semen analysis

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Semen Analysis

Definition

Semen analysis evaluates a man's sperm and semen. It is done to discover cause for infertility and to confirm success of vasectomy.

Purpose

Semen analysis is an initial step in investigating why a couple has been unable to conceive a child. Abnormalities of sperm and semen can cause male infertility. Semen is the thick yellow-white male ejaculate containing sperm. Sperm are the male sex cells that fertilize the female egg (ovum). They contain the genetic information that the male will pass on to a child.Vasectomy is an operation done to sterilize a man by stopping the release of sperm into semen. Success of vasectomy is confirmed by the absence of sperm in semen.

Description

The semen analysis test is usually done manually, though computerized test systems are available. Many laboratories base their procedures on standards published by the World Health Organization (WHO).The volume of semen in the entire ejaculate is measured. The appearance, color, thickness, and pH is noted. A pH test looks at the range from a very acid solution to a very alkaline solution. Semen, like many other body fluids, has a standard pH range that would be considered optimal for fertilization of the egg to take place. The thick semen is then allowed to liquify; this usually takes 20-60 minutes.Drops of semen are placed on a microscope slide and examined under the microscope. Motility, or movement, of 100 sperm are observed and graded in categories, such as rapid progressive or immotile.The structure of sperm (sperm morphology) is assessed by carefully examining sperm for abnormalities in the size and shape in the head, tail, and neck regions. WHO standards define normal as a specimen with less than 30% abnormal forms. An alternative classification system (Kruger's) measures the dimensions of sperm parts. Normal specimens are allowed 14% or less abnormalities.Sperm are counted by placing semen in a special counting chamber. The sperm within the chamber are counted under a microscope. White blood cells are recorded; these may indicate a reproductive tract infection. Laboratories may test for other biochemicals such as fructose, zinc, and citric acid. These are believed to contribute to sperm health and fertility.Results of semen analysis for infertility must be confirmed by a second analysis seven days to three months after the first. Sperm counts may vary from day to day.Semen analysis to confirm success of vasectomy is concerned only with discovering if sperm are still present. Semen is collected six weeks after surgery. If sperm are seen, another specimen is collected 2 to 4 weeks later. The test is repeated until two consecutive specimens are free of sperm.

Preparation

A man should collect an entire ejaculate, by masturbation, into a container provided by his physician. To examine the best quality sperm, the specimen must be collected after two to three days of sexual abstinence, but not more than five to seven days. The specimen must not come into contact with any spermicidal agents used by a female partner for birth control purposes. The man should not have alcohol before the test.A semen specimen to investigate infertility must be brought to the testing laboratory within one hour of obtaining it. Timing is not as critical for the postvasectomy test but the semen must be kept at body temperature. The most satisfactory sample is one obtained in the lab rather than at home.

Normal results

WHO standards have established these normal values:

volume less than or equal to 2.0 mL
sperm count greater than or equal to 20 million per mL
motility (movement of the sperm) value is greater than or equal to 50% with forward progression, or greater than or equal to 25% with rapid progression within 60 minutes of ejaculation
morphology greater than or equal to 30% with normal forms
white blood cell count less than 1 million per mL.

If infertility continues, despite normal semen analysis and female studies, further tests are done to evaluate sperm function.

Abnormal results

Abnormalities of semen volume and liquidity, and sperm number and morphology decrease fertility. These abnormalities may be inherited or caused by a hormone imbalance, medications, or a recent infection. Further tests may be done to determine the cause of abnormalities.

Resources

Periodicals

Kamada, M., et al. "Semen Analysis and Antisperm Antibody." Archives of Andrology March-April 1998): 117-128.

Key terms

Infertility — The inability of a man and woman to conceive a child after 12 months of unprotected sexual intercourse.Morphology — The size and shape of sperm.Motility — The movement of sperm within the semen.

semen analysis

Lab medicine A procedure for evaluating possible ♂ causes of infertility; sperm are ↓ in some forms of infertility or post-vasectomy Ref range Count 20–200 x 109; volume 1.5-6.0 mL; morphology > 70% mature and without defects; > 60% motility; pH 7.5–8.5; liquefaction > 70%. See Post-vasectomy semen analysis, Sperm, Vasectomy.

se·men a·nal·y·sis

(sē'mĕn ă-nal'i-sis) A fluid analysis of semen done as the first step in a male infertility workup; includes measurement of semen volume, liquefaction time, sperm count, sperm morphology and motility, pH, white blood cell levels, and fructose levels.

Semen Analysis

Synonym/acronym: N/A.

Common use

To assess for male infertility related to disorders such as obstruction, testicular failure, and atrophy.

Specimen

Semen from ejaculate specimen collected in a clean, dry, glass container known to be free of detergent. The specimen container should be kept at body temperature (37°C) during transportation.

