Men's health plays an important role for conceiving a child, which is in no way inferior to women's health. Unfortunately, this fact is often underestimated by the representatives of the stronger sex, so the statistics sounds scary - about 40-45% of all infertile couples cannot conceive a baby precisely because of male infertility. That is why it is most reasonable to start planning a pregnancy with a spermogram.
In this article, we will explain what this analysis is and how to decipher it.
Research essence
A spermogram is a quantitative and qualitative analysis of ejaculate, which is carried out mainly microscopically. In laboratory conditions, the study determines the main characteristics of the semen of a man. They can indicate problems with reproductive health, inflammatory processes of the genitourinary system of the future dad.
Based on the results of the spermogram, a fairly accurate conclusion can be made about the ability of a given man to fertilize.
Bad spermogram is not a sentence, because modern reproductive medicine does not stand still and can offer many auxiliary methods to couples who cannot conceive a child due to inadequate sperm quality, pathological forms of male germ cells.
Analysis types
When conducting a spermogram, the doctor takes into account the essence of the patient's treatment. Sometimes it is quite enough to make a basic spermogram, which will include an assessment of the number and quality of germ cells.
However, there are situations when the baseline study shows good results, and the woman does not conceive in the absence of problems. In this case, the doctor prescribes an extended spermogram, within which the morphology of the sperm is assessed - their appearance, compliance with reference standards.
Sometimes it becomes necessary to conduct a spermogram with DNA fragmentation, research with biochemistry, MAP test. The indication for the latter is immunological infertility - a condition in which the body produces antibodies to sperm. It is they who destroy living and mobile germ cells, preventing them from fertilizing an egg. An extended spermogram is always more informative.
The analysis is usually prepared from 1 to 3 days, depending on the workload of the laboratory of the selected clinic. The conclusion is given to the patient in his hands, it is a completed form with an indication of all the determined indicators and individual values.
Decoding should be done by a doctor, but for especially curious men and their wives, we are ready to tell you how to decipher a spermogram yourself.
And now we are looking at what sperm looks like under a microscope with comments from a urologist.
Full interpretation of the results
The form of conclusion usually contains the following parameters.
Volume
This refers to the amount of sperm that is submitted for analysis. According to the WHO standards, which are still the only standard in the world for conducting a spermogram, an amount less than 1.5-2 ml is considered pathological and greatly complicates the study.
The fact is that the amount of ejaculate is affected by the amount of fluid produced by the prostate gland and seminal vesicles. If it is not enough, then this is a reason for additional research of the state of these organs. Low sperm count lowers chances of conception, sometimes it turns out to be impossible to conduct research precisely because of too little material.
Insufficient sperm count may be associated with frequent sexual activity, therefore it is recommended to refrain from sexual intercourse for several days before the spermogram.
Colour
Usually the semen has a white, milky, grayish, pearly, opal hue. In conclusion, it is most often written that the color of the material is "whitish-grayish". What the color of the ejaculate can tell, doctors themselves, for the most part, do not know, because this indicator, although it is included in the main indicators, has no diagnostic value.
Sperm analysis under a microscope allows you to accurately judge the cellular composition, therefore, the color change to pinkish, if there are blood impurities, or greenish, if there are impurities of pus, there is no need to note separately. It's just that the color is always included in the assessment of the ejaculate, and this column exists in the modern form rather as a tribute to tradition.
Smell
Almost the same story happened with the smell. There is this point in the conclusion, but its diagnostic significance is not entirely clear. Some doctors argue that indirect conclusions about the health of the prostate gland can be drawn from the smell of ejaculate. However, these statements do not have convincing evidence.
The smell, like the color, is indicated in the spermogram results because it has always been so. Usually the smell is described as specific pronounced or specific mild.
Consistency
This part of the report describes the physical property of semen as viscosity. After ejaculation, the semen is thick enough, it gradually liquefies.
The increased viscosity can create problems for the movement of the germ cells.
To determine the viscosity, the laboratory technician lowers a glass rod into the semen sample, lifts it above the laboratory container and looks at the length of the "thread" formed by the trace. The more viscous the sperm, the longer this "thread".
Normally, this parameter should be less than 2 centimeters, that is, the length of the residual "thread" should not exceed this value. If the "thread" has a length of 2 centimeters or more, the sperm is considered thick and viscous. In conclusion, if everything is normal for a man with this parameter, indicate - "slightly viscous" or "moderately viscous".
Liquefaction time
This column indicates the time it takes for the sperm to liquefy. Typically this time interval varies between 15 minutes and 1 hour. If the semen does not liquefy after 60 minutes, it usually stays that way. The laboratory technician has to add special enzymes to it in order to carry out all other tests and samples.
The interpretation of this parameter is pretty straightforward. If the column indicates 20 or 30, this is the time in minutes that passed to liquefy the material. 15 to 60 minutes is the norm.
