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A spermogram for those who need to know

A spermogram, or an ejaculate analysis, is one of the most important investigations enabling to assess male fertility. However, the accuracy of such assessment depends on many factors, including the correctness of the procedure. Unfortunately, despite the fairly precise requirements for the investigation procedure  (see WHO manual for the examination and processing of human semen dated 2010), all laboratories carry out semen analysis differently, thus impeding the assessment and interpretation even by seasoned experts, to say nothing of patients. We hope that this material containing a decryption of specific medical terms and definitions will help those who need to understand the results of their investigation. Still, it should be underlined that the assessment of male fertility goes way beyond a spermogram alone. A prognosis based on a spermogram is rather a probability of some result – either a good or a bad one. In other words, the bad results of a spermogram do not necessarily indicate infertility, whereas normal values do not exclude the possibility of existing problems. Therefore, the final conclusion must be made by reproductive medicine experts – andrologists and fertility specialists. 

Ejaculate volume: the normal ejaculate volume comprises 1,5 ml or more. A low volume can indicate that a patient did not provide the whole portion of semen or that a part of it was lost. Other reasons include disorders of the so-called accessory glands in the male genital tract; problems with ejaculation or hormonal levels in the male organism. 

Liquefaction: immediately after ejaculation, a sperm sample has a consistency of gel but then passes into a liquid state, which takes 15-20 minutes. If ejaculate does not turn into liquid within 60 minutes, there may be a problem with the accessory glands in the male genital duct.

pH: semen acidity, or semen pH, normally amounts to at least 7.2 – 8.0. A deviation from the norm can indicate a dysfunction of the accessory glands - the seminal vesicles or the prostate gland.

Vitality is defined as the proportion of live sperm cells in semen, normally comprising 58% or more. This parameter gains significance if the motility of sperm cells is gravely impaired, and doctors need to find live sperm cells among the motionless ones. 

Sperm count and concentration are one of the most important spermogram parameters. Both the relative value (concentration or count in 1 ml of semen) and the absolute value (calculated by way of multiplying semen concentration by semen volume) of sperm count and concentration are determined. The lower limit of normal for semen concentration amounts to 15 mln/ml or more. If semen concentration is so low that it cannot be counted, the conclusion given by a doctor will run as follows: “single sperm cells in the field of view”. 

Motility: to reach the egg cell, sperm cells must be motile. According to the motility grade, they are classified into progressive motile (the most valuable category participating in fertilization itself); non-progressive motile (moving in place) and immotile. The proportion of the first ones should total 32% or more. 

Morphology is defined as the proportion of correctly shaped or normal sperm cells. The semen of a fertile man, i.e. the one who has good fertility, always has many abnormal sperm cells – with incorrectly shaped head, neck, tail et cetera. At the same time, the proportion of normal sperm cells evaluated in accordance with the so-called Kruger's strict criteria should be at least 4%. 

Round cell count: the term “round cells” is a collective notion comprising all cells that are not classified as sperm cells; leukocytes and immature cells, sperm precursor cells. It is leukocyte count that is of importance. The normal leukocyte level should not exceed 1.0 mln/ml. 

The MAR-test: semen can contain factors produced by a male organism and working against its own sperm cells – the so-called anti-sperm antibodies. These antibodies are identified with the help of a mixed antiglobulin reaction (the MAR-test). If the amount of sperm cells with attached antibodies exceeds 50%, the conclusion will be that the sperm contains antisperm antibodies. 

In order to describe changes occuring in semen, the following terms are used:
The norm: if the values of semen correspond to the established normal values, the semen is called normal and is termed as normozoospermia. It is important to mention that despite the fact that a consensus has been reached as regards the definition of normal values, there is still much room for discussion on the matter. 
Oligozoospermia: the concentration of sperm cells is lower than the normal value. 
Astenozoospermia: sperm cell motility is below the norm. 
Teratozoospermia: sperm cell morphology is below the norm. 
Cryptozoospermia: the identification of single sperm cells in the sediment of centrifuged semen.
Azoospermia: the absence of sperm cells in ejaculate.
Aspermia: the absence of ejaculate altogether. 
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