Usually, a routine semen analysis is the most common test for male infertility, but in addition to the routine semen analysis, there are also sperm morphology, sperm acrosome reaction, sperm nuclear DNA fragmentation analysis, and so on. However, for economic reasons, these semen tests are not usually done all at the beginning. So how should male infertility patients choose semen tests? How should semen examination be performed step by step?
1. What is included in the semen examination? What is the purpose of the various tests?
According to the World Health Organization (WHO), a couple who has lived together for more than one year without using any contraception and whose female partner is infertile due to male factors is called male infertility. Men can be evaluated for male fertility at any time, without trying to conceive naturally for more than 1 year. Semen testing is the most important basis for assessing male fertility. There are many types of semen tests, including routine semen analysis, sperm morphological staining analysis, sperm acrosome reaction analysis, sperm nuclear DNA fragmentation analysis, anti-sperm antibody (AsAb) testing, seminal plasma biochemical analysis, and semen infectivity index analysis.
(1) Routine semen analysis: It mainly includes semen volume, semen liquefaction time, semen PH value, sperm concentration, sperm motility (percentage of forward-moving sperm or a+b class sperm). As the most basic index of male fertility, it is applicable to every male infertility patient.
(2) Sperm morphological staining analysis: It is the observation of sperm morphology after special staining of sperm, and the results are often described as the proportion of normal morphological sperm and the proportion of abnormal sperm, which to a certain extent reflects the ability of sperm to fertilize egg cells and form fertilized eggs by sperm-egg union. As the most basic indicator of male fertility, it is applicable to every male infertility patient.
(3) Sperm acrosome reaction analysis: It mainly includes sperm acrosome integrity rate and sperm acrosome enzyme activity analysis, which to a certain extent reflects the ability of sperm to fertilize egg cells. It is suitable for patients with unexplained infertility and infertile patients who are ready for IUI or IVF.
(4) DNA fragmentation analysis of sperm nuclei: analysis of the percentage of sperm with DNA fragmentation in the nucleus. A high rate of sperm nuclear DNA fragmentation indicates that the proportion of sperm with DNA fragmentation in the nucleus is too high, which may affect sperm-egg union, embryo quality, etc. It is suitable for infertile patients whose female partner has unexplained miscarriage and embryonic abortion, and infertile patients who are ready for IVF treatment.
(5) Anti-sperm antibody (AsAb) test: The main test method is the semen mixed antiglobulin test (MAR test). It is suitable for patients with poor sperm viability, more sperm agglutination or unexplained infertility.
(6) Seminal plasma biochemical analysis: It mainly includes neutral alpha-glucosidase and fructose, which reflect the secretory function of epididymis and seminal vesicles and their patency, respectively. It is suitable for patients with azoospermia or severe oligospermia who are suspected of having vas deferens obstruction.
(7) Analysis of semen infectivity index: It mainly includes semen leukocyte peroxidase staining analysis and seminal plasma elastase test, which reflects the presence of infection and inflammation in semen. It is suitable for infertility patients whose routine semen analysis shows a high percentage of round cells and suspected gonadal infection.
2.How should semen examination be performed step by step? When is semen examination such as sperm morphology and acrosome reaction necessary?
All male infertility patients and men who want to know their fertility can undergo the various semen tests mentioned above, but for financial reasons, it is best to perform semen tests step by step under the guidance of a male physician.
(1) First of all, 1-2 routine semen analyses and sperm morphological staining analyses should be performed, which reflect the most basic male fertility. Generally speaking, all hospitals that offer semen examination can perform routine semen analysis, and all tertiary hospitals can perform sperm morphological staining analysis. Routine semen examination is usually performed by computerized scanning method, while sperm morphological staining analysis must be performed by manual observation and analysis to be accurate enough.
(2) Patients with unexplained infertility whose results of routine semen analysis and sperm morphological staining analysis are basically normal can further undergo semen examination such as sperm acrosome reaction analysis, sperm nuclear DNA fragmentation analysis, and anti-sperm antibody (ASAs) detection.