Acidity
Like any other fluid in the human body, sperm has its own acidity. Usually, in healthy adult men, the level of ejaculate acidity is in the range of 7.5-8.2.
A pH above 7.2 is considered normal. If the sperm has less acidity, the man's ability to conceive is reduced, because it becomes more difficult for sperm to dissolve the egg membrane in order to penetrate it.
Sperm concentration
The concentration of sperm is determined in 1 ml of liquid. To count them, you need special equipment - a sperm analyzer or a counting chamber. Less often, laboratory technicians use the smear method, when 1 drop of sperm is applied to a 22x22 glass slide. Then the microscope is adjusted to a magnification of X400 and how many sperm are in the field of view. The same amount, only in millions, will be inherent in 1 ml of liquid.
Example: there were 25 spermatozoa in the field of view, which means that there are 25 million of them in 1 milliliter. Normally, the concentration favorable for fertilization is from 20 million per milliliter.
Total sperm count
This column indicates how many germ cells are present in the total volume of seminal fluid provided for research. Like concentration, this part of the spermogram is considered one of the most informative in terms of identifying the causes of male infertility. The total number is counted by a counting chamber or sperm analyzer.
Knowing that a concentration of 20 million per milliliter is considered normal, a reference value is displayed. If a man donated 3 milliliters of sperm (see the item "Volume"), then the norm will be 60 million or more "live", if the volume is 2 milliliters, then the norm starts from 40 million cells.
This part of the conclusion also indicates a figure. The higher the number of germ cells in the semen, the higher the chances of conception.
Mobility
In the ejaculate, four types of sperm activity are counted. The most mobile, striving only straight, receive a category A from a laboratory assistant and are considered the main contenders for fertilization.
No less progressive, forward-moving, but slightly slower cousins receive category B.
The sperm of a man is considered suitable for natural fertilization, if it contains at least 25% of "live" type A or the number of cells of types A and B in total is equal to half of all spermatozoa. With this result, there are no problems with fertility in a man.
Sperm that move sluggishly, circle in one place, rush chaotically in different directions, get category C, and immobile cells - category D.
In the conclusion, the names of the categories are not always indicated. Sometimes the doctor denotes in percentage the content of actively motile sperm (these are types A and B), inactive (type C cells) and immobile (type D cells). In this case, the norms are similar.
Actively mobile should be at least 50%. If so, the rest can be ignored.
Kruger morphology
Extended spermogram implies a mandatory assessment of the morphological characteristics of the male sex cells. It is understood that healthy sperm must contain a sufficient number of cells of the correct shape with a normal structure. For this sperm is compared with a standard.
The Kruger assessment criteria are the most stringent, any deviation from the norm, even if it is a single one, according to these criteria, is considered a pathology, and sperm are rejected:
- The sperm head should be flat and oval. Any other form is considered abnormal.
- The sperm neck should be positioned correctly, and the tail should not bend and twist, twist.
- Each part of the sperm is measured, the proportions of the cell body are compared.
What a healthy cell looks like is described in detail in the Kruger method, and it is with these parameters that the sample under study is correlated.
Violations:
- one or more heads;
- one or more tails;
- no head or tail;
- twisted ponytails;
- an uneven middle part and a thin flimsy neck that cannot hold the ponytail;
- pathology of the structure of the head;
- wrong angle of attachment of the flagellum.
Morphology is deciphered very simply. Reference, ideal for fertilization spermatozoa and bad ones that do not meet the selection criteria are calculated in the laboratory. The resulting value of "good" cells is called the Kruger index.
If the conclusion indicates that the Kruger fertility index is 14-15% or more, then this means that the content of reference sperm in the seminal fluid is at the level of 14-15%, which is the lower threshold of the norm.
Cell viability
The sperm count in the ejaculate may be normal, but conception still does not happen. The reason may lie in the viability of the cells. If the reproductive cell moves, it is always alive, but if it is motionless, then it can be both alive and dead. The more live cells in the ejaculate, the higher the chances of a man becoming a dad. It is considered normal if the semen contains more than half of the living germ cells.
To find out which sperm are alive and which are not, a laboratory assistant can tint a drop of sperm with a laboratory dye eosin. A living cell will remain of normal color, since its membrane is intact and reliably protects it from the ingress of dye into the cell. The dead sperm will turn pink, because their death is always accompanied by deformation and perforation of the membrane.
Also, the number of dead sperm is calculated after placing a sample of semen in a hypotonic solution. Healthy living sperm from it swell, their tails bend in an arc, dead ones do not react to the nutrient solution. In conclusion, the number is indicated as a percentage. This number means the content of living cells in the ejaculate.
Spermatogenesis cells
These cells are categorized as round cells (round cells) because they are not sperm and lack tails. These are just future sperm, which have to go through several stages of development before they turn into full-fledged germ cells. They are also found in semen microscopic examination.
