm viability is the ability to survive after ejaculation for a certain time. If they live less than a day, then this is an obstacle to fertilization. If there are more than 50% dead male germ cells, this is necrospermia. This pathology is also temporary. The most common cause is poisoning and infectious diseases. Long-term pathology indicates a severe disturbance in spermatogenesis. Sometimes sperm agglutination (spermagglutination) occurs - the gluing of male germ cells. This condition indicates the presence of an inflammatory process in the gonads or a disorder in the immune system. This pathology reduces the speed of sperm movement, but this does not affect the possibility of natural conception.

Spermatogenesis cells are found in every ejaculate. Before they become mature cells, they go through many processes under the influence of the hormonal system. A significant increase in this indicator indicates a secretory form of infertility. A small number of leukocytes is normal, but if it is exceeded, inflammation of the prostate gland, testicles and their appendages is possible, which is caused by a bacterial nature.

There should be no red blood cells normally. Their detection indicates the destruction of microvessels during inflammation of the prostate gland or testicles. In itself, an increase in red blood cells does not affect the ability to conceive, but their presence requires additional research to exclude various tumors. In older men, this situation indicates a high risk of developing prostate cancer. An increased amount of mucus indicates the presence of inflammation in the genitourinary organs. It impedes sperm motility, which affects their ability to conceive. This situation occurs with bleeding, infections, inflammation in the genitourinary organs, and tumors.

The main reasons for the appearance of transparent discharge in women

Evaluation of results

If, when deciphering the spermogram, all indicators are normal, then the chances of early conception and pregnancy are quite high. If any deviations are detected a month later, a repeat analysis is scheduled. The results will not be identical, so the final diagnosis is made after 2-3 spermograms.

To obtain reliable data, a spermogram should be taken in the same laboratory, using the same method and with the same abstinence interval. Even the standards in different laboratories are different. But you shouldn’t rely only on this study, because there are many reasons for infertility: a woman’s reproductive health, frequency of sexual intercourse, age and general condition of the patient.