Analysis of sperm( ejaculate).Spermogramma - Causes, symptoms and treatment. MF.

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Spermogram - a method for studying the ejaculate for evaluating the fertilizing capacity of male sperm. Spermogram analysis shows the quantitative, qualitative, morphological parameters of sperm.

Sperm analysis is performed in the case of:

1. Infertile marriage( detection of the male factor, spermogram - male infertility).Infertile is a marriage in which pregnancy does not occur within 1 year of regular sexual life without the use of contraceptives.
2. Infertility in men( prostatitis, varicocele, infection, trauma, hormonal disorders).
3. Preparations for artificial insemination.
4. Pregnancy planning.
5. The desire of a man to test his fertility( fertility).

How does spermogram surrender?

The material for the study is collected by masturbation. You can bring the ejaculate in a sterile, hermetically sealed container, in the warmth( in the axilla or thermostat at body temperature), within an hour after the assay. Before taking the test, abstinence is not less than 4 days, but not more than a week. At this time, refusal of thermal procedures, alcohol. After taking antibiotics should be at least 2 weeks.

Methods of sperm research: phase-contrast microscopy, special staining for evaluation of morphology of spermatozoa.

Spermogram norm

• Volume - more than 2 ml;
• Consistency - viscous;
• Liquefaction after 10-30 minutes;
• Viscosity up to 2 cm;
• Color - white-gray;
• Smell - specific;
• pH 7.2-8.0;
• Turbidity - cloudy;
• Mucus - absent;
• The number of spermatozoa in 1 ml - 20 million - 200 million;
• The total number of spermatozoa in the ejaculate is over 40 million;
• Number of actively mobile spermatozoa - more than 25%;
• The total number of active and slow-mobile - more than 50%;
• Fixed spermatozoa - less than 50%;
• Absence of agglutination and aggregation;
• Number of leukocytes up to 1 million;
• Normal spermatozoa - more than 50%;
• Spermatozoa with normal morphology of the head - more than 30%;
• Cells of spermatogenesis - 2-4.

Spermogram interpretation, classification of the ejaculate indicators:

• aspermia - absence of ejaculate,
• oligozoospermia - decrease in the number of spermatozoa in the ejaculate( less than 20 million in 1 ml),
• azoospermia - absence of spermatozoa in the ejaculate,
• cryptozoospermia - the presence of single spermatozoa inejaculate after centrifugation,
• astenozoospermia - decreased sperm motility,
• teratozoospermia - reduced sperm content of normal morphology.

Results of spermogram

At results other than normal, it is necessary to sperm after 1-2 weeks and with the results obtained, go to an andrologist to find the causes of the pathology. An exception is the suspicion of genital infections, in this case, treatment must begin immediately. For example, the effect of prostatitis on the spermogram is manifested in the mobility of spermatozoa. Infectious prostatitis( especially caused by sexually transmitted infections) has a great influence on the quality of sperm. The inflammatory process in the prostate reduces the mobility of spermatozoa, promotes their agglutination( gluing due to the presence of bacterial bodies on the surface, or products of their vital activity) and the formation of inferior forms( for example, a bad spermogram as a result of ureaplasmosis).

How to improve the spermogram? Sometimes it is possible to improve the quality of sperm by eliminating production and household harmful factors, adjusting the normal rhythm of work and rest, it is also necessary to provide adequate nutrition, the correct rhythm of sexual life. It is useful to exercise daily physical exercises with an emphasis on exercises that improve the work of the pelvic muscles and abdominal muscles.

The most effective for improving the quality of spermogram is the treatment of urological, endocrine diseases, as well as taking some medications. What drugs and duration of their appointment is appointed by the urologist-andrologist.

The state of spermatogenesis is assessed by spermogram( spermiogram).

