Complete Semen Analysis Including Morphology
A complete semen analysis (SA) with morphology is a complex test performed to determine the quantity and quality of a patient's sperm. Our laboratory technicians count the sperm on a standard count slide under a microscope. A drop of semen is placed on an additional slide which will be used to look at the morphology, or shape of the sperm. We test the pH of the specimen and comment on the conditions of the raw sample. These conditions include but are not limited to:
Liquefaction - a freshly collected semen sample will have a thick consistency. Within 30 minutes the ejaculate should thin to a watery consistency.
Aggregation - sperm combined together in a clump usually consisting of many immotile and non-progressive sperm.
Color - semen is generally white, yellow or clear. It can also have brown or red tints usually indicating blood in the sample. Any other colors are noted with high caution.
Viscosity - viscosity can be thin, normal, slight, moderate or extreme.
Round cells - the number of round cells visualized per field of view (under a microscope).
A semen analysis looks at the total motility, concentration, volume, pH and morphology of an ejacualte. Sperm motility can be broken down into 5 categories:fast forward, slow forward, weak progression, non-progressive and immotile. The total motility (ToMo) of the patient’s sperm is determined by multiplying the concentration, the volume of the ejaculate and the percent of fast forward and slow forward sperm. After finding the ToMo for the raw sample, the patient’s specimen is washed to remove the sperm from the semen.
During the washing process the sample is spun in a centrifuge for 20 minutes through 1 of 4 different washes: 90% gradient, 45% over 90% gradient, 45% gradient or sperm wash. Gradient acts like a screen, as the percentage of gradient increases, the lower the amount of debris and immotile sperm will pass through it while the sample is being spun.
During the wash the sperm travel through the gradient towards the bottom of the test tube and form a pellet. After the wash all the fluid in the test tube is removed leaving only the pellet containing "good" sperm in the bottom of the tube. Sperm friendly media is added to the pellet and the sperm are resuspended. A drop of the washed specimen is placed on slide and visualized for count and motility.
Morphology looks at the shape and size of the head, midpiece and tail of the sperm. Two morphology slides are prepared. One slide is kept in a catalog for reference if needed; the other is stained and observed under 100x oil immersion. Albany IVF utilizes the Krueger’s Strict Morphology method which requires the technician to measure 100 sperm. The measurement categorizes sperm into the following morphological fields: normal heads, amorphous heads, tapered/elongated heads, acrosomal abnormalities, midpiece abnormalities and tail abnormalities.
After the semen analysis is completed all the parameters are reviewed and the analysis is resulted in the following manner:
Normal - Sperm concentration over 20 million with 4% or greater normal morphological forms.
Asthenozoospermia - < 50% fast forward and slow forward sperm
Teratozoospermia - < 4% normal morphological forms
Oligozoospermia - sperm concentration less than 20 million per ml
Azoospermia - no sperm in ejaculate
Abnormal Semen Analysis Recommendations
Albany IVF recommend repeat semen analysis for all patients who have an abnormal analysis. Many factors can contribute to a semen analysis so variable parameters are not uncommon. If abnormalities continue a consultation with an urologist may be recommended. Dietary supplements are recommended for men with viscosity and motility issues. These supplements include:
Coast Reproductive’s Male Fertility MFS - Formerly known as Fertile One, this is a supplement developed to increase motility, morphology, concentration and decrease sperm DNA fragmentation. Because sperm production occurs within a 90 day time frame, the recommendation for use of this supplement is 4 capsules a day for 3 months.
Vitamin C - Vitamin C helps decrease viscosity in a man’s raw ejaculate. Because it is a vitamin and is ingested orally it works in the body to decrease viscosity whereas our techniques to reduce viscosity are done to the sample after it has been expelled from the body. Our recommendation is 2 grams of Vitamin C a day.
Folic Acid and Zinc - Both of these supplements are used to increase motility.
Semen Culture - Patients who have elevated round cells (more than 8 round cells per field of view), we recommend having a semen culture. This can be done at most hospital laboratories. The patient will need a script from the doctor. Patients should collect at home or at the hospital. They are also allowed to make an appointment with our lab to collect their sample and then transport it to Memorial Hospital. The patient is responsible for getting their sample to the hospital lab within 30 minutes of collection.