Alles over Semen

1. Dr. R. Schats
Amsterdam UMC
IVF Centrum VUmc
Everything you always wanted to
know about semen but never
dare to ask

2. Regulation of
spermatogenesis

3. Regulation of
spermatogenesis

4. The hormones

5. Sperm production

6. Sperm production

7. Semen Analysis
 Great variations
 Density per ml
 Motility
 Morphology
 Chemical analysis

8. The way out
 Orgasm
 Ejaculation
 Ritmic contractions
 Antegrade / Retrograde

9. WHO criteria Semen analysis
 Volume: 2 – 5 mL
 pH : 7,5 – 8,5
 Density: > 15 million/mL
 Motility: > 35%
 Morphology: > 4% normal forms
 Chemical analysis:
— acidic fosfatase, fructose

10. WHO criteria Semen analysis
 Volume: 2 – 5 mL
 pH : 7,5 – 8,5
 Density: > 15 million/mL
 Motility: > 35%
 Morphology: > 4% normal forms
 Chemical analysis:
— acidic fosfatase, fructose

11. Volume of a Semen sample
 Contributions of:
— Prostate
— Vesiculae seminales
— Epidydimis

12. WHO criteria Semen analysis
 Volume: 2 – 5 mL
 pH : 7,5 – 8,5
 Density: > 15 million/mL
 Motility: > 35%
 Morphology: > 4% normal forms
 Chemical analysis:
— acidic fosfatase, fructose

13. pH
 Determined by:
— Fluid of the prostate
— Fluid of the vesiculae seminales
— Infection?

14. WHO criteria Semen analysis
 Volume: 2 – 5 mL
 pH : 7,5 – 8,5
 Density: > 15 million/mL
 Motility: > 35%
 Morphology: > 4% normal forms
 Chemical analysis:
— acidic fosfatase, fructose

15. Variations in semen parameters:
density over time

16. WHO criteria Semen analysis
 Volume: 2 – 5 mL
 pH : 7,5 – 8,5
 Density: > 15 million/mL
 Motility: > 35%
 Morphology: > 4% normal forms
 Chemical analysis:
— acidic fosfatase, fructose

17. Motile spermatozoa

18. WHO criteria Semen analysis
 Volume: 2 – 5 mL
 pH : 7,5 – 8,5
 Density: > 15 million/mL
 Motility: > 35%
 Morphology: > 4% normal forms
 Chemical analysis:
— acidic fosfatase, fructose

19. Morphology
 WHO criteria
 Kruger criteria
 Poor predictive value

20. WHO criteria Semen analysis
 Volume: 2 – 5 mL
 pH : 7,5 – 8,5
 Density: > 15 million/mL
 Motility: > 35%
 Morphology: > 4% normal forms
 Chemical analysis:
— acidic fosfatase, fructose

21. Function of spermatozoa
 Fertilisation
 Package of DNA with an engine
 Acrosome reaction

22. IVF
Oocytes and spermatozoa

23. Function tests of spermatozoa
 Penetration of cervical mucus
 Transport through uterus, tubae
 HEPT
 IVF
 ICSI

24. Therapy
 No causal therapy
 Only in Kallmann’s syndrome
 IUI, IVF, ICSI

25. The laboratory:
processing of the semen sample
 Aim: to recover the best spermatozoa
from the semen sample for IUI
 Methode:
1. Centrifugation process
in combination withe
2. Biological filter (Puresperm)

26. Semen processing

27. Semen processing

28. ICSI-procedure

29. ICSI-procedure

30. ICSI-procedure

31. Conclusions
 Nothing so inpredictable as a man
 Almost no treatment options
 Only ART as a realistic option

32. What kind of indications?
PESA
 Obstructive
azoospermia
 History (vaso-vaso,
CBAVD, OK etc.)
 FSH < 10
 Testicular volume:
— > 15 mL
TESE
 Non-obstructive
azoospermia
 History often not clear
duidelijk / cryptorchism
 FSH > 15
 Testicular volume:
— < 15 mL
Testicular biopsy

33. PESA-procedure

34. PESA-procedure