Advanced Semen Analysis

One significant component of couples involved in an infertility work up relates to the status of the male partner’s sperm evaluation. The complexity of a sperm analysis at Advanced Fertility is more sophisticated than a standard test. In fact, many couples come to the practice reporting a normal semen analysis only to find issues with sperm quality upon undergoing this advanced analysis.

While there is no substitute for the evaluation of semen and sperm testing results by a highly trained and specialized professional, the truth is that many modern laboratories and even some very well qualified physicians have not kept totally abreast of our changing understanding of sperm function, and our new and evolving views of “fertile” sperm test results.

Sperm Counts

Laboratories performing sperm “counts”, in general, vary in the details that they provide the physician requesting the “count”. A general sperm count as part of a fertility evaluation should include the total density or count (20 million per ml or above), and the motile density (8 million per ml or higher). The motile density is perhaps the most important part of the semen analysis, as it reports the total number of sperm thought capable of progressing from the site of sperm deposition to the site of fertilization. This value is essential in both allowing a determination regarding whether or not a semen analysis is “normal”, as well as in providing prognostic information should advanced reproductive medical assistance be required. (Numbers in italics are what “normal” values should be.) Definitions of “abnormal” counts:

  • Aspermia: No semen volume
  • Asthenozoospermia: Sperm motility < 40%
  • Hematospermia: Red blood cells present in semen
  • Hyperspermia: Semen volume > 5.5 ml
  • Hypospermia: Semen volume < 1.5 ml
  • Necrozoospermia: Nonviable (“dead”) sperm
  • Oligoasthenozoospermia: Motile density < 8 million sperm/ml
  • Oligozoospermia: Sperm count less than 20 million/ml
  • Polyzoospermia: Excessively high sperm concentration
  • Pyospermia: Leukocytes (germ fighter cells) present in semen
  • Teratozoospermia: > 40% of sperm seen are of abnormal form

Sperm Morphology (Shape and Appearance)

The evaluation of sperm size, shape and appearance characteristics should be assesed by carefully observing a stained sperm sample under the microscope. The addition of colored “dyes” (stains) to the sperm allow the observer to distinguish important normal landmarks (characteristics) as well as abnormal findings. Several methods of staining sperm are used, and the method employed should be one with which the examiner is comfortable and experienced.

Several different shapes or forms of human sperm have been identified and characterized. These forms fall into one of four main categories: normal forms, abnormal head, abnormal tail and immature germ cells (IGC), as follows:

Normal forms Normal sperm have oval head shapes, an intact central or “mid” section, and an uncoiled, single tail.

Abnormal heads
Many different sperm head abnormalities may be seen. Large heads (macrocephalic), small heads (microcephalic) and an absence of identifiable head are all seen in evaluations. Tapering sperm heads, pyriform heads (teardrop shape) and duplicate or double heads have been seen. Overall (gross) abnormalities in appearance may be termed “amorphous” changes.

Abnormal tails
Coiling and bending of the tail are sometimes seen. Broken tails of less than half normal length should be categorized abnormal. Double, triple and quadruple tails are seen and are abnormal. Cytoplasmic droplets along the tail may indicate an immature sperm.

Immature germ cells (IGC’s)¬†
White blood cells (germ fighters) in the semen should rarely be seen. It is very difficult to distinguish between an immature germ cell and a white blood cell.

Because the presence of white blood cells in the semen (pyospermia) can be a serious concern, if a report of “many IGC’s” is delivered, it becomes very important to assure that these cells are not, instead, white blood cells.

Sperm “Motility” (Movement)
Sperm motility studies identify the number of motile (moving) sperm seen in an ejaculate specimen.

Motility characteristics:

Decreased sperm motility. If found to be present, exam should be repeated to assure that laboratory conditions did not cause the problem. Frequent causes: abnormal spermatogenesis (sperm manufacture), epididymal sperm maturation problems, transport abnormalities, varicocele. These conditions should all be looked for if sperm motility is repeatedly “low”.

A total absence of moving sperm. It is vital, if sperm are seen, but are not moving, to carry out studies (vital stains) to see if the sperm seen are alive. It is possible to have sperm with normal reproductive genetics that are deficient in one or several of the factors necessary to produce motility.

Chemical and Biochemical Semen Characteristics

Semen acid-base balance (pH)
The pH of semen is measured using a specially treated paper blot that changes color according to the pH of the specimen that it is exposed to. The pH of normal semen is slightly alkaline ranging from 7.2 to 7.8.

Color and Turbidity
Semen is normally translucent or whitish-gray opalescent in color. Blood found in semen (hematospermia) can color the semen pink to bright red to brownish red. The presence of blood in semen is abnormal and should be reported. The presence of particles, nonliquified streaks of mucus or debris requires further evaluation.

Semen is normally produced as a coagulum. The specimen will ususally liquify within 30 minutes. The failure to liquify within one hour is abnormal.

Nonliquefaction and excessive viscosity are two separate conditions. Viscosity is measured after complete liquefaction has occurred.

Advanced Fertility does perform semen analysis for individuals who are not currently patients when they have an order from their family, urology or OBGYN physician.