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The spermiologist and spermioculture

letto 7396 volte | autore: Claudio Manna, ginecologo specialista in fecondazione assistita (vai al curriculum)

         

Seminal liquid that contains a normal number of spermatozoa sufficient to fertilise an ovum is “good”.

To test the quality of the seminal liquid the biologist uses two principal tests, the most important being a spermiogram.

A spermiogram allows the biologist to study the consistency of the sperm using a sperm count and observing therir mobility, the duration and the morphology.  The results of a spermiogram can show:

  • Azoospermia: the complete absence of spermatozoa in the ejaculate
  • Oligospermia: less that 30million spermatozoa per ml
  • Asthenospermia: insufficient mobility of the spermatozoa
  • Terathospermia: a very high number of abnormal spermatozoa

When these last three causes accumulate, this is referred to as oligo-astheno-terathospermia. The fertilising capacity becomes very poor, even if you cannot exclude accidental pregnancy. Whatever the result of the first examination may be, a spermiogram should show similar results after several tests (2 to 3 after an interval of one month): This is the condition that leads to the diagnosis of a pathology.  The analysis of normal seminal liquid is characterised by the definition of these parameters: volume, viscosity, number of spermatozoa per millimetre, mobility one hour and three hours after ejaculation and a morphological analysis of the spermatozoa.

Spermatozoa are mature reproductive cells, resulting from the maturation stage of the process of spermatogenesis.  Spermatozoa unite themselves with the secretions of the accessory glands to make sperm which is emitted during ejaculation. The spermatozoon fertilises the ovum in the moment of reproduction.  Produced in the seminal canal of the testicle, spermatozoa are directed towards the abdomen through different channels, where they mix with other secretions from the prostate to form sperm  During sexual intercourse, the spermatozoa are deposited into the woman’s vagina, from where they will continue their path till the fallopian tubes.  When they meet the ovule in the moment of fertilisation, only one spermatozoon can penetrate the membrane in that moment, the head enters but the tail remains outside.

A spermiogram is an analysis of the sperm, which is collected via masturbation (more rarely via coitus interruptus) into a sterile container (never a condom which may contain disactivating chemical agents) after three days of sexual abstinence.  A spermiogram is a simple, economic, quick, painless and absolutely fundamental examination.  The characteristics of the sperm should be observed immediately after withdrawal.  A spermiogram is generally repeated a month after the ferst withdrawal to confirm the diagnosis of infertility because the production of sperm can fluctuate in time.  Normal sperm contains between 20 – 200 million spermatozoa per cubic millimetre, of which 80% mobile, and the volume of the ejaculate between 2 and 5ml.

Spermioculture
This exam checks for bacteria in the sperm and is effected when there is a suspicion that an infection of the sperm could be the cause of  male infertility or when the presence of an infection could affect the result of FIV or ICSI.  The exam involves the  withdrawal of sperm via masturbation (like in a spermiogram) which is then put in culture in order to search for bacteria.
If the analysis identifies the presence of germs the doctor immediately prescribes therapy not only for the man, but often for his companion as well, who could be a carrier of an identical germ.

Male fertility depends on:
An adequate production of spermatozoa by the testicles (spermatogenesis), free circulation of the seminal liquid within the male genital tract, and lastly an adequate deposit of spermatozoa in the vagina of the woman.  Normal seminal liquid has the following characteristics;

  • volume: 2-5ml
  • number: 50-180 million spermatozoa/ml
  • mobility: 80% on emission, 60% after 4 hours
  • morphology: 60-80%  with normal form
  • pH: 7.6-8.2
  • fructose: >1g/l

When these parameters are altered the following conditions are present:

  • Oligospermia : reduction of the total number of spermatozoa,
  • Oligoasthenospermia : reducton of the number and the mobility of the spermatozoa
  • Oligoasthenoterathospermia : reduction of the number, mobility and the presence of  abnormally shaped spermatozoa
  • Azoospermia : total absence of spermatozoa
  • Necrozoospermia: the sample does not contain live spermatozoa
  • Haemospermia and piospermia: respectively presence of blood and pus in the ejaculate
  • Hyperspermia and hypospermia: respectively a higher volume than 6ml and lower than 2ml

Abnormalities regarding the deposit of the sperm in the vagina can be traced back to: surgery of the bladder, of the neck of the bladder or of the prostate (retrograde ejaculation), prostatectomy (surgical removal of the prostate), ipospadia, premature ejaculation, impotence, anatomic abnormality of the female genitalia

The factors of male infertility are:

  • Varicocele , damage to the veins of the spermatic funiculi that causes the reduction of spermatozoa production.
  • Hormonal deficit : because of the hypophysis, resulting in alteration of spermatogenesis
  • Infections : of the prostate, the testicles (orchitis) caused by differing pathogens, especially of the sexually transmitted kind.
  • Immunologic : auto immune response
  • Genetic : damage of the chromosomes (micro deletion of the Y), syndromes of genetic origin (Klinefelter syndrome) cystic fibrosis.
  • Obstructive: from acquired or congenital pathologies

The list shows the normal values of the parameters of a spermiogram

  • Normal volume : higher than or equal to 2.0ml
  • pH : between 7.2 and 8.0
  • concentration of spermatozoa, number : between 50 – 180mil/ml
  • concentration of spermatozoa : higher than 20 x 106/ml
  • mobility (1 hour after ejaculation) : higher than or equal to 50% progressive mobility
  • morphology : higher than or equal to 50% normal form
  • vitality : higher than or equal to 55% live spermatozoa

Another exam that facilitates the analysis of sperm is the Hunher test, or post coital test. This analysis facilitates the study of the behaviour of the spermatozoa in female mucus after sexual intercourse during the female ovulatory period, over and above the analysis of the sperm, it allows for the verification of the consistency of the female mucus during ovulation.  In this case, however, the problem could be because of the mucus and not of the spermatozoa.  Other tests are available for the analysis of the sperm which specifically measure the survival rate of the spermatozoa by measuring the dosages of certain components of the sperm and through bacteriologic research.  In case of abnormality, complementary exams are:

  • karyotype
  • hormonal dosages
  • immunologic research
  • testicular biopsy

Disclaimer: the information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician.

venerdì 21 marzo 2008


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