Normally, in a healthy adult male, the ejaculate contains about 2-4% of such still maturing young germ cells.
Exceeding the norm can speak of a variety of pathologies, mainly associated with the process of production and maturation of sperm.
Leukocytes
A small number of white blood cells in the laboratory assistant's field of view is normal. There is nothing wrong with the fact that 1 ml of semen contains up to a million white blood cells. This is the norm.
However, if the number of cells exceeds this norm, this indicates an inflammatory process in the male reproductive system. Therefore, the entry in the conclusion of "leukocytes - 1-2 in p / sp" should not cause concern - there are no inflammatory and infectious processes with such a result.
Lecithin grains
They must be present in healthy semen. Lecithin grains or lipoid bodies (they are non-cellular formations) are part of the secretion of the prostate gland, therefore, their decrease indicates problems with the prostate.
Normally, lecithin grains are contained in an amount of about 10 million per milliliter. In conclusion, their number in a numerical or percentage ratio is not indicated, usually the description looks rather generalized - "norm" or "moderate".
Mucus and macrophages
The appearance of mucus, clots in the semen is always a very alarming symptom, which may indicate a strong inflammatory or infectious process in the organs of the reproductive system.
Large cells - macrophages can normally be in single quantities in the field of view. An increase in their number is also a sign of infection.
Amyloid bodies
Amyloid bodies, which resemble starch in their structure, appear in semen when pathological processes occur in the prostate gland.
The appearance of amyloid formations in the ejaculate indicates that a man develops prostatitis, prostate adenoma and other ailments.
The simultaneous detection of macrophages and amyloid bodies may indicate the development of prostate adenoma.
Sperm agglutination
The term "agglutination" refers to the bonding process. In this case, we mean the gluing of spermatozoa together. Such cells cannot take part in fertilization.
The reasons for this pathology can be varied, most often this phenomenon is observed in immunological infertility. Normally, agglutination processes during the spermogram should not be detected, about which the conclusion is made "not found" or "not found".
Antisperm antibodies (MAP test)
Antibodies to sperm can be produced in both the female body and the male. If their number is large, then they begin to destroy the sex cells of a man, completely healthy and suitable for fertilization. Sperm heads or tails are affected. Damaged cells stick together, aggregation occurs, gamete mobility is impaired.
The MAP test is based on the addition of rabbit antibodies to human antibodies to the semen. If the injected drug begins to adhere and envelop the sperm, we are talking about the presence of antibodies and immunological infertility.
Norms in the table (normospermia):
Pathology
What pathological conditions a spermogram can tell about, it becomes clear from the very name of these pathologies:
- Oligospermia - the concentration of sperm in the semen is below normal.
- Asthenospermia - impaired mobility of germ cells. There are few or no sperm that could quickly travel in a straight line to an egg awaiting fertilization.
- Teratozoospermia - sperm morphology is impaired. There is a large number of ugly, mutated germ cells that are not capable of fertilization, and if they succeed, then the risks of genetic abnormalities in the fetus are high. Such a pathology is said when the Kruger fertility index is less than 4%.
- Azoospermia is the absence of sperm in the semen. In this condition, a man's fertility is absent; we are talking about a severe form of infertility.
- Aspermia is the absence of sperm at all. At the same time, a man may have reduced or no organismic sensations at all.
- Leukocytospermia - the presence of a large number of leukocytes in the semen. It is regarded as a sign of infection or inflammation and is not directly related to fertility.
- Necrospermia is the absence of living sperm in the semen completely or the presence of too few living cells.
- Akinospermia is the absence of motile sperm in the semen. They may be alive, but they have significant difficulties with motor function. The condition differs from asthenospermia in severity and severity.
- Cryptospermia is a negligible amount of sperm in the ejaculate. Their number is not subject to microscopic and hardware counting. The material is centrifuged, and if then a small amount of spermatozoa is found in the sediment or they are not found, then we are talking about cryptoospermia.
- Hemospermia is the presence of blood in the semen. Erythrocytes should not normally be present in semen. Blood impurities are a very alarming symptom of serious diseases of the reproductive system.
- Bacteriospermia is the detection of a large number of bacteria in the semen. These can be cocci, such as staphylococcus aureus, staphylococcus aureus, streptococcus, entercoccus faecalis and other opportunistic microorganisms. Such a picture may indicate the presence of a bacterial infection.
Reasons for deviations
There are many reasons why spermogram results can upset a man and his soul mate. Most often, the factors that spoil sperm counts lie in an inflammatory or infectious disease. These include untreated on time and chronic inflammatory ailments of the genitourinary system, venereal diseases, sexually transmitted infections - ureaplasma, mycoplasma, chlamydia, etc.