(3) Infertile patients whose routine semen analysis shows high round cell concentration and suspected gonadal infection can undergo semen infectious index analysis, mainly including semen leukocyte peroxidase staining analysis and seminal plasma elastase assay. A high semen infectivity index indicates possible inflammation of reproductive glands such as the epididymis, prostate and seminal vesicles. Inflammation of the reproductive glands is the most common cause of male infertility and can lead to sperm damage, which can cause various semen abnormalities such as azoospermia, oligospermia, weak spermia, deformed sperm, abnormal sperm acrosome function, and excessive sperm nuclear DNA fragmentation rate.
(4) Patients with azoospermia or severe oligospermia who are suspected of having vas deferens obstruction can have seminal plasma biochemical analysis. Low neutral alpha-glucosidase indicates possible obstruction, dysplasia or inflammation of the epididymis or vas deferens; low fructose indicates possible obstruction, dysplasia or inflammation of the seminal vesicles or ejaculatory ducts.
(5) Infertile patients preparing for artificial insemination or IVF need comprehensive semen examination to provide a basis for the development of assisted reproduction programs. Routine semen analysis, sperm morphological staining analysis and sperm acrosome reaction analysis are generally required, and sperm nuclear DNA fragmentation analysis, anti-sperm antibody (AsAb) testing and semen infectious index analysis are also required when deemed necessary by the male physician.
(6) Male infertility patients whose female partner has unexplained miscarriage and embryonic abortion, and male infertility patients who are ready to undergo expensive IVF treatment need to be examined for sperm nuclear DNA fragmentation analysis. Genetic tests such as peripheral blood chromosomes and thalassemia gene mutations are also desirable.
3.What are the things that men should pay attention to when having a semen test?
Men should pay attention to the following matters when having semen examination to ensure that the semen examination results can correctly reflect male fertility.
(1) Abstinence time. Abstinence (no sexual intercourse, masturbation or seminal emission such as semen loss) is required for 2 to 7 days before coming to the hospital for semen examination. This is because if the abstinence time before semen examination is too short, the number of sperm and the volume of semen will decrease; if the abstinence time is too long, dead sperm and abnormal sperm will increase, which will result in inaccurate semen examination results and cannot correctly reflect male fertility.
(2) Collection method. It is best to use the masturbation method to collect semen, which will ensure that the semen collected is intact and free of contamination. It is best not to collect semen with ordinary condoms, direct vaginal intercourse, oral sex, anal sex, etc., because ordinary condoms contain ingredients that can kill sperm and affect sperm motility, and female vaginal secretions, saliva, feces, etc. can affect sperm motility, and semen collected by these methods can affect the analysis of sperm motility. Before masturbating to take semen, you need to wash your hands and penis, especially for men with long foreskin, it is best to turn up the foreskin and clean it to avoid contaminating the semen and causing inaccurate test results. When taking semen, use a non-toxic and disinfected container with a large opening (hospitals usually provide them). When ejaculating, pay attention to ejaculate all the semen into the container and do not spill it outside, if the semen taken is incomplete, the results of semen analysis will be inaccurate.
(3) What should I do if I have difficulty collecting semen? Men who have difficulty ejaculating when masturbating on their own can look at pornographic books, pictures or videos while masturbating, or have the woman help them masturbate to get enough sexual stimulation. Men who have difficulty getting an erection can take oral medication such as Viagra (sildenafil tablets) to help the penis get an erection 1-2 hours before starting masturbation under the guidance of a male doctor. If semen is taken at a place far away from the semen examination laboratory (at home or in a hotel), the semen taken out must be delivered to the laboratory within one hour after ejaculation. Care should be taken to keep the semen warm during transportation, and it is best to bring the semen container to the laboratory by holding it in your hand or placing it close to your underwear, and indicating the time of ejaculation (specifically, what time and how many minutes).
4. If all semen tests are normal, is it basically confirmed that there is no problem with the male partner’s fertility?
If all the above semen tests of the male partner are normal, and genetic tests such as sexual function, peripheral blood chromosomes and thalassemia mutations are also normal, the male partner can be considered to have normal fertility. At this point, the focus of the examination for the infertile couple will tend to be on the female partner’s side.