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Semen analysis - Wikipedia, the free encyclopedia

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Semen analysis
From Wikipedia, the free encyclopedia

A semen analysis (plural: semen analyses) evaluates


certain characteristics of a male's semen and the
sperm contained therein. It is done to help evaluate
male fertility, whether for those seeking pregnancy or
verifying the success of vasectomy. Depending on the
measurement method, just a few characteristics may
be evaluated (such as with a home kit) or many
characteristics may be evaluated (generally by a
diagnostic laboratory). Collection techniques and
precise measurement method may influence results.

Contents
1 Reasons for testing
2 Relation to fertility
3 Collection methods
4 Parameters
4.1 Sperm count
4.2 Motility
4.3 Morphology
4.4 Volume
4.5 Fructose level
4.6 pH
4.7 Liquefaction
4.8 MOT
4.9 Total motile spermatozoa
4.10 Others
5 Abnormalities
6 Factors that influence results
7 Measurement methods
8 See also
9 References
10 External links

Semen analysis
Diagnostics

Human sperm stained for semen quality testing in


the clinical laboratory.
MedlinePlus 003627
HCPCS-L2 G0027 (http://www.icd9data.com
/HCPCS/2011/G/G0027.htm)

Reasons for testing


The most common reasons for laboratory semen analysis in humans are as part of a couple's infertility
investigation and after a vasectomy to verify that the procedure was successful. It is also commonly used
for testing human donors for sperm donation, and for animals semen analysis is commonly used in stud
farming and farm animal breeding.

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Occasionally a man will have a semen analysis done as part of routine pre-pregnancy testing. At the
laboratory level this is rare, as most healthcare providers will not test the semen and sperm unless
specifically requested or there is a strong suspicion of a pathology in one of these areas discovered
during the medical history or during the physical examination. Such testing is very expensive and
time-consuming, and in the U.S. is unlikely to be covered by insurance. In other countries, such as
Germany, the testing is covered by all insurances.

Relation to fertility
The characteristics measured by semen analysis are only some of the factors in semen quality. One
source states that 30% of men with a normal semen analysis actually have abnormal sperm function.[1]
Conversely, men with poor semen analysis results may go on to father children.[2] In NICE guidelines,
mild male factor infertility is defined as when 2 or more semen analyses have 1 or more variables below
the 5th percentile, and confers a chance of pregnancy occurring naturally through vaginal intercourse
within 2 years similar to people with mild endometriosis.[3]

Collection methods
Different methods used for semen collection are masturbation, coitus interruptus, condom collection,
epididymal extraction, etc.

Parameters
Examples of parameters measured in a semen analysis are: sperm count, motility, morphology, volume,
fructose level and pH.

Sperm count
Sperm count, or sperm concentration to avoid confusion
with total sperm count, measures the concentration of sperm
in a man's ejaculate, distinguished from total sperm count,
which is the sperm count multiplied with volume.[4] Over 15
million sperm per milliliter is considered normal, according
to the WHO in 2010.[5] Older definitions state 20 million.
[1][2] A lower sperm count is considered oligozoospermia. A
vasectomy is considered successful if the sample is
azoospermic. Some define success with rare non-motile
sperm are observed (fewer than 100,000 per millilitre).[6]
Others advocate obtaining a second semen analysis to verify
the counts are not increasing (as can happen with
re-canalization) and others still may perform a repeat
vasectomy for this situation.
The average sperm count today is between 20 and 40
million per milliliter in the Western world, having decreased
by 1-2% per year from a substantially higher number
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Approximate pregnancy rate varies with


amount of sperm used in an artificial
insemination cycle. Values are for
intrauterine insemination, with sperm
number in total sperm count, which may
be approximately twice the total motile
sperm count.

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decades ago.[7]
Chips for home use are emerging that can give an accurate estimation of sperm count after three samples
taken on different days. Such a chip may measure the concentration of sperm in a semen sample against
a control liquid filled with polystyrene beads.[8]

Motility
The World Health Organization has a value of 50% and this must be measured within 60 minutes of
collection. WHO also has a parameter of vitality, with a lower reference limit of 60% live
spermatozoa.[5] A man can have a total number of sperm far over the limit of 20 million sperm cells per
milliliter, but still have bad quality because too few of them are motile. However, if the sperm count is
very high, then a low motility (for example, less than 60%) might not matter, because the fraction might
still be more than 8 million per millilitre. The other way around, a man can have a sperm count far less
than 20 million sperm cells per millilitre and still have good motility, if more than 60% of those
observed sperm cells show good forward movement.
A more specified measure is motility grade, where the motility of sperm are divided into four different
grades:[9]
Grade a: Sperm with progressive motility. These are the strongest and swim fast in a straight line.
Sometimes it is also denoted motility IV.
Grade b: (non-linear motility): These also move forward but tend to travel in a curved or crooked
motion. Sometimes also denoted motility III.
Grade c: These have non-progressive motility because they do not move forward despite the fact
that they move their tails. Sometimes also denoted motility II.
Grade d: These are immotile and fail to move at all. Sometimes also denoted motility I.