Normal findings

(Method: Macroscopic and microscopic examination)

Test	Normal Result
Volume	2–5 mL
Color	White or opaque
Appearance	Viscous (pours in droplets, not clumps or strings)
Clotting and liquefaction	Complete in 15–20 min, rarely over 60 min
pH	7.2–8
Sperm count	Greater than 15 million/mL
Total sperm count	Greater than 39 million/ejaculate
Motility	At least 40% at 60 min
Vitality (membrane intact)	At least 58%
Morphology	Greater than 25–30% normal oval-headed forms

The number of normal sperm is calculated by multiplying the total sperm count by the percentage of normal forms.

Description

Semen analysis is a valid measure of overall male fertility. Semen contains a combination of elements produced by various parts of the male reproductive system. Spermatozoa are produced in the testes and account for only a small volume of seminal fluid. Fructose and other nutrients are provided by fluid produced in the seminal vesicles. The prostate gland provides acid phosphatase and other enzymes required for coagulation and liquefaction of semen. Sperm motility depends on the presence of a sufficient level of ionized calcium. If the specimen has an abnormal appearance (e.g., bloody, oddly colored, turbid), the patient may have an infection. Specimens can be tested with a leukocyte esterase strip to detect the presence of white blood cells.

This procedure is contraindicated for

N/A

Indications

Assist in the diagnosis of azoospermia and oligospermia
Evaluate infertility
Evaluate effectiveness of vasectomy
Evaluate the effectiveness of vasectomy reversal
Support or disprove sterility in paternity suit

Potential diagnosis

There is marked intraindividual variation in sperm count. Indications of suboptimal fertility should be investigated by serial analysis of two to three samples collected over several months. If abnormal results are obtained, additional testing may be requested.

Abnormality	Test Ordered	Normal Result
Decreased count	Fructose	Present (greater than 150 mg/dL)
Decreased motility with clumping	Male antisperm antibodies	Absent
Normal semen analysis with infertility	Female antisperm antibodies	Absent

Increased in

N/A

Decreased in

(unusual and abnormal elevation in body temperature may result in insufficient sperm production)

(related to insufficient production of sperm)

(insufficient sperm production usually related to viral infection, rarely bacterial infection)

(related to obstruction of the vas deferens)

(congenital, as in Klinefelter’s syndrome, or acquired via infection)

(abnormal enlargement of the blood vessels in the scrotal area eventually damages testicular tissue and affects sperm production)

Critical findings

N/A

Interfering factors

Drugs and substances that may decrease sperm count include arsenic, azathioprine, cannabis, cimetidine, cocaine, cyclophosphamide, estrogens, fluoxymesterone, ketoconazole, lead, methotrexate, methyltestosterone, nitrofurantoin, nitrogen mustard, procarbazine, sulfa-salazine, and vincristine.
Testicular radiation may decrease sperm counts.
Cigarette smoking is associated with decreased production of semen.
Caffeine consumption is associated with increased sperm density and number of abnormal forms.
Delays in transporting the specimen and failure to keep the specimen warm during transportation are the most common reasons for specimen rejection.

Nursing Implications and Procedure

Pretest

Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
Patient Teaching: Inform the patient this test can assess for infertility.
Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
Obtain a history of the patient’s immune and reproductive systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
Note any recent procedures that can interfere with test results.
Review the procedure with the patient. Instruct the patient to refrain from any sexual activity for 3 days before specimen collection. Instruct the patient to bring the specimen to the laboratory within 30 to 60 min of collection and to keep the specimen warm (close to body temperature) during transportation. The requesting health-care provider (HCP) usually provides the patient with instructions for specimen collection. Address concerns about pain and explain that there should be no discomfort during the procedure.
Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

Potential complications: N/A
Instruct the patient to cooperate fully and to follow directions.
Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection.
Ejaculated Specimen
Ideally, the specimen is obtained by masturbation in a private location close to the laboratory. In cases in which the patient expresses psychological or religious concerns about masturbation, the specimen can be obtained during coitus interruptus, through the use of a condom, or through postcoital collection of samples from the cervical canal and vagina of the patient’s sexual partner. The patient should be warned about the possible loss of the sperm-rich portion of the sample if coitus interruptus is the collection approach. If a condom is used, the patient must be instructed to carefully wash and dry the condom completely before use to prevent contamination of the specimen with spermicides.
Cervical Vaginal Specimen
Assist the patient’s partner to the lithotomy position on the examination table. A speculum is inserted, and the specimen is obtained by direct smear or aspiration of saline lavage.
Specimens Collected From Skin or Clothing
Dried semen may be collected by sponging the skin with a gauze soaked in saline or by soaking the material in a saline solution.
General
Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
Recognize anxiety related to test results. Provide a supportive, nonjudgmental environment when assisting a patient through the process of fertility testing. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Encourage the patient or family to seek counseling and other support services if concerned with infertility.
Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

Related tests include antisperm antibodies, cancer antigens, Chlamydia group antibodies, estradiol, FSH, hysterosalpingography, laparoscopy gynecologic, LH, testosterone, and US scrotal.
Refer to the Immune and Reproductive systems tables at the end of the book for related tests by body system.