The environment in which the sperm is located is like the environment in which the blood cells are located called plasma, and the quality of seminal plasma directly affects the mobility of sperm and their ability to conceive. For men who are unable to have children and whose male reproductive function is affected, most of the checkups focus on sperm, namely: azoospermia, dead sperm, weak sperm, poor semen liquefaction, low semen volume, abnormal sperm and other items, and the cause of these items is often unknown after the abnormalities are found, leading to poor treatment results. In fact, semen examination, in addition to the above items, there are many chemical components that can be examined to check the cause of poor sperm quality and bring positive significance to the treatment of infertility.
I. Clinical significance of seminal plasma biochemical examination.
1, different combinations of seminal plasma biochemical markers are analyzed separately to help analyze the causes of azoospermia, oligospermia, weak spermia, teratozoospermia and abnormal semen liquefaction, which are especially suitable for the localization and diagnosis of vas deferens obstruction, where the biochemical indicators reflect completely different from different obstruction sites.
2.Assist in the evaluation of testicular spermatogenic function and sperm quality.
3.It can be used as an indicator for the diagnosis, treatment and efficacy evaluation of testicular and accessory gonadal disorders.
Second, seminal plasma biochemical test is suitable for the following groups.
1, sperm quality analysis is normal, but long marriage without pregnancy
2, those with abnormal sperm quality who need to find the cause
3, inflammatory infections such as prostate, epididymitis and seminal vesiculitis.
4. Those who combine with semen routine as pre-fertility physical examination.
Third, the common male examination items related to fertility.
1, physical examination and imaging examination (testicular ultrasound).
2, semen quality analysis and semen paddle biochemical examination.
5, sex hormones, gonadal function evaluation and analysis.
4, seminal plasma biochemical common examination items.
1.Quantitative determination of seminal plasma neutral alpha-glucosidase – epididymal secretion function index
Clinical significance.
To diagnose the ability of epididymis and testis to produce and transport sperm, and to help in the diagnosis of the causes of oligospermia.
2.Quantitative determination of seminal plasma zinc
Zinc is one of the evaluation indicators of prostate function. Zinc content of seminal paddle is helpful for the diagnosis of sperm vitality and prostatitis, and lower zinc content leads to testicular dysplasia and hypogonadism. Zinc is also involved in regulating androgen metabolism, and lower zinc levels can promote the transformation of testosterone into dihydrotestosterone, affecting sexual function.
3.Seminal plasma fructose – an indicator of seminal vesicle secretion function:
Clinical significance.
Fructose secreted by seminal vesicles is the main source of sperm energy. Congenital seminal vesicle deficiency is negative if fructose is determined.
Fructose content is reduced in sperm vesiculitis, incomplete ejaculation or excessive ejaculation.
It is used to identify azoospermia caused by simple vasal obstruction (normal fructose content) and azoospermia caused by vasal and seminal vesicle dysplasia.
4.Seminal plasma acid phosphatase quantification and seminal plasma zinc quantification
The seminal plasma acid phosphatase is one of the indicators for the diagnosis and evaluation of the treatment effect of prostatitis and related diseases. The content of seminal plasma acid phosphatase is reduced in patients with prostatitis and increased in those with prostate hypertrophy or early prostate malignancy.
5.Quantitative determination of seminal plasma citric acid.
Clinical use.
Citric acid in semen is secreted by the prostate gland and its role is to complex calcium ions, regulate seminal plasma calcium ion concentration and directly affect the process of semen liquefaction after ejaculation, and lack of citric acid in semen can lead to delayed semen liquefaction.
The seminal plasma citric acid level is correlated with testosterone level. The seminal plasma citric acid level is an important indicator to help determine the status of androgen secretion and to evaluate the function of the prostate. A decrease in seminal plasma citric acid level indicates impaired prostate secretion.
6.Quantitative determination of semen lactate dehydrogenase isoenzyme X
It is mainly used to quantitatively determine the activity of lactate dehydrogenase isoenzyme X in human semen specimens, which is used to evaluate the integrity of sperm membrane function, and its low activity indicates damage or resistance to sperm differentiation.
Clinical use.
