Question

Case #4 • A semen analysis is received by the lab. For infertility evaluation. • Results of the routine analysis are: Volume 3 ml Viscosity normal рн Count Motility Morphology 7.8 20 million 30% in 3hr 10% abnormal forms

Answer 1

1. Answer

Here given data indicates the following:

Viscosity: normal

pH: 7.8

Count: 20 million

Motility: 30% in 3 hr

Morphology: 10% abnormal forms

Here the most important matter of concern for infertility is the sperm count. The normal minimum range for the sperm count is 20 million/ml (20 million per ml). But here 20 million in 3 ml is just 6.666 million/ml which is very low. At the other end talking about pH the normal pH range should be between 7.2 to 7.8. Here the pH lies at the extreme of the upper range, However pH is acceptable.

The sperm motility should be at least 40% (including non-progressive motility also), or at least 32% progressive motility. Less motility encounters the decrease in the activity of the sperm for the fertilization.

2. Answer

Following are the 2 additional test that could be taken in order to get more effective conclusion for the result of sperm test analysis.

a) Liquefaction:

It should take 15 to 30 minutes before semen liquefies. While semen is initially thick, its ability to liquefy, or turn to a watery consistency, helps sperm to move. If semen does not liquefy in 15 to 30 minutes, fertility could be affected.

b) Appearance:

The appearance should be whitish to gray and opalescent. Semen that has a red-brown tint could indicate the presence of blood, while a yellow tint could indicate jaundice or be a medication side effect.

In addition to the above the following tests can also be done:

• Hormone testing
• Genetic testing
• Urinalysis after ejaculation
• Taking a tissue sample from your testicles
• Anti-sperm immune cells testing

3. Answer

Clumping of spermatozoa indicates: Anti-sperm antibodies cause the agglutination of spermatozoa, which is seen in fresh semen preparation, this indicates further immunological studies to be carried out.

Anti-sperm antibodies (ASA) can be detected with the MAR test (mixed antiglobulin reaction test) or Immunobeads test. Detailed description of the procedures please refer to the current WHO manual (WHO, 2010).

For detail about clumping/Agglutination of Spermatozoa see below:

Agglutination of motile spermatozoa may be head-to-head, head-to-tail or tail-to-tail. Agglutination of spermatozoa suggests the existence of anti-sperm antibodies. The agglutination of mobile spermatozoa to each other has to be separated from non-specific adherence of immobile spermatozoa and from the adherence of motile spermatozoa to epithelial cells or debris. The extent and nature of agglutination should be judged with the following graduation:

• Grade 1 (isolated): <10 spermatozoa per agglutinate, many free mobile sperm
• Grade 2 (moderate): 10–50 spermatozoa per agglutinate, many free mobile sperm
• Grade 3 (strong): agglutinates with >50 spermatozoa, only few free mobile spermatozoa
• Grade 4 (complete): completely agglutinated spermatozoa, no mobile free spermatozoa visible

4. Answer

Apart from the abnormality discussed above following are the few more reasons which can leads to the infertility.

• Infection
• Diabetes
• Hormonal imbalances (Sex hormones)
• Gonadal trauma
• Consistency of the semen
• Gross Appearance of Semen
• Fructose in semen
• Oligozoospermia
• Azoospermia
• Cryptozoospermia
• Pyospermia
• Any obstruction or fertility related problem in female etc.

5. Answer

To give the more valid result the recipient should must have recorded the following specific information about the specimen:

a). Whether the person have submitted the fresh sample not delayed by 60 min

b). Whether the patient have taken any of the followings:

• Any other medication
• any hormonal therapy
• caffeine
• Alcohol
• herbs, such as St. John’s wort
• prescription drug use of medicines known to reduce sperm count, such as cimetidine
• recreational drug use
• tobacco etc

c). Have had sex or masturbation within 72 hours

d). When he had ejaculated or have sex last time if longer then 15 days it would be of medical importance.

e). Have maintained the sperm storage condition (Temperature body temperature) or not?

f). Whether the person is suffering from stress.

g). About the procedure how he had ejaculated?

Thank you