Spermogram index	What is the score of the	Spermogram index	What is the	score? WHO norms	Comment
Recommended by us standards
Term of abstinence	Number of days of sexual abstinence before analysis of	2-7 days	If the abstinence period is not met, the result of the analysis can not be compared with the standard and spermiological diagnosis inThis case should be considered incorrect. The average period of abstinence is optimal for the study of ejaculate. Repeated analysis should be taken with the same period of abstinence that the first.
3-5 days, optimally - 4 days
Volume of	Total volume of ejaculate.	2 ml or more	The volume of ejaculate less than 2 ml is qualified as microspermia, which in most cases is associated with an insufficient function of the accessory genital glands *.The upper limit of the volume of ejaculate WHO guidance is not limited. However, according to our observations, the increase in the volume of ejaculate is more than 5 ml.often indicates an inflammatory process in the adnexa of the genital glands.
3-5 ml
Color	Color of the ejaculate.	Grayish	Red or brown color indicates the presence of blood, which can be caused by the presence of a tumor, stones in the prostate gland or injuries. A yellowish hue may be a variant of the norm or evidence of a jaundice or the intake of certain vitamins.
White, grayish or yellowish
PH	The ratio of negative and positive ions.	7.2 or more	WHO experts limited only the lower value of pH.However, according to our observations, not only the decrease in pH below 7.2, but also its increase above 7.8 in most cases indicates the presence of an inflammatory process in the adnexal sex glands.
7,2-7,8 ​​
Liquefaction time	Time of liquefaction of sperm up to viscosity norms.	Up to 60 min	Increasing the liquefaction period is usually the result of prolonged ongoing inflammatory processes in the adnexa of the genital glands, for example prostate( prostatitis), seminal vesicles( vesiculitis), or enzyme deficiency. We consider the time of liquefaction as one of the most important spermiological indicators. It is very important that the spermatozoa as quickly as possible get active movement. With prolonged liquefaction, spermatozoa, moving in a viscous environment, lose bioavailable energy( ATP) faster, stay in the vagina longer, the acidic environment of which significantly reduces their mobility, and hence their ability to fertilize.
Up to 60 min
Viscosity( consistency)	Viscosity of the ejaculate. Measured in centimeters of filament, at which it forms into a drop and is separated from a pipette or special needle.	Small individual drops( up to 2 cm)	The reasons for the viscosity increase are the same as for the dilution time. The WHO Guidelines do not have a clear norm on the viscosity of sperm. Only the following is said: "Normally, ejaculate, emerging from a pipette, forms small individual drops, and a sample with pathological viscosity forms a filament more than 2 cm".We believe that a drop of normal liquefied sperm should not extend more than 0.5 cm, because according to our observations, the fertility of patients whose sperm viscosity exceeds 0.5 cm, and even more 2 cm, is significantly reduced.
0.1-0.5 cm
Sperm density	Number of spermatozoa in 1 ml.ejaculate.	20 million or more	Increase or decrease in sperm density is defined as polysooospermia or oligozoospermia, respectively. The upper limit of the norm of the sperm density index by WHO experts is not limited. However, according to our observations, the increase in sperm density above 120 million / ml, in most cases, is combined with their low fertilizing ability and in many patients is subsequently replaced by oligozoospermia. Therefore, we are convinced that patients with polyzoospermia need dynamic observation. The reasons for the change in sperm density are not fully understood. It is believed that they are the result of endocrine disorders, blood flow disorders in the scrotum organs, toxic or radiation effects on the testicle( enhancing or depressing spermatogenesis), inflammatory processes and, less often, immunity disorders.
20-120 million
Total number of spermatozoa	Sperm density multiplied by volume.	40 million or more	The reasons for the possible inconsistency with the standards are the same as in the previous paragraph.
From 40 to 600 million
Sperm motility	Ability to move. It is estimated on 4 main groups: 1. Actively movable with rectilinear motion( A) 2. Motionless small parts with straight motion( B) 3. Motionless with vibrational or rotational motion( C) 4. ImmobileD)	type A & gt;25%, or A + B & gt;50% after 60 min.after ejaculation	Reduced sperm motility is called astenozoospermia. The causes of asthenozoospermia are not completely clear. It is known that asthenozoospermia can be a consequence of toxic or radiation effects, inflammatory processes or immunological factors. Also, the ecological situation is important. Asthenozoospermia is often observed in people working at elevated temperature( a cook, a bathhouse attendant, an employee of a hot shop, etc.).
type A & gt;50%, type B - 10-20% type C - 10-20% type D - 10-20% after 60 min.after ejaculation
Morphology	Content in the ejaculate of spermatozoa that have a normal structure and are capable of fertilization.	More than 15% of	There is no unified opinion of experts on both the evaluation of the morphology of spermatozoa and the normative values ​​of the content of normal spermatozoa in the ejaculate. Therefore, evaluation of the morphology of spermatozoa is one of the most subjective and ambiguous sections in spermiological research. Normally, morphologically normal spermatozoa make up 40-60%.In Russia, the diagnosis of teratospermia, i.e."ugly sperm", is put in those cases when the number of normal sperm is less than 20%.The deterioration of morphological indicators is often temporary and occurs under stress, toxic effects, etc. Also, the morphological picture of the ejaculate largely depends on the ecological situation in the patient's region of residence. As a rule, the number of pathological forms increases in residents of industrial zones.
More than 20%
Live spermatozoa( sometimes - dead spermatozoa)	The content of live sperm in the ejaculate in percent.	More than 50%	The content of more than 50% of dead sperm in the ejaculate is called necrospermia. Necrospermia, as well as deterioration of morphology, is often temporary. Possible causes of necrospermia - poisoning, infectious disease, stress, etc. Long-existing necrospermia indicates severe disorders of spermatogenesis.
More than 50% of
Spermatogenesis cells( immature germ cells)	Spermatogenesis cells are the cells of the epithelium of the seminiferous tubules of the testicle.	No percentages of	occur in each ejaculate. A significant number of cells of spermatogenesis( slimming epithelium), occurs in the secretory form of infertility.
Up to 2%
Agglutination of spermatozoa	Agglutination of spermatozoa is the gluing of spermatozoa among themselves, which prevents their translational movement.	Normally should not be	True agglutination is rare and indicates a violation in the immune system. It is necessary to distinguish true agglutination from aggregation of spermatozoa. Unlike aggregates, with true agglutination only spermatozoa are glued together and the "sockets" of them do not contain cellular elements.
Normally should not be
Leukocytes	White blood cells. There are always.	1 * 106( 3-4 in the standard field of view)	Excess of the norm indicates the presence of inflammation in the genitals( prostatitis, vesiculitis, orchitis, urethritis, etc.).
1 * 106( 3-4 in the standard field of view)
Red blood cells	Red blood cells.	Normally should not be	The presence of erythrocytes in semen can be associated with tumors, genital tract injuries, the presence of prostate stones, vesiculitis. Anxious symptom requiring serious attention!
Normally should not be
Amyloid bodies	Formed as a result of prostate secretion stagnation in its various sites. The quantity is not counted.	No WHO Standards	Marked as "Present / Missing( +/-)".Amyloid bodies are presently absent in many patients, which suggests a certain decrease in the functions of the prostate gland.
No standards
Lecithin grains	Produced by the prostate gland. The quantity is not counted.	No WHO Standards	Denoted as "Present / absent( +/-)".A small amount of lecithin grains indicates a decrease in the functions of the prostate gland.
No standards
Slime	The mucus contained in the ejaculate.	No WHO Standards	May be present. A large amount of mucus indicates a possible inflammation of the accessory genital glands.
No Standards

