Semen analysis: Introduction, Physical, chemical, microscopic examination, normal range of sperm count and clinical significance
Introduction of Semen analysis
Semen is a grey opalescent fluid that forms at ejaculation. It consists of a suspension of spermatozoa in seminal plasma. Semen analysis uses to check the reproductive status of a person. It is necessary to note the following points while reporting for routine semen examination.
Abstinence days (Obtain the semen analysis at least 3 days of abstinence from coitus)
Method of sample collection
Time and place of sample collection
Collection and examination time is also necessary for semen analysis. Semen should examine within 30 minutes.
Colour and appearance: Greyish-white, viscid, opaque (normal finding)
Increased turbidity may associate with inflammatory processes in some parts of the reproductive tract.
Viscosity: The specimen of normal viscosity can be poured drop by drop.
Increased viscosity is concerned with the poor invasion of the cervical mucus in post-coital studies. Absence of viscosity points to reduced cell content.
Volume: 2-5 ml (normal finding)
A lesser amount may arouse suspicion of deficiency and premature weakening by vaginal acidity.
Liquefaction time: 20-30 minutes (normal finding)
Failure to liquefy within 30 minutes may associate with infertility. The semen from males with bilateral congenital absence of the vas deferens and seminal vesicles fails to coagulate due to the absence of coagulation substrate.
pH: 7.2-7.8 (normal finding)
pH values less than 7.0 are frequently associated with semen consisting largely of prostate secretions due to congenital aplasia of the vasdeferens and seminal vesicles.
Fructose: 150-300 mg/dl (normal finding)
Disorders of seminal vesicles may lead to reduction in fructose concentration. There is an inverse relationship between fructose level and sperm count. High fructose values associated with low sperm count.
Sperm count: 40-300 millions/ml (normal value)
The complete absence of spermatozoa is called azoospermia. A reduced number is termed oligozoospermia.
related clinical conditions:
mumps, orchitis, prostatitis, occlusion or absence of efferent ducts, hypopituitarism, hypogonadotropic hypogonadism. The sperm count may be low in estrogen secreting tumors and in hypo-and hyperthyroidism.
Motility after 2 hours, 3 hours, and 6 hours: 60-95% (normal finding)
Motile forms decrease by about 5% per hour after the fourth hour following collection. Motility less than 60% may be associated with infertility.
Abnormal forms: 0-20%
More than 20% of abnormal forms may be associated with infertility.
Following abnormalities in spermatozoa are observed.
Heads: too small, too large, double heads, pointed heads, ragged heads
Middle piece: absent, bifurcated, or swollen.
Tails: double, curved, rudimentary, or absent
pus cells: 1-2/ HPF (normal finding)
Increased number of pus cells-Inflammation due to infection in some parts of the reproductive system. Infection of the seminal vesicle.
Epithelial cells: 1-2/HPF (normal finding)
Increased number: not significant
Red blood cells: Absent (normal finding)
Tuberculosis of seminal vesicle, rupture of the blood vessel, infection of the prostate, vitamin C deficiency.