Seminal Fluid Analysis 105.2
Sperm morphology
(structure) Another measure of semen quality. Complement other information and to better estimate the chances of fertility. -Only 14% of sperm in the entire ejaculate appear normal. - Assessment includes the dimensions and shape characteristics of the sperm head, midpiece, and tail.
Ejaculate volume
1.5mL to 5.5 mL
Liquation time for semen
5 to 30 minutes after ejaculation
Characteristics and Variables
5 to 30 minutes of liquification time after ejaculation Semen viscosity should not show evidence of stranding Ejaculate volume: 1.5ml to 5.5ml Sperm concentration should be greater than 20 million sperm/mL Sperm motility - single most important measure of semen quality Sperm morphology
Sperm motility normal value
50-60% motility.
Semen Analysis
A routine test for evaluation of infertility At least two semen analysis are required, at intervals of 2 to 4 weeks, because of normal variations in semen
Azosperm
Absence of sperm
Semen collection
Collected after 48 to 72 hrs. of sexual abstinence Collect by masturbation in a wide mouthed, clean specimen container Maintain semen specimen at body temperature during transportation. Analyze specimen within 1 hr. of procurement.
Pt. hx/family hx.
Cryptorchidism Midline defects (Kartagener syndrome) Hypospadias Exposure to diethylstilbestrol Other rare syndromes (prune belly, etc.)
Rationale
Diagnosis of male infertility Infertility - Failure to conceive after 1 year of unprotected sexual intercourse Post vasectomy check - to verify fertility
Pt. hx/sexual hx.
Erections Time and Frequency Lubricants
Pt.hx/social hx
Ethanol Smoking/tobacco Cocaine Anabolic Steroids
Pt.hx/occupational hx.
Exposure to ionizing radiation Chronic heat exposure (sauna) Aniline dyes Pesticides Heavy metals (lead)
PT. hx/physical exam: Medical hx.
Fevers systemic illness (e.g., diabetes, cancers infection) genetic diseases (cystic fibrosis, Kleinfelter syndrome) Cryptorchidism Pubertal onset
Sperm concentration
Greater than 20 million sperm/mL
Pt.hx/medication hx.
Nitrofurantoin Cimetidine Sulfasalazine Spironolactone Alpha Blockers
Pt. hx/physical exam: Surgical hx.
Orchidopexy Herniorraphy Trauma Torsion Pelvic, bladder, retroperitoneal surgery Transurethral resection for prostatism
Of the surgical histories we discussed, which ones could have a negative effect on fertility?
Orchidopexy, Herniorrhaphy, Trauma, Torsion, Pelvic, bladder, retroperitoneal surgery, Transurethral resection for prostatism
Diagnosing infertility
Patient history Physical examination Semen analysis Hormone assessment
Factors that may alter seminal fluid analysis results
Period of abstinence Examining semen specimen greater that 1 hour after ejaculation Drug or steroids use
What are 3 factors that may alter seminal fluid analysis results?
Period of sexual abstinence, examining semen greater than 1 hour after ejaculation, and drug use within the time of study
Which test verifies sterility?
Post-vasectomy check
Sperm motility
Single most important measure of semen quality
What is the single most important measure of semen quality?
Sperm motility
Semen collection process for post vasectomy
To verify absence or presence of sperm Routinely testes starting 2 months post vasectomy and repeated every month until 2 consecutive monthly specimens are free of sperm.
Sperm motility quality score
at least 2 to 4 (on a scale of 0)
What is a routine test for evaluation of infertility
seminal analysis
