Semen analysis - Revisited

SEMEN ANALYSIS – REVISITED

Dr. Shah Dupesh MBBS, DCE, FASM, (PhD)

The guy who takes care of the MEN in the WOMENS CENTER ;-)

SEMEN ANALYSIS: A BIT OF HISTORY

ANTON VON LEEUWENHOEK

Prathima T, Ranjani, N. Pandiyan. History of semen analysis, chcmj, vol 4, no 1

Father of Microbiology – first discovered the sperm in 1677

SEMEN ANALYSIS – BIG DEAL?

6-7 years ago concerns were raised about the standard of care of men with infertility

Changes in semen analysis among infertile men are usually non specific and frequently give very little information about the cause of infertility. non specific and frequently give very little information about the cause of infertility.

At a UG Level doctors also receive little training pertinent to this specialty. So how effectively are we managing the couple?

The prevalence of male factor infertility is 7% of all men*. This incidence is higher than Diabetes Mellitus

Jecquir and Cummins, 1997. Tournaye, 1997. *Nieschlag and Behre 2000

SEMEN ANALYSIS

Overview

Remains the gold standard test of choice when assessing test of choice when assessing infertility in a couple.

Ultimately decides the course of treatment for a couple

Gives an idea about a mans testicular germ cell output

Influenced by numerous factors.

SEMEN ANALYSIS – LIMITATION?

Several!!

Collection artifact

Analysis artifact

Interpretation artifact

What is Normal? remains controversial

Male fertility cannot be determined based on single report or solely on these results.

Depends on Man-laboratory-Physician unit.

ARTEFACTS IN SEMEN ANALYSIS

Collection Artefacts

Interpretation Artefacts

Analysis Artefacts

COLLECTION ARTEFACTS?

Again Several!!

Difficulty in semen Difficulty in semen collection.

Agony of Split ejaculate.

Incomplete sample.

Improper container.

Inconvenient space.

COMMERCIAL DIAGNOSTIC LABORATORIES DO NOT CARE!

Collection Artifacts? The hard truth

Environment if not conducive for arousal

Can affect a man’s erectile function

Can affect mans ability to give a complete

sample

Treatment strategies drastically change

ANALYSIS ARTEFACTS?

Over 95% of standalone commercial laboratories have still not upgraded to the latest WHO 2010 guideline values

This means men suffering from a genuine problem may be missedmissed

Our data of over 300 samples(unpublished), clearly shows that there is at least a 30% to 40% variance in sperm parameters of conc, motility and morphology between a good laboratory following WHO guidelines vs. those that don’t. Scary!!!!

INTERPRETATION ARTEFACTS?

Interpreting a requires ahigh degree of clinicalskill and past experience

15mill/ml sample with 2ml volume =

30million/ejaculate

6mill/ml sample with 5ml volume =

30million/ejaculate

SEMEN ANALYSIS: WHAT IS ABNORMAL?

Although the clinical value of the analysis of human semen has previously been

questioned, it has lately regained its position as the cornerstone of the male

infertility work-up

(Chong et al, 1983, McDonough P, 1997)

SEMEN ANALYSIS: WHAT IS NORMAL?

Semen is the most heterogeneous of biological fluids wherein parameters

concerning the motility, concentration and morphology varies between regions,

countries, individuals and between two samples in the same individual

(Cooper et al, 2009)

Semen parameters WHO 1980 WHO 1987 WHO 1992 WHO 1999 WHO 2010

Volume (mL) -- ≥ 2 ≥ 2 ≥ 2 1.5

Sperm concentration (106/mL)

20 - 200 ≥ 20 ≥ 20 ≥ 20 15

Total sperm concentration (106)

-- ≥ 40 ≥ 40 ≥ 40 39

WHO REFERENCE VALUES: HOW GOOD IS IT??

Total motility (% motile)

≥ 60 ≥ 50 ≥ 50 ≥ 50 40

Progressive motility ≥ 2 5% ≥ 25% ≥ 25%

(grade A)

≥ 25%

(grade A)

32% (A+B)

Vitality (% alive) -- ≥ 50 ≥ 75 ≥ 75 58

Morphology (% normal)

80.5 ≥ 50 ≥ 30 14 4

Leukocyte count (106/mL)

<4.7 < 1.0 < 1.0 < 1.0 < 1.0

WHO REFERENCE VALUES: HOW GOOD IS IT??

A significant overlap of parameters of sperm concentration, motility andmorphology has been reported between fertile and infertile male populations

(Gao et al, 2008)

There is a little consensus as to which of the parameters within a conventional

“Semen analysis remains a numbers game”

There is a little consensus as to which of the parameters within a conventionalsemen analysis is the BEST POOR PREDICTOR of pregnancy

(Jecquir, 2005 & 2006)

RED SIGNAL SIGNS IN SA !

Low volume - <0.5 ml Low motility - <32% High amount of

round cells

Low concentration -< 5 mill/ml

No sperm in the ejaculate

Low normal forms - < 3%, pinheads

100% immotile sperms or occasional

motile sperm seen

Hyperviscoussamples

Completely dead sperms in comment

section

Despite limitations, remains the

most important test.

No count below which pregnancy

is not possible- except

SEMEN ANALYSIS: THE CORNERSTONE TEST IN FERTILITY EVALUATION

500 million guys to one girl…hmm I

have better chances at winning a lottery

Azoospermia.

No count above which pregnancy

is certainly possible.

Men with Azoospermia, Total

asthenozoospermia or Total

Necrozoospermia are infertile

INTO THE FUTURE…..

SCSA

What are Normal or Reference values?

Which of the three is important?

Would semen analysis become binary reporting soon?

DNA fragmentation test of spermatozoa prior to IUI may be able to predict IUI success, we have seen good results as far ICSI is concerned

GENTLEMEN AND LADIES. THANK YOU!!!!