It is the first step towards evaluation of fertility potential of the male.
The 2010 criterion of WHO is the 5th edition of reference values & is most commonly used reference for evaluating semen parameter about 4500 fertile men (who were able to achieve pregnancy with a normal female partner within 1year of unprotected intercourse) were evaluated for their sperm parameters. 5th centile of average was taken as reference point predicting fertility potential of male reference values given are 5th centile and are used as lover cut off limits of normality.
Vol - >1.5ml
Count (106/ml) - > 15
TC (106) - >39
Motility (%) - > 40
Progressive (%) - >32%
Vitality (%) - >58
Morphology (%) - >4
Leukocytes (106/ml) - < 1.0
Analysis is done in 2 broad categories: -
Macroscopic microscopic
MACROSCOPIC
- Volume - N -1.5-4ML
Hypospermia Hyperspermia (>6ML)
Spillage increased days of abstinence
Obstruction Male accessory gland dysfunction
Retrograde ejaculation
Absence of vas deferens
- P - N 7.2-8.2
Low High
Acute prostatitis Duct Obstruction
Vesiculitis Absence of vas deferens
Chronic infection
3.Appearace - Grey Opalescent
Less opaque Red Yellow
Low Concentration UTI Pus cell
of sperm Trauma Sever Jaundice
4.Liquefaction Time - N 30-60 Min
Absence of liquefaction Absence of coagulation
Prostate Gland dysfunction Ejaculatory duct obstruction
Congenital absence of seminal vesicle
- Viscosity - string Test
N < 4 CM
Equivocal 4-6 cm
Hyper viscous > 6CM –
Zinc Level
Antibody coated spermatozoa interfere with motility & concentration.
Microscopic Parameters:
This is carried out after complete liquefaction of the sample using a small drop of it placed over Mackler chamber & seen under phase contrast microscope (40x magnification)
1.Concentration & count
Normozoospermia > 40 mill /ml
Polyzoospermia > 350 mill/ml
Oligozoospermia < 40 mill /ml
Mild Moderate Severe
10-20 mill /ml 5-10 mill/ml < 5mill/ml
Genetic evaluation
Karyotyping error
Y chromosome microdeletion
2.Agglutination
Sperm versus Sperm versus
Sperm cell round cells
Gr 1 - < 10 spermatozoa (Agglutinate) Round cell –infection
Gr 2- 10-50 spermatozoa (Agglutinate) more immature
Gr 3 - > 50 spermatozoa (Agglutinate) Germ cell – defective spermatogenesis
Gr 4 - all agglutinates & interconnected
3.Motility – lower reference value -40%
Progressive motility -32%
Rapidly progressive - > 2.5 um/s non progressive
Immobile -> 50% check for vitality (vitality > 58% is normal)
Immobile+ viable Immobile + non-viable epididymal
Structural – defect in sperm tail / Kartagener’s syndrome pathology
4.Morphology
< 4% - Teratozoospermia
Teratozoospermia index –defined as no of abnormalities present per abnormal spermatozoa
< 1.8 –good prognosis
< 1.8 bad prognosis (ICSI/ IMSI)
What Is Varicocele and Its Implications on Fertility? When Is Surgery Indicated for Varicocele?
VARICOCELE:
Varicocele is vascular abnormality of testicular venous drainage system. it is as abnormal dilatation of internal spermatic vein & pampiniform plexus that drain blood from testis
Incidence -15% of adult men.
90 % on L Side.
50% bilaterally.
2-5% R Side
Diagnosis – physical examination scrotal USG is not an alternative for physical examination incidental finding of varicose vein on USG has no impact on fertility.
Investigations:
1.Physical examination-bag of worms, use Valsalva maneuver to elicit.
2.Semen analysis-2 or 3 Samples-Reduce total count, impaired sperm motility.
3.Scrotal USG, color flow Doppler.
4.FSH, LH, S. testosterone.
Grades:
Subclinical-No varicocele on examination but present on USG Doppler.
Grade 1: Not visible or palpable at rest elevated on Valsalva.
Grade 2: Palpable intrascrotal venous distension but not visible.
Grade 3: Bulging venous previous seen through skin & palpable
PATHOGENESIS:
Varicocele increases reactive oxidative species & Oxidative stress thus impairing testicular & spermatozoa function.
Treatment:
Treatment to offered to male partner when all these factors are present.
Varicocele is palpable.
Couple has documented infertility.
Female partner or convertible fertility.
Male partner has one more abnormal semen parameters.
Preoperative Predictors of seminal improvement after varicocelectomy.
. Gr 3 Varicocele.
. Lack of testicular atrophy.
. N FSH
. Total Motility >60%.
. Total count > 5mill/ml
SURGERY:
Open repair
Laparoscopic repair.
Percutaneous embolization.
After surgery semen analysis done at approximately 3 months internal.
