| Semen characteristic | Lower reference limit |
| Volume, | 1.5 ml |
| Sperm concentration | 15 lakh /ml |
| Total sperm number | 39 lakh |
| Total motility (PR + NP) | 40 % |
| Progressive motility (PR) | 32% |
| Vitality (live spermatozoa) | 58% |
| Sperm morphology (normal forms) | 4% |
| pH | >/= 7.3 |
| Seminal fructose | >/=13 micromol/ejaculate |
Normal semen parameters
April 3, 2019
Normal semen parameters
In 1980, the World Health Organization (WHO) recruited a team of physicians and scientists to publish a manual describing in detail what the normal semen parameters of a fertile man should be and how to analyse semen in the laboratory. Since then, they have updated the manual four times, with the latest being in 2010 .
Table 1: Normal semen parameters lower reference limits as defined by WHO 2010
PR, progressive motility; NP, non-progressive motility.
What is a semen analysis?
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A semen sample is collected by masturbation after an abstinence period of 2–7 days, preferably near the laboratory to limit the time between collection and analysis. The physical characteristics of the semen sample, such as the volume, pH, colour, liquefaction and viscosity is
measured, and the sample is then evaluated under a microscope to determine the motility, vitality, concentration, and morphology . The values obtained are compared to the reference values determined by the WHO manual (Table 1).
Limitations of semen analyses:
The female factor
Female age must be considered when talking about a couple’s fertility. Males with poor quality sperm could conceive when their relative sub fertility is compensated by a young female with a high probability of conception .That same man may experience problems with conception if his partner is a 45-year-old woman. It is important to remember that infertility itself is a couple’s issue and it must be treated as such. The reverse is also true in that a man with a nor- mal sperm count may not be able to conceive a child due to factors such as sperm aneuploidy and high sperm DNA fragmentation.
The use of the 5th centile in the WHO manual means that, out of the 1953 fertile men, 5% of them had semen parameters below the lower reference limit for normal.
Intra-individual variability i.e same person with different results of semen analysis at different time
Sperm concentration shows the greatest intra-individual variation followed by other parameters such as: sperm count, morphology, motility, and semen volume. On the other hand, the parameters that showed the the least variation within an individual is sperm vitality and total motility.
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Specimens collected in the afternoon showed higher numbers and concentration of spermatozoa compared to those collected in the morning. This was also true for the progressive linear motility of spermatozoa.
Semen analysis parameters may vary according to seasons. Semen quality in the midsummer was found to be significantly lower when compared to other periods of the year. In other studies, there was a gradual decrease in the fast forward motility and sperm concentration from spring towards autumn (fall) with recovery during winter. Furthermore, the percentage of sperm with normal
morphology was found to be higher in the winter and spring compared to the summer.
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Absolute predictors of fertility on semen analysis
When there is azoospermia, severe asthenospermia (0%motility), or globozoospermia
are the only cases in which semen analyses can predict infertility with absolute certainty.
Minimum number of sample needed:
At least two semen analyses are recommended to properly evaluate male fertility because of
these fluctuations.For patients with azoospermia (no sperm ) at least three sample are needed to confirm the diagnosis.
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GLOSSARY
Azoospermia:No spermatozoa seen under microscopy
Asthenospermia:Poor movement of spermatozoa
Oligospermia:Low sperm counts
Aspermia:No semen/ejaculate
Globospermia:Round headed spermatozoa
Teratospermia:Abnormal shape of spermatozoa ge globospermia
Pyospermia:Pus cells in semen
Hematospermia:Blood in semen
CABVD-Congenital bilateral absence of vas deference:Vas deference are not palpable on both side. It happens in Cystic fibrosis
Kallmann syndrome: a condition characterized by delayed or absent puberty and an impaired sense of smell.Males born with Kallmann syndrome often have an unusually small penis (micropenis) and undescended testes (cryptorchidism). At puberty, most affected individuals do not develop secondary sex characteristics, such as the growth of facial hair and deepening of the voice in males, the start of monthly periods (menstruation) and breast development in females, and a growth spurt in both sexes. Without treatment, most affected men and women are unable to have biological children (infertile).
Young’s syndrome:Also known as azoospermia sinopulmonary infections, sinusitis-infertility syndrome and Barry-Perkins-Young syndrome, is a rare condition that encompasses a combination of syndromes such as bronchiectasis,rhinosinusitis and reduced fertility. In individuals with this syndrome, the functioning of the lungs is usually normal but the mucus is abnormally viscous.Epedidymal obstruction is found in this genetic disorder
Cystic fibrosis:
Cystic fibrosis is a hereditary disease that affects the lungs and digestive system. The body produces thick and sticky mucus that can clog the lungs and obstruct the pancreas. Most men with CF (97-98 percent) are infertile because of a blockage or absence of the sperm canal, known as congenital bilateral absence of the vas deferens (CBAVD).
Immotile cilia syndrome (ICS):Also known as Kartagener syndrome is characterized by abnormal ciliary motion and impaired mucociliary clearance. Ultrastructural and functional defects of cilia result in the lack of effective ciliary motility, causing abnormal mucociliary clearance. This leads to recurrent or persistent respiratory infections(bronchiectasis), sinusitis,otitis media (chronic sinusitis), and male infertility. In 50% of the patients, ICS is associated with situs inversus.
Primary infertility:Unable to have pregnancy in one year of unprotected sexual intercouse
Secondary infertility:Unable to have pregnancy after successful prior pregnancy
OAT-Oligoasthenoteratospermia:low count,poor movement and abnormal shapes of spermatozoa
References:
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