A man’s fertility is usually not a question of his virility, but depends on his sperms’ ability to successfully fertilize an ovum. A comprehensive semen analysis, referred to as spermiogram, constitutes an important step towards assessment of male fertility. Doctors will recommend a spermiogram if a couple experiences difficulties conceiving and also if sterility is to be verified following vasectomy.
A spermiogram is a microscopic analysis of ejaculate (semen) in a laboratory. This examination is fast, simple and non-invasive. Please see your urologist, dermatologist or andrologist for more information.
Costs of a Spermiogram
Expenses for a spermiogram average 100 to 200 €. If you have difficulties conceiving or if your gynecologist has recommended semen analysis, there is a fair chance that your health insurance will meet the costs.
Prior to Analysis
For the sake of validity semen is gathered after three to five days of abstinence. The specimen is collected directly into a sterile container. It is not recommendable to use normal condoms for semen collection, as most condoms contain sperm-harming substances that may cause mortification of spermatozoa. However, if you prefer to gather semen during intercourse special uncoated condoms are available.
The semen specimen has to be analyzed in a laboratory about 30 minutes to one hour after collection. A prolonged waiting period or cooling down of the ejaculate may harm the sperm cells. Therefore analysis should commence straight after liquefaction of semen, which usually occurs after 15 to 30 minutes. Analysis focuses on microscopic assessment of sperm cells regarding their concentration, motility and shape.
Sometimes it makes sense to have two spermiograms performed within four weeks, because sperm concentration as well as motility may vary considerably from day to day
Spermiogram: Values According to WHO
Usually WHO (world health organisation) guidelines are used for spermiogram assessment. These guidelines have recently been revised by the WHO. Please find the new standard values for a normal spermiogram in the table below:
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Standard Values for Spermiogram (WHO)
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Ejaculate volume
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≥ 1,5 ml
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PH-value
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≥ 7,2
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Sperm concentration
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≥ 15 million sperms per ml
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Total sperm count
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≥ 39 million sperms
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Motility
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≥ 32 % progressively moving spermatozoa, ≥ 40 % mobile sperms
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Morphology
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>4 % normal shape
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Percentage of living sperms (Eosin-test)
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≥ 58 %
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Anti sperm antibodies
Mixed antiglobulin reaction (MAR)
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< 50 % sperms with particles attached
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< 1 million per ml
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Volume
This is a measurement of the volume of the ejaculate. Normal is 1,5 milliliters or greater. The volume may be low if a man is anxious when producing a specimen, if all of the specimen is not caught in the collection container, or if there are hormonal abnormalities or ductal blockages. Normally the volume itself does not influence fertility. It is the number of sperm cells in the semen that makes the difference.
pH-Value
Usually the specimen should have an alcaline pH. An acid pH may kill sperm cells.
Concentration (sometimes referred to as the "count")
This is a measurement of how many million sperm there are in each milliliter of fluid. The value is obtained by counting the sperm in a special device called hemocytometer. A defined volume of semen is put into the counting chamber of the hemocytometer and sperm cells are counted with the microscope. Subsequently the total sperm concentration can be projected.
Motility
Until recently, motility has been divided into four categories from a to d by the WHO:
a: fast progressive = sperm with progressive motility. They swim fast in a straight line
b: progressive = slow, sluggish forward progression
c: non progressive = local motility, swimming in circles, no visible progression
d: immotile = these are immotile and fail to move at all
Motility was considered normal if either 25 % of sperms or more showed fast forward progression (category a) or 50 % of all sperms belonged to categories a + b.
The revised guidelines of the WHO now combine the two groups of sperms with forward progression.
Morphology
This describes the shape of the sperm and is a major aspect for assessing fertility.
The sperm cell consists of a head, a midpiece and a tail. The head contains the
nucleus with the DNA, surrounded anteriorly by an
acrosome, which contains enzymes used for penetrating the female egg. The midpiece has a many mitochondria, used for energy production for the journey through the female
cervix,
uterus and
uterine tubes. The tail executes the lashing movements that propel the spermatocyte.
