This ppt gives you an expert's overview of semen analysis, its pitfalls and important clinical information that could be used in assessing an infertile male when he presents to a fertility clinic

1. SEMEN ANALYSIS – REVISITED
Dr. Shah Dupesh MBBS, DCE,
FASM, (PhD)
The guy who takes care of the
MEN in the WOMENS
CENTER ;-)

2. SEMEN ANALYSIS: A BIT OF
HISTORY

3. ANTON VON LEEUWENHOEK
Prathima T, Ranjani, N. Pandiyan. History of semen analysis, chcmj, vol 4, no 1
Father of Microbiology – first discovered the sperm in 1677

4. SEMEN ANALYSIS – BIG DEAL?
6-7 years ago concerns were raised about the standard of
care of men with infertility
Changes in semen analysis among infertile men are usually
non specific and frequently give very little information
about the cause of infertility.
non specific and frequently give very little information
about the cause of infertility.
At a UG Level doctors also receive little training pertinent
to this specialty. So how effectively are we managing the
couple?
The prevalence of male factor infertility is 7% of all men*.
This incidence is higher than Diabetes Mellitus
Jecquir and Cummins, 1997. Tournaye, 1997. *Nieschlag and Behre 2000

5. SEMEN ANALYSIS
Overview
 Remains the gold standard
test of choice when assessingtest of choice when assessing
infertility in a couple.
 Ultimately decides the course
of treatment for a couple
 Gives an idea about a mans
testicular germ cell output
 Influenced by numerous
factors.

6. SEMEN ANALYSIS – LIMITATION?
Several!!
 Collection artifact
 Analysis artifact
 Interpretation artifact
 What is Normal? remains
controversial
 Male fertility cannot be
determined based on single
report or solely on these
results.
 Depends on Man-laboratory-
Physician unit.

7. ARTEFACTS IN SEMEN ANALYSIS
Collection
Artefacts
Interpretation
Artefacts
Analysis
Artefacts

8. COLLECTION ARTEFACTS?
Again Several!!
 Difficulty in semen Difficulty in semen
collection.
 Agony of Split ejaculate.
 Incomplete sample.
 Improper container.
 Inconvenient space.

9. COMMERCIAL DIAGNOSTIC
LABORATORIES DO NOT CARE!

10. Collection Artifacts? The hard truth
Environment if not
conducive for arousal
Can affect a man’s
erectile function
Can affect mans ability
to give a complete
sample
Treatment strategies
drastically change

11. ANALYSIS ARTEFACTS?
Over 95% of standalone commercial laboratories have still
not upgraded to the latest WHO 2010 guideline values
This means men suffering from a genuine problem may be
missedmissed
Our data of over 300 samples(unpublished), clearly shows
that there is at least a 30% to 40% variance in sperm
parameters of conc, motility and morphology between a
good laboratory following WHO guidelines vs. those that
don’t. Scary!!!!

12. INTERPRETATION ARTEFACTS?
Interpreting a requires a
high degree of clinical
skill and past experience
15mill/ml sample with
2ml volume =
30million/ejaculate
6mill/ml sample with 5ml
volume =
30million/ejaculate

13. SEMEN ANALYSIS: WHAT IS
ABNORMAL?

14.  Although the clinical value of the analysis of human semen has previously been
questioned, it has lately regained its position as the cornerstone of the male
infertility work-up
(Chong et al, 1983, McDonough P, 1997)
SEMEN ANALYSIS: WHAT IS
NORMAL?
 Semen is the most heterogeneous of biological fluids wherein parameters
concerning the motility, concentration and morphology varies between regions,
countries, individuals and between two samples in the same individual
(Cooper et al, 2009)

15. Semen parameters WHO 1980 WHO 1987 WHO 1992 WHO 1999 WHO 2010
Volume (mL) -- ≥ 2 ≥ 2 ≥ 2 1.5
Sperm concentration
(106/mL)
20 - 200 ≥ 20 ≥ 20 ≥ 20 15
Total sperm
concentration (106)
-- ≥ 40 ≥ 40 ≥ 40 39
WHO REFERENCE VALUES: HOW
GOOD IS IT??
Total motility (%
motile)
≥ 60 ≥ 50 ≥ 50 ≥ 50 40
Progressive motility ≥ 2 5% ≥ 25% ≥ 25%
(grade A)
≥ 25%
(grade A)
32% (A+B)
Vitality (% alive) -- ≥ 50 ≥ 75 ≥ 75 58
Morphology (%
normal)
80.5 ≥ 50 ≥ 30 14 4
Leukocyte count
(106/mL)
<4.7 < 1.0 < 1.0 < 1.0 < 1.0

16. WHO REFERENCE VALUES: HOW
GOOD IS IT??
 A significant overlap of parameters of sperm concentration, motility and
morphology has been reported between fertile and infertile male populations
(Gao et al, 2008)
 There is a little consensus as to which of the parameters within a conventional
“Semen analysis remains a numbers game”
 There is a little consensus as to which of the parameters within a conventional
semen analysis is the BEST POOR PREDICTOR of pregnancy
(Jecquir, 2005 & 2006)

17. RED SIGNAL SIGNS IN SA !
Low volume - <0.5 ml Low motility - <32%
High amount of
round cells
Low concentration -
< 5 mill/ml
No sperm in the
ejaculate
Low normal forms - <
3%, pinheads
100% immotile
sperms or occasional
motile sperm seen
Hyperviscous
samples
Completely dead
sperms in comment
section

18.  Despite limitations, remains the
most important test.
 No count below which pregnancy
is not possible- except
SEMEN ANALYSIS: THE CORNERSTONE
TEST IN FERTILITY EVALUATION
500 million guys to
one girl…hmm I
have better chances
at winning a lottery
Azoospermia.
 No count above which pregnancy
is certainly possible.
 Men with Azoospermia, Total
asthenozoospermia or Total
Necrozoospermia are infertile

19. INTO THE FUTURE…..
SCSA
 What are Normal or Reference values?
 Which of the three is important?
 Would semen analysis become binary reporting soon?
 DNA fragmentation test of spermatozoa prior to IUI may be able
to predict IUI success, we have seen good results as far ICSI is
concerned

20. GENTLEMEN AND LADIES.
THANK YOU!!!!