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Semen Analysis and Culture

All About Semen Analysis

Overview of Semen analysis and culture

Semen is a thick, fluid-like substance that a man ejaculates during sexual activity. This semen contains sperms, which help to fertilize a woman’s egg in the ovaries and helps in the process of creating an embryo.

Modern couples have enough trouble getting pregnant because of various factors which affect reproductive health & capability. In all the cases, IVF experts & gynecologists advise couples to undergo different fertility tests, depending upon the initial diagnosis.

Out of all infertility cases, 1/3rd cases of infertility are due to female infertility, another 3rd is due to male infertility & the last 3rd where the majority of fertility factors are normal in both the partners, but still the couple is infertile, is due to unexplained infertility.

Everything You Need to Know About Semen Analysis and Culture

Male Infertility | Semen Analysis | Why is it Done | How is it Performed | Semen Analysis Report

What is male infertility?

Male infertility is any health issue in a man that lowers the chances of his female partner getting pregnant naturally after having unprotected sex for 6 months to 1 year. There are multiple causes like low sperm production, abnormal sperm function or blockages in the sperm delivery path that prevent sperm delivery.

There are significant diseases like varicocele, STDs like HIV or gonorrhea, infections like inflammation of the epididymis (epididymitis) or testicles (orchitis), ejaculation issues like retrograde ejaculation where semen enters the bladder during orgasm instead of emerging out of the penis can cause male infertility.

Along with this, permanent damage to the testis can also affect sperm production drastically which would lead to male infertility. There are other reasons like cancer treatment, chromosome defects, birth defects like undescended testicles during fetal development and fertility issues in men.

What is semen analysis?

Semen analysis is the first test or an analysis procedure that is done in the management of male infertility. In this preparatory assessment, doctor looks at certain physical characteristics like quantity of the ejaculate, its pH, time taken to liquefy & levels of fructose.

Microscopic examination helps to measure the count or the concentration, motility of the sperm (forward), morphological characteristics of the sperm (size and shape) & concentration of white blood cells (WBC). This analysis gives an idea to the clinician to proceed further and manage accordingly.

Out of all the fertility diagnostic tests which are done to find out the exact cause of infertility, a semen analysis is the most basic testing of the male partner. Normal semen analysis with a good number of actively motile sperms is of utmost importance for natural conception.

The semen analysis helps the doctors

  1. To determine the shape of sperm i.e. Sperm morphology. Normal-shaped sperms are most likely to fertilize the woman’s egg than abnormal sperms.
  2. To analyze the movement of sperms i.e. Sperm motility
  3. Approximate Amount of sperms in the semen sample i.e. Sperm Count. A sperm count above 39 million is considered to be a normal sperm count in men. The decreasing amount of sperms in male partners, lowers the chances of natural conception in couples.

Why is it done or when to undergo a semen analysis?

A semen analysis will help a doctor to determine the following things.

  1. To determine the exact nature of the type of male factor contributing to the problem of infertility.
  2. To determine if a man has a low sperm count.
  3. It also helps to determine whether a man has a dysfunctional reproductive system.
  4. It can also be used to monitor the success of vasectomy/ sterilization procedures. This test helps to make sure that there are no sperms present in the semen which can fertilize an egg. In such cases, a semen analysis is done once a month for the first three months to check whether any sperms are present.

How is it performed? (Different techniques with accuracy)

Semen analysis is performed through various steps right from the collection of the semen sample to sending it to the laboratory for further tests.

Semen analysis includes a series of processes which are as follows:

  1. Doctors will ask the man to ejaculate in a collection cup in a private room or sometimes samples can also be given from home. Some clinics have a provision of providing the patients with a special condom that helps in the collection of semen.
  2. Physicians may ask you not to have sex or masturbate for 2-5 days before the test to make sure the sperm count is correct.
  3. Other methods of semen collection are electrostimulation or vibro stimulation. Patients who have got neurological injury may use other ways of semen analysis.

