Diagnostic Methods in Male Infertility

1- Semen Analysis (Spermiogram)

It is the first of the tests to be performed in male infertility. Since many factors such as smoking, alcohol, heat, medications and infections affect sperm production, abnormal samples should be repeated at least twice, one month apart. If a fertility problem is detected in the sperm analysis, further physical and hormonal examination of the man is carried out. The sperm production cycle repeats every 2-3 months. That is, a sperm produced will be secreted into the semen 2-3 months later. Likewise, harmful factors encountered by the person (severe febrile illnesses, stress, fatigue, environmental factors) or beneficial medications used for treatment can also affect sperm characteristics 3 months later. This process should be kept in mind when evaluating semen analysis results. If no medication has been used and no febrile illness has been experienced, at least two sperm samples should be evaluated 3-4 weeks apart and a decision should be made based on the average of these samples. Preferably, the sample to be examined should be provided at a location close to the laboratory.

When is semen analysis performed?

This test should be performed after a 3-5 day period of sexual abstinence, i.e., a period without intercourse. Samples collected in less than 2 days show low sperm concentration, while samples given after 7 days of sexual abstinence are not preferred because sperm motility decreases. Semen samples to be examined should not be exposed to ambient temperatures below 20 °C or above 40 °C. Cold and heat shock cause serious changes in sperm motility.

How is the sample collection performed?

Sample collection should be done by masturbation; condoms, soap and cream should not be used, and sterile containers should be preferred. Since the first portion of the semen sample contains more sperm cells, if the first portion spills outside or is lost during sperm collection, this must be reported to the laboratory staff.

Spermiogram; It provides information about the volume of the semen, color, pH, liquefaction time (liquefaction duration), viscosity, sperm count, motility rate and morphology (shape).

Volume (Quantity): Semen should be >1,5 ml.

Color: Normally semen is opaque and grayish in color. In cases of prolonged sexual abstinence it may appear yellow; if erythrocytes (red blood cells) are present in the semen, it may appear red-brown; after prolonged antibiotic use it may appear colorless.

pH: Normal semen pH is between 7,2-8. Situations where the pH is above 8 indicate an acute infection or that the measurement was performed late. In azoospermia cases where the pH is below 6,5, obstruction of the ejaculatory ducts, underdevelopment of the accessory glands, chronic infections and possible mixing of urine with the semen should be considered.

Liquefaction (Semen Liquefaction): A problem such as prolongation of the liquefaction (melting) time indicates that semen viscosity has increased, which is an undesirable situation; it may be caused by changes in prostate gland function or by infection.

Viscosity: Normally semen is slightly viscous, i.e., thick. In chronic infections such as prostatitis and vesiculitis, viscosity may be increased.

According to World Health Organization (WHO) criteria, the normal values in spermiogram are;

Volume: >1,5 ml

Sperm concentration: 15 million/ml and above

Finding the above values in a sperm analysis does not definitively indicate that pregnancy will occur. For example, pregnancy may occur in the partners of men with a sperm concentration of 10 million/ml, while the partners of men with a sperm concentration of 80 million/ml may not become pregnant.

Sperm motility: %32 and above (Grade A+B)

Classification is made according to movement types:

Grade A (+4) = rapid forward movement (this is the normal movement pattern)

Grade B (+3) = slow, non-linear movement

Grade C (+2) = movement in place

Grade D (+1) = immotile

Sperm movement is related to the midpiece and tail being anatomically and functionally intact. Infections, tail-related abnormalities, varicocele, alcohol, antisperm antibodies and immotile cilia syndrome may cause sperm motility disorders.

Sperm structure (morphology): %4 and above should be of normal structure (according to Kruger criteria). There are several different criteria in sperm evaluation. 'Kruger criteria' is a microscopic evaluation method that particularly takes into account shape abnormalities in sperm. After special staining, the shape (morphology) characteristics of sperm are examined to determine the fertilizing capacity of the sperm sample.

The sperm cell, which is 0.05 mm in length, consists of three parts: head, neck and tail. The head contains genetic material, the neck provides the energy required for sperm movement, while the tail enables sperm movement.

Azoospermia: Absence of any sperm in the semen

Oligospermia: Low sperm count

Asthenospermia: Decrease in the motility rate

Teratospermia: Shape (structure, morphology) abnormality