To detect seminal plasma and sperm LDH-X levels in the same subject and to calculate the seminal plasma/sperm LDH-X ratio, which can be used to evaluate the integrity of their sperm membrane function.
The semen LDH-X test can be used for the analysis of the etiology of weak spermatozoa, providing an important basis for further definitive diagnosis and treatment. When semen LDH-X is normal and sperm viability is reduced, abnormal sperm differentiation should be excluded, with emphasis on post-testicular factors (e.g. infection, sperm antibodies, etc.) and accidental factors (e.g. sperm inactivation during specimen collection, transportation and preservation, detection errors, etc.).
7.Quantitative measurement of seminal plasma elastase (enzyme-linked immunosorbent assay)
In male genital tract infection, lobulated granulocytes participate in the local anti-inflammatory response by secreting a large amount of elastase to the extracellular area to phagocytose pathogens. To prevent excessive damage to tissues and organs by elastase, the body then secretes α1-trypsin inhibitor to neutralize elastase, eventually forming an elastase-α1-trypsin inhibitor complex, the increased concentration of which predicts an anti-inflammatory effect of fractionated nucleolar leukocytes.
Clinical use.
Reproductive urinary tract infection detection.
8, quantitative detection of sperm acrosome enzyme activity (solid phase BAPNA method)
Clinical use: Acrosomal enzymes are important protein hydrolytic enzymes in the fertilization process and are present between the acrosomal membrane and the equatorial membrane of the sperm head. When a spermatozoon unites with an oocyte, the acrosome reaction occurs in the sperm head and the acrosomal outer membrane ruptures, releasing acrosomal enzymes to dissolve the radial crown and zona pellucida around the oocyte, allowing the sperm to cross the zona pellucida and fuse with the oocyte to complete fertilization. In addition to the quality of the sperm itself, severe reproductive system infections can also cause a decrease in sperm acrosome enzyme activity.
Patients with causes of infertility that are difficult to identify by semen routine also have low acrosome enzyme activity.
Acrosome enzyme activity is one of the important evaluation indicators to determine the strength of male sperm function and fertility.
V. Examination items for analysis of abnormal embryonic development or causes of infertility
(1) DNA fragmentation test
Reliable statistics show that the decline of male sperm quality caused by various reasons is now an indisputable fact. It is the wish of every parent to know how to maintain the best sperm quality or to hope for the best next generation.
The DNA fragmentation test is one of the objective indicators of sperm integrity and fertility. The principle is to detect the amount of sperm fragmentation cells in the sperm paddle and measure the integrity of the sperm by using a fully automated sperm paddle biochemistry analyzer in reproductive medicine, and to calculate the amount of good sperm in the semen by computer.
Clinical significance.
1, analysis of the etiology of infertility, spontaneous abortion and embryonic abortion
2.Prediction of pregnancy outcome
3. Selection of assisted reproduction pregnancy methods
Who needs to be tested for sperm DNA fragmentation?
1.All men who have been infertile for more than 6 months – 1 year
2.History of spontaneous miscarriage
3.Considering IUI, IVF, ICSI
4.Male partner is over 40 years old
5.Smokers
6.Taking certain drugs
7.Patients undergoing cancer treatment
8.Exposure to toxic environment
9.Urogenital infection
10.Those considering varicocele surgery
(2) The quality of husband’s sperm has a great relationship with wife’s infertility, spontaneous miscarriage and embryo abortion
The content and degree of immature sperm in each ejaculation of male semen directly determines the wife’s ability to conceive and whether the fetus can develop normally to natural delivery. “Nucleoprotein staining, sperm DNA fragmentation, and sperm-hyaluronic acid binding test are effective indicators for diagnosing sperm maturity. The combination of these three tests can further improve the diagnostic benefit.
With a 1 in 10 million chance of conception, there are some key aspects of the slow journey that are most likely to affect sperm-egg union.
The female partner is healthy and has the conditions for fertility; the requirements for semen are unusually strict: semen volume 3-5 ml. The liquefaction time should be less than 30 minutes. pH value at 7.5-7.8, sperm count above 20 million/ml, more than 70% of normal sperm, a+b more than 50%. No white blood cells and other irrelevant impurities, etc.