Fertility

1. Semen Analysis
The initial lab. test of male infertity
Sohag University
Sohag Faculty of Medicine
Obstetrics & Gynaecology Department

2. Instructions for semen collection
1. Period of abstinence: 2-3 days
– If shorter affect volume & concentration
– If longer affect morphology & motility
2. Method co collection:
– Masturbation
– Condom: special type
– Withdrawal during intercourse
3. Time: must be examined within 1 hour
4. Temperature: if collected at home, avoid
extremes

3. Traditional WHO normal reference values
Normal
Parameter
1.5 - 5
Semen volume (ml)
20
Sperm concentration (million/ml)
40
Total sperm number (million/ejaculate)
50
Progressive motility (%)
14
Sperm morphology (Normal Forms : %)
7.2
pH
< 1
Pus cells (million/ml)
< 50
MAR/Immunobead test (%)

4. Repeat after at least 4 weeks
If Abnormal

5. Sperm motility
• Grade A: Sperm with progressive linear motility. These are
the strongest and swim fast in a straight line.
• Grade B: Sperm with progressive non-linear motility :
These also move forward but tend to travel in a curved or
crooked motion.
• Grade C: These have non-progressive motility because they
do not move forward despite the fact that they move their
tails.
• Grade D: These are immotile and dead sperms.
Normal:
Grade A = 25 %
Grade A+B = 50 %

6. Sperm morphology

7. Terminology
• Oligospermia  low sperm concentration < 5
• Polyzoospermia  high sperm concentration, >200
• Asthenozoospermia  motility
• Teratozoospermia  morphology
• Oligo-astheno-teratozoospermia
• Azoospermia  no spermatozoa in semen
• Aspermia – no semen volume
• Pyospermia – leukocytes present in semen, >1M/ml
• Hematospermia – red blood cell present in semen
• Necrozoospermia – “dead” sperm

8. Low (absent) semen volume
1. Collection problem: failure of ejaculation,
incomplete collection, short abstinence
2. Obstruction e.g. Congenital Bilateral Absence
of the Vas Deferens (CBAVD): PH is < 7.2 & no
fructose
3. Hypogonadism:  spermatogenesis
4. Retrograde ejaculation

9. Azospermia
A. Obstructive azosperima
Diagnosis: absence of sperms on at least 2
occasions +normal FSH
Causes:
– Congenital: CBAVD
– Infection
– Iatrogenic: surgery

10. Azospermia
B. Non-Obstructive azosperima
Diagnosis: absence of sperms on at least 2
occasions +high/low FSH
Causes:
– Primary testicular failure: e.g. Klinefelter
syndrome……..high FSH
– Secondary testicular failure: Low FSH