Morphology
Regarding sperm morphology, the WHO criteria as described in
2010 state that a sample is normal (samples from men whose
partners had a pregnancy in the last 12 months) if 4% (or 5th
centile) or more of the observed sperm have normal morphology.
[5][10]

Morphology is a predictor of success in fertilizing oocytes during


in vitro fertilization.
Up to 10% of all spermatozoa have observable defects and as
such are disadvantaged in terms of fertilising an oocyte.[11]
Also, sperm cells with tail-tip swelling patterns generally have
lower frequency of aneuploidy.[12]
A motile sperm organelle morphology examination (MSOME) is
a particular morphologic investigation wherein an inverted light
microscope equipped with high-power optics and enhanced by digital imaging is used to achieve a

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magnification above x6000, which is much higher than the magnification used habitually by
embryologists in spermatozoa selection for intracytoplasmic sperm injection (x200 to x400).[13] A
potential finding on MSOME is the presence of sperm vacuoles, which are associated with sperm
chromatin immaturity, particularly in the case of large vacuoles.[14]

Volume
WebMD advises that semen volumes between 1.0 mL and 6.5 mL are normal;[2] WHO regards 1.5 ml as
the lower reference limit.[5] Low volume may indicate partial or complete blockage of the seminal
vesicles, or that the man was born without seminal vesicles.[1] In clinical practice, a volume of less than
2 mL in the setting of infertility and absent sperm should prompt an evaluation for obstructive
azoospermia. A caveat to this is be sure it has been at least 48 hours since the last ejaculation to time of
sample collection.

Fructose level
Regarding the level of fructose in the semen, WebMD lists normal as at least 3 mg/mL.[2] WHO
specifies a normal level of 13 mol per sample. Absence of fructose may indicate a problem with the
seminal vesicles.[1]

pH
WebMD lists a normal pH range of 7.1-8.0;[2] WHO criteria specify normal as 7.2-7.8.[1] Acidic
ejaculate (lower pH value) may indicate one or both of the seminal vesicles are blocked. A basic
ejaculate (higher pH value) may indicate an infection.[1] A pH value outside of the normal range is
harmful to sperm.[2]

Liquefaction
The liquefaction is the process when the gel formed by proteins from the seminal vesicles is broken up
and the semen becomes more liquid. It normally takes less than 20 minutes for the sample to change
from a thick gel into a liquid. In the NICE guidelines, a liquefaction time within 60 minutes is regarded
as within normal ranges.[15]

MOT
MOT is a measure of how many million sperm cells per ml are highly motile,[16] that is, approximately
of grade a (>25 micrometer per 5 sek. at room temperature) and grade b (>25 micrometer per 25 sek. at
room temperature). Thus, it is a combination of sperm count and motility.
With a straw [17] or a vial volume of 0.5 milliliter, the general guideline is that, for intracervical
insemination (ICI), straws or vials making a total of 20 million motile spermatozoa in total is
recommended. This is equal to 8 straws or vials 0.5 ml with MOT5, or 2 straws or vials of MOT20. For
intrauterine insemination (IUI), 1-2 MOT5 straws or vials is regarded sufficient.[18] In WHO terms, it is
thus recommended to use approximately 20 million grade a+b sperm in ICI, and 2 million grade a+b in
IUI.

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Total motile spermatozoa


Total motile spermatozoa (TMS)[19] or total motile sperm count (TMSC)[20] is a combination of sperm
count, motility and volume, measuring how many million sperm cells in an entire ejaculate are motile.
Use of approximately 20 million sperm of motility grade c or d in ICI, and 5 million ones in IUI may be
an approximate recommendation.

Others
The NICE guidelines also include testing vitality, with normal ranges defined as more than 75% of
sperm cells alive.[15]
The sample may also be tested for white blood cells. A high level of white blood cells in semen is called
leucospermia and may indicate an infection.[1] Cutoffs may vary, but an example cutoff is over 1 million
white blood cells per milliliter of semen.[1]

Abnormalities
Aspermia: absence of semen
Azoospermia: absence of sperm
Hypospermia: low semen volume
Hyperspermia: high semen volume
Oligozoospermia: Very low sperm count
Asthenozoospermia: poor sperm motility
Teratozoospermia: sperm carry more morphological defects than usual
Necrozoospermia: all sperm in the ejaculate are dead
Leucospermia: a high level of white blood cells in semen

Factors that influence results


Apart from the semen quality itself, there are various methodological factors that may influence the
results, giving rise to inter-method variation.
Compared to samples obtained from masturbation, semen samples from collection condoms have higher
total sperm counts, sperm motility, and percentage of sperm with normal morphology. For this reason,
they are believed to give more accurate results when used for semen analysis.
If the results from a man's first sample are subfertile, they must be verified with at least two more
analyses. At least 2 to 4 weeks must be allowed between each analysis.[21] Results for a single man may
have a large amount of natural variation over time, meaning a single sample may not be representative of
a man's average semen characteristics.[22] In addition, sperm physiologist Joanna Ellington believes that
the stress of producing an ejaculate sample for examination, often in an unfamiliar setting and without
any lubrication (most lubricants are somewhat harmful to sperm), may explain why men's first samples
often show poor results while later samples show normal results.[23]
A man may prefer to produce his sample at home rather than at the clinic. The site of semen collection
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does not affect the results of a semen analysis.[24]