Sometimes these diseases, popularly nicknamed "winged", proceed without symptoms at all, so a man may not even know about the presence of chlamydia, for example.
Approximately the same number of bad spermogram results are found in men who have inflammatory diseases of the seminal vesicles, the prostate gland, in which epithelial cells that produce sperm are affected.
Varicocele is often the cause of sperm quality problems. Genital herpes is very dangerous in terms of the likelihood of infertility., which causes mutations and changes in the morphological structure of germ cells, as well as mumps (mumps), suffered by a boy in childhood.
Even a simple influenza virus or SARS affects the state of sperm, but their effect is temporary, and within 2-3 months the composition of the sperm returns to normal. However, one must not forget about this when planning to take a spermogram.
Among the "painful" reasons, not the last place is occupied by the consequences of injuries and surgical operations. If a man has suffered a brain or spinal cord injury, if operations were performed on these organs, if there were surgical interventions on the liver, kidneys, then the likelihood that the quality and quantity of sperm will become worse is high. Fights, blows "below the belt" - all this does not pass without leaving a trace for men's health.
Less often, the reasons for the violations identified during the check lie in congenital pathologies - the absence of testicles from birth, the absence of the vas deferens, defects and anomalies in the structure of the organs of the reproductive system. Such reasons are usually irreparable.
Even modern methods of reproductive assisted medicine cannot offer anything to a man whose infertility is a natural fact from birth.
The quality of sperm is significantly worse in men who live in large polluted cities with a deplorable state of the environment.
A man's fertility is strongly influenced by his lifestyle. If a representative of the stronger sex works a lot, especially at night, and rests little, if he abuses alcohol, drugs, smokes a lot, all this leads to a violation of the morphology of sperm and other abnormalities in the spermogram, indicating that the male reproductive function is reduced.
At risk for male infertility are those who like frequent trips to the bathhouse and sauna, those who like to bask in the sun and visit the solarium, as well as men who use heated seats in their cars every day for a long time. The thermal effect on the scrotum and the gonads located in it negatively affects all processes of spermatogenesis.
The reason for problems with sperm quality can lie in long-term stress factors that a man experiences, as well as in hormonal problems in his body, for example, problems with fertilization begin when the balance of thyroid hormones, as well as sex hormones, for example, testosterone ...
Hormonal imbalance can begin with hormonal treatment, as well as with the use of steroid drugs to achieve athletic performance.
Sperm abnormalities and sperm dysfunction can also be caused by genetics, if the boy received from his parents a "defective" gene responsible for reproduction.
Treatment and prognosis for conception
If pathological forms of spermogram are detected, a man will need additional diagnostics. He will have to go to an andrologist, as well as visit other specialists - an endocrinologist, a surgeon, a neurologist and, possibly, a psychotherapist, if no objective medical reasons are established.
He is prescribed additional tests - blood, urine, ultrasound of the prostate gland, manual examination of the prostate.
Treatment begins after the cause is revealed. If reproductive capacity has decreased due to inflammation, infection, prostatitis, anti-inflammatory treatment with antibiotics will be prescribed.
If the cause is varicocele, surgery may be indicated.
Hormonal problems are detected by a blood test for the concentration of various hormones, therapy is prescribed by an endocrinologist.
To all, without exception, representatives of the stronger sex with problematic spermogram it is recommended to reconsider your work schedule, give up work at night, start getting enough sleep. Sometimes a change of scenery is beneficial - moving from city to city, where the air is cleaner and the environment is better.
Alcohol, drugs and smoking are contraindicated. But all, without exception, regardless of the cause of infertility, are prescribed vitamin preparations, which include vitamins A, E, C, D, B vitamins, folic acid, as well as zinc and selenium.
There are ready-made complexes created specifically for men planning to conceive. Vitamin therapy should last at least 3 months, this is how long spermatogenesis lasts.
A man's diet must include protein-rich dishes - meat and fish dishes, dairy products, fresh herbs (as a source of folic acid), nuts.
A man is not recommended to wear tight-fitting underwear, and in the summer, synthetic pants and shorts, in which the scrotum overheats. In winter, genital hypothermia should be avoided.
A man who is planning to conceive a child is advised to change his usual rest on the TV on weekends for active leisure - skiing, light jogging, swimming. Baths and saunas are minimized or temporarily abandoned altogether.
Sexual life should be carried out taking into account the personal recommendations of an urologist-andrologist, who will tell you the best mode based on the spermogram: if the sperm is too thick, more frequent sexual intercourse, if liquid, then sex should be somewhat less frequent.
The prognosis for conception is favorable even with serious violations of the spermogram. Medicine today can offer many ways to solve the problem - these are IVF and ICSI. In 97% of cases of acquired infertility, it can be dealt with. An unfavorable prognosis only in the case of congenital and genetic abnormalities.
How to prepare a man for conceiving a child, see below.
