In the process of diagnosing and treating male infertility, routine examination of semen is an important and indispensable component, and is an important indicator of male fertility, but many patients do not understand the indicators of semen analysis very well and are prone to misinterpretation.
Semen volume: Each ejaculate volume of a normal person is about 2-6 ml, 1-2 ml is suspected to be abnormal, and less than 1 ml or more than 7 ml are considered abnormal. Semen volume measurement is related to the abstinence time before the specimen is taken, and a long abstinence time results in a relatively high semen volume, generally 3-5 days of abstinence is appropriate. In pathological cases, when the volume of one ejaculation is more than 7ml, not only the density of sperm is reduced, but also it is easy to flow out from the vagina, so that the total number of sperm is reduced; less than 2ml is too little semen volume, but usually less than 1ml is too little. In this case, the contact area between the semen and the female reproductive tract is small, or the viscous consistency is not conducive to sperm entering the female cervical opening, resulting in infertility.
Sperm density: It is generally expressed as the number of sperm in each ml of semen. The sperm density of a normal person is 20-150 million/ml, but it varies greatly from person to person. Those with less than 20 million/ml are considered oligospermia, which is seen in various causes of spermatogenic dysfunction, etc. It can lead to low fertility or infertility due to reduced chances of sperm entering the uterine cavity and fallopian tubes; those with more than 250 million/ml are considered polyspermia, where sperm motility is affected; if no sperm is found in the semen after multiple examinations or after centrifugation, they are considered azoospermia. All three of these are factors of infertility. It should be noted that some people have less than 20 million/ml, but they can also be fertile due to their high sperm motility and low malformation rate.
State of liquefaction: After normal semen is ejaculated, it becomes jelly-like under the action of seminal vesicle coagulase and changes to a less viscous liquid form after 5-30 minutes. If it does not liquefy for more than half an hour, the semen is not liquefied and the free movement of sperm is restricted, which leads to male infertility. In addition, touching a glass rod to the already liquefied semen, observing the viscosity and gently lifting and holding it, semen filaments can be formed, which are less than 50px in length when normal.
Malformation rate: Normal spermatozoa have a flat oval head and a long, curved tail, similar to a tadpole; however, some have abnormalities such as a pointed, large, double-headed head and a thick, short, bifurcated, double-tailed body tail. If the deformed sperm exceeds 30%, it is called deformed spermatozoa and can affect fertility.
Color: The color of normal semen is off-white or light yellow. If there is blood in the semen and it turns red or pink, it is hemorrhagic semen with a large number of red blood cells visible under the microscope, which is commonly seen in inflammation of the secondary gonads, posterior urethra, and occasionally in tuberculosis or tumors; if the semen contains yellow discharge, it is purulent semen with a large number of pus balls visible under the microscope, suggesting inflammation of the genital tract or secondary gonads.
pH: The pH value of normal human semen is between 7.2 and 7.8. Excessive acidity or alkalinity is not conducive to sperm activity and metabolism.
Inflammatory cells: Normal semen should have less than a “+” sign for white blood cells. Increased leukocytes indicate infection in the reproductive tract or paraphilic glands.
Viability: Usually within one hour after ejaculation, at least 70% of the spermatozoa should be motile (generally 60-80%), if less than 60%, the spermatozoa are weak; if all the spermatozoa in the semen are dead, the spermatozoa are dead.
Motility: The motility of sperm is generally divided into four levels. level 0 refers to inactive sperm; level 1 refers to sperm moving in place; level 2 refers to sperm swimming slowly forward in a curve; level 3 refers to sperm swimming straight forward; level 4 refers to sperm swimming fast and straight forward. Generally sperm of grade 3 or higher are required to fertilize the egg. Grade 3+4 (some labeled as grade a+b) sperm are generally required for ≥50% of the sperm.
Sperm count, sperm motility and morphology are the most important elements of semen examination, but several items must be analyzed together. In some cases, although the sperm density is low, such as below 20 million, but the sperm motility is strong and there are few deformed sperm and dead sperm, then fertility is still possible. Some people have not low sperm density, even up to 100 million per ml, but too many dead sperm, deformed sperm, the vast majority of sperm motility is weak, may also lead to infertility. In addition, the sperm count or sperm density can vary greatly due to individual differences and testing errors, so several laboratory reports must be compared with each other for analysis.
In conclusion, the results of the semen examination must be analyzed comprehensively, and the results of several tests must be compared before and after in order to reach a more correct conclusion. The causes of male infertility are very complex, and only by doing a detailed examination, making a correct judgment, identifying the causes and treating the symptoms, can we receive satisfactory results. In fact, more and more men are facing the embarrassment of declining sperm count and quality. According to statistics, among infertile couples, the number and quality of male sperm fail to meet the requirements of infertility has accounted for about 30%. In the routine sperm examination, the overall quality of sperm is normal for less than 60% of the men who come to the examination. It is worth noting that the trend of lowering sperm quality has become apparent at a younger age. The news from several sperm banks across the country is that the quality of sperm of college students, once considered a sperm mine, is worrying. A family planning institute once openly solicited sperm in colleges and universities, but unexpectedly, 400 college student volunteers who came to donate sperm, less than 50 sperm qualified.
Semen routine examination deep understanding.
First, the quality of human semen is fluctuating.
Many people think that semen quality should always remain stable like other organs of the body. But in fact this is not the case. The quality of human semen fluctuates and sometimes fluctuates widely. Under normal circumstances, this fluctuation can manifest itself in a number of ways, including sperm density, motility, and morphology. This is why it is often very embarrassing to encounter patients with decreased semen quality during infertility treatment. This is sometimes related to the normal fluctuations in semen quality, but patients often shake their confidence in treatment!
Second, poor comparability of semen examination results in different hospitals
The poor comparability of semen quality test results from different hospitals is also a very noteworthy thing! Most patients think that semen quality tests should be as comparable as liver and kidney function, blood and urine routine test results. However, this is not the case, as the test results can vary greatly from one hospital or institution to another due to differences in semen analysis systems, related hardware and individual practices.
For the same specimen, if there is a discrepancy between “no sperm” and “normal density”, it is unacceptable and usually one hospital must have made a mistake. However, if the discrepancy is only within a small range, it is acceptable.
Third, the credibility of some hospitals’ test reports is not high
It is not uncommon for some hospitals to have test reports that are not highly credible. The medical market, especially for hepatitis, tumor and infertility, is very clear to everyone. We will not comment on it here. There are two main reasons for the low credibility of some hospital reports. On the one hand, some of the examiners have not undergone formal training. The routine semen examination may seem simple, but it requires certain operational steps and skills, such as resting and waiting for liquefaction, homogenizing and taking samples, and testing. In case of “no sperm”, centrifugal testing is also required. On the other hand, the reports issued by some unscrupulous medical units are also very unreliable. The common feature is: infertility visit → semen examination → poor semen quality → told to have prostatitis → treat prostatitis first!