CASA (Computer-assisted sperm analysis)

Computer Assisted Semen Analysis (CASA) is an automatic or semi-automatic semen analysis technique. CASA provides fast, accurate, and objectively repeatable results of semen. Any kind of observer bias can be eliminated using this advanced technique. It analyzes the sperm basing on image analysis and tracks cell movement on a tablet/computer.

The digital system provides immediate and objective results of motility and concentration in a detailed report. It also provides a precise morphological and morphometric analysis of each spermatozoid. This equipment can also perform some specialized tests like sperm DNA fragmentation index & sperm vitality.

Understanding the semen analysis report (Normal vs. abnormal)

Getting the results of sperm count is not enough because sperm counts vary from person to person. There are also various underlying factors that determine the sperm counts in a man especially age, weight, and overall health. A man, aged 70+ will generally have a low sperm count whereas a man who is in his early twenties or thirties will have a normal or high sperm count.

The World health organization considers the normal sperm count which ranges from 15 million sperm per millimeter to 200 million per millimeter.

A condition where the sperm count is low is oligospermia. This happens when a man has a sperm count which is lower than 15 million sperm per millimeter or sometimes less than 39 million sperm total in each ejaculation.

Azoospermia is a result of completely sterile semen. This happens when there are no sperms present in the semen which happens mainly because of vasectomy.

Following are the cut off parameters for semen analysis according to WHO consensus, 2010

Parameter Lower Reference Limit
   
Semen Volume (ml) 1.5 (1.4 – 1.7)
Total Sperm Number (10Per Ejaculate) 39 (33 – 46)
Sperm Concentration (10Per ml) 15 (12 -16)
Total Motality (PR  + NP, %) 40 (38 – 42)
Progressive Motility (PR , %) 32 (31- 34)
Vitality (Live Spermatozoa, %) 58 (55 – 63)
Sperm Morphology (normal forms, %) 4 (3.0 – 4.0)

When you go for a semen analysis, It is advisable not to draw conclusions instantly from the report. You should visit your fertility expert for correct inference of the report and following cure plan for infertility treatment.

A low sperm analysis can be a result of Alpha-blockers like silodosin, alfuzosin, tamsulosin, etc. It can also result from taking prolonged antibiotics, chemotherapy, colchicine (a drug used to treat gouts), long-term steroid use, etc. Prolonged use of such other drugs in the pill form especially ketoconazole, spironolactone, etc. affects the sperm count adversely.

If your report has a low sperm count, you must visit a doctor. There can be multiple reasons for a low sperm count but medications can treat such conditions. Doctors also recommend hormone therapy for treating such conditions.

Other reasons for low sperm count can be vasectomy where the semen contains zero sperms. Smoking and alcoholism are some of the most common causes contributing to abnormal semen analysis. One must not do self-medication as it can badly affect your health.

Semen culture and sensitivity testing

Culture and sensitivity testing is done to rule out the presence of any infections in the semen. This is important as various bacterial infections can lead to abnormal morphology of the sperms and can also affect the motility of the sperms. Also, seminal infections can lead to cross-infection of the female partner, so it needs to be treated whenever detected.

Treatment for Sperm related issues

Milder issues in semen analysis like those relating to counts and motility of sperms can be treated by oral medicines. Severe abnormalities however may need detailed hormonal evaluation and hormonal therapy. Cases with no visible sperms in semen (azoospermia) may need minor surgical procedures like PESA, TESE, and/or Micro-TESE.

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Dr. Gunjan Gupta Govil

MRCOG(UK), MD(Gynae) – Founder & Director

She is a Gynaecologist with specialization in IVF, Infertility & Laparoscopy specialist doctor and has close to 2 decades of experience in treating Infertility, performing Gynae Laparoscopy (Keyhole Surgeries) & Handing high risk Pregnancies. She is a noted speaker in National and International level conferences and has also chaired various sessions on Infertility

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