The sperm are examined under a microscope and must meet specific sets of criteria for several sperm characteristics in order to be considered normal.
Viability
Sperm may be alive, but not moving. A specialized staining technique using eosin is applied to determine the percentage of sperm alive. Eosin penetrates the cell membrane of dead cells, staining them effectively. The cell membrane of living cells however is impenetrable for eosin, leaving life cells unstained.
Anti-Sperm Antibodies
Some men may produce antibodies to their own sperm. These antibodies may decrease fertility rates in a number of ways. They may impede the movement of the sperm through a woman's cervical mucus, inhibit the binding of a sperm to the egg, and/or inhibit its penetration into the egg. The presence of these antibodies is detected by a test called mixed antiglobulin reaction (MAR).
White Blood Cells (Leukocytes)
The semen may contain a high number of white blood cells, which may be an indication of either infection or inflammation. White blood cells are considered significant if more than one million are found in each milliliter of the ejaculate.
Liquefaction of Semen
According to WHO, liquefaction should occur within 10 to 30 minutes after ejaculation. If this process takes longer, fertility may be impaired because the sperms may not be able to get to their destination quickly enough.
Specialized Semen Tests
During fertility treatment specialized test may be required in order to select sperms suitable for fertilization. Some clinics offer examination of sperms with special high-definition microscopes (MSOME) or binding assays using hyaluronic acid coated petri dishes (PICSI). Other assays are designed to examine integrity of sperm-DNA (Halo-test, TUNEL test and others) to get an impression of the proportion of genetically sound spermatocytes.
Further Biochemical Assays
More biochemical assays are available if required. They can provide evidence for disorders of the prostate, seminal gland and seminal duct.
Reduced Sperm Quality
A major reason for male fertility problems is reduced sperm quality in terms of diminished sperm count (oligozoospermia), reduced sperm motility (asthenozoospermia) or abnormal morphology (teratozoospermia).
Unfortunately male fertility issues are often caused by a combination of these findings and sometimes a patient may even suffer from all three of the problems simultaneously. This is referred to as OAT syndrome.
Global Development of Male Fertility
Semen quality has been on the decline throughout the past decades, particularly in industrial nations. Experts claim that the average sperm count in the US has decreased by 1,5 % per year. Renowned NIH (National Institute for Health, USA) scientists proclaimed for European countries an even more dramatic decline of 3,1 % per year.
In addition to reduced sperm counts, the integrity of sperm DNA constitutes a vital factor for successful conception. In this respect problems are increasing as well. During a normal semen analysis, however, DNA issues are not detectable. Examination of sperm DNA usually requires specialized lab tests (please see above for more information).
However, high-definition microscopy of single sperm cells, as applied during IMSI (Intracytoplasmic Morphologically Selected Sperminjection), which is available in some state–of-the-art fertility clinics, is a very recommendable alternative which can provide valuable clues and has increased success rates of fertility treatment considerably.
Consequences of Reduced Sperm Quality
It has to be emphasized that the diagnosis “reduced sperm quality” does not mean that the man cannot father a child at all. First of all a second spermiogram should be performed and if the findings are verified it is advisable to consult your doctor.
Some harmful factors such as smoking, excessive alcohol consumption, hyperthermia of testes by inappropriate clothing, some drugs or inflammation may be eliminated quite easily.
In any case, taking Fertilovit®M is an important step towards improving sperm quality by providing sperms with antioxidants, vital substances, energy carriers and anti-inflammatory components.
References:
World Health Organization. Laboratory manual for the examination of human semen and sperm–cervical mucus interaction, 4th ed. Cambridge, Cambridge University Press, 1999
WHO. Laboratory manual for the examination and processing of human semen. Fifth edition,
Publication date: 2010
ISBN: 978 92 4 154778 9
Mikronährstoffe machen die Spermien fit
Jedes Spermium ist ca. 0,06 mm lang und