Measurement methods
Volume can be determined by measuring the weight of the sample container, knowing the mass of the
empty container. Sperm count and morphology can be calculated by microscopy. Sperm count can also
be estimated by kits that measure the amount of a sperm-associated protein, and are suitable for home
use.[25]
Computer Assisted Semen Analysis (CASA) is a catch-all phrase for automatic or semi-automatic
semen analysis techniques. Most systems are based on image analysis, but alternative methods exist
such as tracking cell movement on a digitizing tablet.[26][27] Computer-assisted techniques are
most-often used for the assessment of sperm concentration and mobility characteristics, such as velocity
and linear velocity. Nowadays, there are CASA systems, based on image analysis and using new
techniques, with near perfect results, and doing full analysis in a few seconds. With some techniques,
sperm concentration and motility measurements are at least as reliable as current manual methods.[28]
Raman spectroscopy has made progress in its ability to perform characterization, identification and
localization of sperm nuclear DNA damage.[29]

See also
Semen quality
Artificial insemination for more details of how semen parameters affects pregnancy rate

References
1. "Understanding Semen Analysis" (http://www.uhmc.sunysb.edu/urology/male_infertility
/SEMEN_ANALYSIS.html). Stonybrook, State University of New York. 1999. Retrieved 2007-08-05.
2. Essig, Maria G.; Edited by Susan Van Houten and Tracy Landauer, Reviewed by Martin Gabica and Avery L.
Seifert (2007-02-20). "Semen Analysis" (http://www.webmd.com/infertility-and-reproduction/guide/semenanalysis). Healthwise. WebMD. Retrieved 2007-08-05.
3. Fertility: assessment and treatment for people with fertility problems (http://guidance.nice.org.uk/CG156).
NICE clinical guideline CG156 - Issued: February 2013
4. sharedjourney.com - Male Infertility Testing (http://www.sharedjourney.com/define/semen.html)
5. Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM, Haugen TB, Kruger T, Wang C,
Mbizvo MT, Vogelsong KM (MayJun 2010). "World Health Organization reference values for human
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Human reproduction update 16 (3): 23145. doi:10.1093/humupd/dmp048 (https://dx.doi.org
/10.1093%2Fhumupd%2Fdmp048). PMID 19934213 (https://www.ncbi.nlm.nih.gov/pubmed/19934213).
6. Rajmil O, Fernndez M, Rojas-Cruz C, Sevilla C, Musquera M, Ruiz-Castae E (2007). "Azoospermia
should not be given as the result of vasectomy". Arch. Esp. Urol. (in Spanish) 60 (1): 558. PMID 17408173
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8. New Chip Provides Cheap At-Home Sperm Counting (http://www.popsci.com/technology/article/2010-01


/counting-chip-provides-cheap-home-sperm-counting) By Stuart Fox Posted 01.26.2010 in Popular Science
9. Shared Journey: Semen Analysis (http://www.sharedjourney.com/define/semen2.html)
10. Rothmann SA, Bort AM, Quigley J, Pillow R (2013). "Sperm morphology classification: a rational method
for schemes adopted by the world health organization.". Methods in molecular biology (Clifton, N.J.) 927:
2737. doi:10.1007/978-1-62703-038-0_4 (https://dx.doi.org/10.1007%2F978-1-62703-038-0_4).
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12. Pang MG, You YA, Park YJ, Oh SA, Kim DS, Kim YJ (June 2009). "Numerical chromosome abnormalities
are associated with sperm tail swelling patterns". Fertil. Steril. 94 (3): 10121020.
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for People with Fertility Problems. London: RCOG Press. 2004. ISBN 1-900364-97-2.
16. Cryos International - What does MOT mean? (http://dk.cryosinternational.com/private-customers/questionsanswers.aspx#7175)
17. Cryos International - What is a straw? (http://dk.cryosinternational.com/private-customers/questionsanswers.aspx#7179)
18. Cryos International - How much sperm should I order? (http://dk.cryosinternational.com/private-customers
/questions-answers.aspx#7169)
19. Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H (November 2008). "Predictive factors
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literature". Fertil. Steril. 93 (1): 7988. doi:10.1016/j.fertnstert.2008.09.058 (https://dx.doi.org
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27. Hinting A, Schoonjans F, Comhaire F (1988). "Validation of a single-step procedure for the objective
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Jayaprakasan R, Naeem A, Pridmore T (April 2010). "Validation of a novel computer-assisted sperm analysis
(CASA) system using multitarget-tracking algorithms". Fertil. Steril. 93 (6): 191120.
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External links
Geneva Foundation for Medical Education and Research (http://www.gfmer.ch/Endo/Lectures_09
/semen_analysis.htm) - complete list of parameters.
Semen analysis (http://labtestsonline.org/understanding/analytes/semen/tab/test) - Lab Tests
Online
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