To obtain the correct spermiological diagnosis when surrendering the ejaculate, the following conditions must be met:

• abstinence from ejaculation within 2-7 days( optimal period is 4 days);
• refraining from taking alcoholic beverages, including beer, of potent drugs( hypnotics and sedatives) during this period;
• abstinence from visiting saunas, baths, and also from taking hot baths 2-7 days;

Often andrologists inform patients of a spermiological diagnosis and give a spermogram in their hands without a detailed explanation. The patients have a huge number of questions: which of the indicators does not correspond to the norm, what does this discrepancy mean, how are the spermiogram parameters related to each other?

We have tried to compile for you a table of the main indicators of the spermogram with brief comments. The table shows WHO spermiological parameters( 4th edition, Cambridge University Press, 1999( MedPress, 2001)), as well as recommended norms.

We hope that this table will help you better navigate the spermogram, but note that the results of the spermogram are evaluated comprehensively and can be interpreted correctly only by a professional.

Spermiogram parameters, their norms and deviation comment:

* The subordinate glands include the prostate gland, seminal vesicles, Cooper glands, etc.

The norms of spermiogram indices specified in the WHO Manual and recommended by us in some cases are different.

Let's try to argue our position.

1. The norms of spermiogram indexes proposed by the World Health Organization were developed by averaging the statistical data collected from various countries of the world. At the same time, in different regions, as a rule, the average spermiological indicators of male ejaculate are different. Moreover, these differences can be significant.
2. The authors of the WHO Guidelines "consider it preferable for each laboratory to determine its own regulatory values ​​for each spermogram index" .
3. The norms of ejaculate indicators proposed by us were obtained as a result of studies of endocrine glands carried out in the Clinical Center of Andrology and Transplantation under the guidance of Professor IDKirpatovsky, published works of Russian specialists and our laboratory and clinical experience.

The study of ejaculate is one of the most subjective laboratory tests, and its result - spermogram in many respects depends on the level of spermiologist's skill.

In some organizations, special instruments are used for the study of ejaculate - sperm analyzers. We are convinced that the spermogram performed on the apparatus must necessarily be duplicated by the spermiologist's research, since the apparatuses can "confuse" certain morphological structures with each other. For example, the heads of spermatozoa and small leukocytes.

In conclusion, it should be noted that none of the normative indicators of ejaculate does not indicate the minimum values ​​at which the onset of pregnancy is possible .

Free consultation of an andrologist for decoding the spermogram can be obtained from our forum