Semen Analysis and Male Infertility

What do the tests measure?

APPEARANCE

VOLUME

LIQUEFACTION

VISCOCITY

AGGLUTINATION

pH

MOTILITY

LEUCOCYTE COUNT

SPERM COUNT

VITALITY

MORPHOLOGY

ANTI-SPERM ANTIBODIES


  1. APPEARANCE
    What the sample looks like - a yellowish colour may indicate the presence of leucocytes (pus cells), a brownish tinge may indicate the presence of blood.


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  2. VOLUME
    As you would expect - how much there is of the sample. After two days abstinence there should be more than 2ml of semen.


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  3. LIQUEFACTION
    When semen is produced (ejaculated) it coagulates on contact with the air, then, over a short period of time, it liquefies. Liquefaction should be complete at the time of testing (1 hour after ejaculation).


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  4. VISCOCITY
    This is a measure of how fluid the sample is (for example, water has a low viscosity, treacle has a high viscosity. Semen should have a fairly watery consistency at the time of testing (1 hour after ejaculation).


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  5. AGGLUTINATION
    A sample of semen is looked at under the microscope. The presence of motile sperm 'stuck' together is called agglutination and may indicate the presence of antibodies.


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  6. pH
    The pH of a substance is a measure of how acid or alkaline it is (pH 7.0 is neutral). The pH of semen increases with time but should not be less than 7.2 at 1hour.


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  7. MOTILITY
    This measures what percentage of sperm are moving and how well they are moving.
    Motility will be graded "A, B, C, and D"
    • A = percentage of sperm which are actively progressively motile (they move forward quickly).
    • B = percentage of sperm which are slowly progressively motile (they move forward slowly).
    • C = percentage of sperm which are non progressively motile (they move but stay in the same place).
    • D = percentage of sperm which are nonmotile (they do not move at all).

    At 1 hour 'A' sperm should be more than 25%, or 'A+B' sperm should be more than 50% of the total

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  8. LEUCOCYTE COUNT
    Leucocytes, also known as white cells, or pus cells, may be normally present in the semen in small numbers (less than 1 million per ml) larger numbers may indicate the presence of infection, although this is not necessarily so.


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  9. SPERM COUNT
    The sperm count is a measure of the total number of sperm (spermatozoa) present. It is usually recorded in millions of sperm per ml of semen. A normal count is regarded as being greater than 20 million per ml.


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  10. VITALITY
    The vitality of a sample is the percentage of sperm which are alive. Note that this is not the same as the percentage of sperm which are motile. Motile sperm are obviously alive, but non-motile sperm may or may not be dead. At 1 hour, more than 50% of the sperm should be alive.


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  11. MORPHOLOGY
    Morphology estimation involves looking at the individual spermatozoa and saying what percentage of them are normal. It involves making stained preparations of the sample and examining them under the microscope. This is a time consuming procedure calling for both experience and expertise and involving visual examination and measurements. As such, it is too involved to describe fully here, though I do intend to add this information to the site soon.

    Normal morphology levels should be given as in the region of greater than 14%.

    I have seen web sites for various infertility clinics which give normal morphology as greater than 60%. These places cannot be using the strict criteria of the World Health Organisation, which is the recognised standard for male infertility testing.


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  12. ANTI SPERM ANTIBODIES
    Since very early on in the growth of a foetus, the area which will develop into the testes (or the ovaries in the female) has been kept, as it were, shut away from the rest of the body. This is because sperm cells are different from the other body cells and would be recognised by the body as alien invaders, in much the same way as harmful bacteria or viruses are. Injury or trauma to this region can allow this barrier to be broken, and the body will begin making antibodies to its own sperm.

    Antibody levels may reported as a percentage or in words, thus:
    • Less than 50% = Negative
    • Greater than 50% = Highly probable immunological infertility


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What can affect the results

What is a normal result?

Assisted fertilization techniques

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