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SEMEN ANALYSIS

SEMEN ANALYSIS

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                      

  1. Volume                                                    -  N -1.5-4ML  
  2.   

                                                 

 

Hypospermia                                                        Hyperspermia (>6ML)

Spillage                                                                   increased days of abstinence

Obstruction                                                           Male accessory gland dysfunction

Retrograde ejaculation

Absence of vas deferens

 

  1. 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

  1. 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.

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