Semen analysis – What is measured ?

Experts estimate that malefactors are to blame in up to 40% of couples which experience fertility issues. As a result, many couples find it extremely helpful for the man to undergo a semen test at the earliest sign of difficulty in trying to conceive.

Compared to many of the female fertility tests and exams, semen analysis is non-invasive, relatively inexpensive, and produces results quickly and accurately – making it a valuable tool for couples as they begin their fertility journey.

Using the ExSeed device to test sperm quality, you can get the same results as analyzing in the clinic using a microscope.

Fig 1

Firstly, semen is the fluid a man ejaculates during orgasm while the sperm cells within the semen are the cells that can fertilize the woman’s egg. For most semen tests, the man is asked to masturbate into a container, which is then delivered to a laboratory for testing.  Almost all laboratories performing sperm tests will evaluate the following semen and sperm parameters:

Semen Volume: Semen volume is the total quantity of fluid that is ejaculated. A normal amount is between 2 and 5 milliliters. A volume of less than 1.5ml is called Hypospermia and can, for example, be caused by the presence of hormonal abnormalities or ductal blockages. A large volume of more than 5.5ml is called Hyperspermia.

Sperm Count: Sperm count is determined by looking at the semen sample under a microscope and is a measurement of how many million sperm cells there are in each milliliter of semen. In the literature it also called “Sperm concentration”.

A normal sperm count is 15 million or more sperm cells per milliliter. Being below 15 million sperm cells per milliliter is referred to as oligospermia, and if there are no sperm cells at all, azoospermia, see figure 2.

Sperm Motility (or “Sperm movement”)

Sperm motility is defined as the forward swimming motion of sperm. For a sperm to fertilize the egg, it must travel quickly through the female reproductive system, which requires strong swimming action. The World Health Organization (WHO) grades motility from A to D [1];

A – the sperm cells that swim forward, fast (>25 µm/sec) and in a straight line

B – the sperm cells that swim forward, but in a curved or crooked line, or slowly (<25 µm/sec)

C – the sperm cells that move their tails, but swim in a small circle or don’t move forward

D – the sperm cells that don’t move at all

To have more than 32% of progressively motile sperm cells (Grade A and B) or 40% as a combination of progressive motile (Grade A and B) and non-progressive motile (Grade C) is considered normal. Asthenozoospermia (see figure 2) refers to a condition where a great portion of sperm in a semen sample which are immotile or have reduced motility, compared to the WHO reference values.

Total Motile Sperm Count (TMSC): The total motile sperm count refers to the total number of moving sperm cells in the entire ejaculate.

It is calculated by multiplying the volume (ml) by the concentration (million sperm/ml) by the motility (% moving). Ideally, the TMSC should be above 39 million sperm cells.

Fig 2

In fertility clinics, the above 4 semen parameters are considered to be enough for their initial sperm quality assessment. However, if any abnormalities are discovered or indeed infertility persists, one may go to a clinic for a further, more comprehensive, analysis. Such analysis may include:

Sperm Size and Shape: Also known as sperm morphology. Abnormal sperm cells may be unable to move normally or to penetrate an egg. As a result, too many sperm cells of abnormal size and shape can pose a significant fertility issue.

Most laboratories will evaluate the sperm cells based on the criteria provided by the World Health Organization (WHO) which is called the “Kruger” criteria. According to the Kruger criteria, a normal sperm cell must have an oval shape with a smooth outline. To be considered normal, at least 4% of the sperm cells must have an oval head with a connecting mid-piece and a long straight tail.

Take a look at figure 2 to see how a normal sperm cell should look. If under 4% of a sample is normal, the condition is referred to as Tetrazoospermia. 

Fig 3: showing what is considered a normal shaped sperm cell (left) and what is considered abnormal (all the other cells shown).

Color and viscosity: An evaluation of the color and viscosity (how thick the semen is) of the seminal fluid, and the time until the semen sample liquefies, is often included in a comprehensive semen analysis.

The color should be grey-opalescent. If it appears red-brown, it may be an indication of red blood cells in the ejaculate (Haemospermia). It’s normal for the semen to liquefy in no more than 20 minutes. If it doesn’t liquefy, it may indicate the presence of an infection of the seminal vesicles and/or the prostate.

Semen pH: Semen is typically a slightly alkaline substance, with a normal pH of 7.2-8.0. An abnormally high or low semen pH can cause sperm death and impact the ability of the sperm to swim quickly and or effectively penetrate the egg.

Sperm Vitality: Sperm vitality relates to how many sperm cells are alive and intact. To determine sperm vitality, a dye is used where only the dead sperm are stained because they are not intact anymore. For a semen sample to be considered normal, the percentage of live sperm should be above 58% – below is referred to as Necrozoospermia.

White blood cell infiltration: While it’s normal for semen to contain some white blood cells, many white blood cells in a semen sample may indicate the presence of an infection, which can decrease semen quality. It’s considered normal to be below 1 million white blood cells per milliliter of semen- above that is called as Leukospermia.

Presence of zinc, fructose, and glucosidase in the semen

A range of different nutrients is released from accessory glands in the male reproductive system. Some of these include, zinc, fructose and glucosidase. There should be above a certain limit of these markers for the semen to be considered normal; zinc (≥2.4 µmol/ejaculate), fructose (≥ 13 µmol/ejaculate), and glucosidase (≥20 µU/ejaculate).

What is needed to assess semen quality?

For a sufficient first line test of sperm quality, the following is needed:

  • Semen volume
  • Sperm concentration
  • Sperm motility
  • Total Motile Sperm Count (TMSC)

All of the above information can be obtained by using the ExSeed device. According to the scientific evidence, TMSC is the best indicator of how big the chances are for reaching pregnancy. ExSeed is the only home sperm test device that can provide this on the market.

What, when, where, and how?

There is no perfect semen analysis test. Some men with low sperm counts can achieve pregnancies without assistance, while others with normal sperm count are unable to get pregnant with their partner.

In general, men with better semen parameters do have a better chance of reaching pregnancy faster in the process, and optimizing these parameters as much as possible is therefore beneficial for fertility.

At ExSeed Health we encourage all men to have an assessment of how many sperm cells they have and how many of them swim. This should be done as early as possible to allow time to improve the quality if any inconsistencies are found.

 

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