Male infertility, semen examination in three steps In the examination of male infertility, the first and foremost is the semen routine, other than sperm morphological examination, acrosome reaction, sperm DNA fragmentation and chromosomes, etc., but in order to avoid over-examination, save the economic and time cost of the examination and physical damage, etc., not all of them will be done at the beginning.
1. How should I go down the semen test step by step? When is it necessary to do sperm morphology, acrosome reaction, etc.?
There are roughly three steps.
Step 1: Generally, semen routine + sperm morphology will be checked first to get a preliminary understanding of male fertility and help the doctor find the direction to further investigate the cause of the disease; Step 2: Semen will be checked for in-depth aspects according to the characteristics of the disease: such as infection indicators, trace elements, antibodies, DNA fragmentation, acrosome analysis, etc.; Step 3: Further, genetic problems, such as chromosomal and Y chromosome microdeletions, may be considered. .
This is like enemy reconnaissance or map enlargement, which needs to be carried out step by step, progressively, for the significance of each of the following tests, combined with an individualized analysis of the principles. So a special reminder to sufferers, you need to buy a plastic hard cover file bag to protect each and every one of your test results (regular hospitals have standardized processes, combined with the unique experience of doctors), to see the infertility needs enough time, the information must be left up before and after to facilitate the doctor’s analysis, each test is not easy, to say that are “tears “In addition, the sperm test requires 2-7 days of abstinence, and can be directly to our outpatient clinic to check the bill.
2.What does the semen test include? What is the purpose of each examination?
Semen routine + morphology: semen color, volume, sperm concentration, semen liquefaction time, semen pH (PH value), sperm motility (percentage of forward-moving sperm or a+b level sperm), survival rate and morphology, round cell concentration, white blood cell concentration, and sperm malformation rate situation.
Purpose: To understand the general condition of the semen and to make a preliminary determination of the presence or absence of “hostility” or possible areas of concern.
Seminal plasma biochemistry: mainly includes neutral alpha-glucosidase and fructose, carnosine, acid phosphatase, lactate dehydrogenase, zinc, etc.
Purpose: To contribute to the understanding of the function of the epididymis, prostate, and seminal vesicle glands. Neutral α-glucosidase and fructose reflect the secretory function of epididymis and seminal vesicles respectively and their patency, and are suitable for patients with azoospermia or severe oligospermia who are suspected of having vas deferens obstruction; seminal plasma acid phosphatase is a marker of prostate function, and this test is important for patients with poor semen liquefaction; seminal plasma lactate dehydrogenase test is a key enzyme for sperm motility and energy, and this enzyme test can assist in determining sperm quality The test can help determine sperm quality and predict sperm fertilization ability.
Sperm acrosome analysis: It mainly includes sperm acrosome integrity rate and sperm acrosome enzyme activity analysis.
Purpose: It reflects to a certain extent the ability of sperm to penetrate the egg cell to fertilize it. It is suitable for male infertility patients with no previous history of pregnancy in the female partner and for infertility patients who are ready for IUI or IVF.
Infectious semen indicators: seminal plasma elastase test and semen leukocyte staining; purpose of related microbiological examination: elastase is a protein enzyme secreted by neutrophils in the lobulated nucleus during the inflammatory process and is a marker of male genital tract inflammation, through this test combined with semen leukocyte staining can determine the presence of genital tract inflammation; the concentration of round cells in semen routine is also considered as one of the indicators of semen infection It can be used to find out the presence of urinary and reproductive system infections and their associated pathogenic microorganisms (bacteria, viruses, spirochetes, mycoplasma, chlamydia, etc., commonly gonococci, papillomavirus, adenovirus, Chlamydia trachomatis, etc.).
Anti-sperm antibody (AsAb) test: The main test is the semen mixed antiglobulin test (MAR test).
Purpose: To detect patients with poor sperm motility, high sperm agglutination or unexplained infertility.
Sperm nuclear DNA fragmentation analysis and nucleoprotein staining analysis: To analyze the proportion of sperm with DNA fragments in the nucleus and the proportion of sperm with immature nucleoproteins.
Purpose: It is suitable for infertility patients whose female partner has unexplained miscarriage and embryonic abortion, and infertility patients who are ready for IVF treatment, because a high rate of sperm nuclear DNA fragmentation indicates that the proportion of sperm with DNA fragmentation in the sperm nucleus is too high, which may affect sperm-egg union and embryo quality, etc. Some studies point out that the chance of pregnancy is almost zero with a sperm DNA fragmentation rate greater than 30%.
Seminal plasma trace element analysis: the most common ones are zinc test, phosphorus, etc.
Purpose: For those with low sperm motility and high malformation rate. Zinc, as a cofactor of more than one hundred enzymes in the body, is an essential and important element related to human growth and development, and is closely related to the metabolic activities of the reproductive system. The detection of seminal plasma zinc has certain guiding significance for the treatment of male infertility.
Chromosomal and Y chromosome microdeletions: Generally, chromosomal examination is also required in two cases: multiple routine semen examinations of the male partner.
Purpose: To find out whether there are congenital factors in male infertility patients, applicable to sperm density less than 10 million/mL; those with a history of two (including two) or more spontaneous abortions, especially early abortions (within 3 months of pregnancy).
3.If all the tests are normal, is it basically confirmed that the male partner has no problem?
If all the above semen tests are normal, and the male partner has a normal sex life and a reasonable sex time (reasonable intercourse: start the day before ovulation and have sex on the next day, 3 times in a row, usually can fully cover the ovulation period; usually regular sex, 1-2 times a week, do not “mess up” because of fertility.) If genetic tests such as chromosomal and Y chromosome microdeletions and thalassemia mutations are also normal, the male partner’s fertility cannot be confirmed to be absolutely normal, but this is where the focus of screening should shift to the spouse; if both partners are normal, further analysis may be required.
If they are not normal, further analysis and diagnosis is needed in the direction suggested by the abnormality.