Understanding Semen Analysis
Semen Analysis is basically the evaluation of the male partner of a couple but it is a systematic evaluation of various parameters of the semen sample of the male partner. Ideally, the sample should be produced in the laboratory itself. But if the patient has any issues producing the sample in the lab then it should be done on a nearby premise or if it is done at home, then it should be transported to the lab within one hour of collection. It should be a masturbatory sample. While collecting and while transporting it, maintenance of temperature is very important. So, many times it has been seen that patients carrying the sample with ice packs similar to what they do with drugs, so they take it for granted. Even the semen sample needs to be transported cold and they bring it with ice packs. One very important diagnosis could be retrograde ejaculation where it was found a very low semen volume. Also the low concentration of sperms and looking at the history there could be a history of previous surgery or there could be a history of a neural problem in the patient.
If a patient shows the absence of sperms then only the patient can be labeled as having azoospermia. Now azoospermia can be obstructive or non-obstructive. The very important test in the evaluation of fructose in the seminal plasma. If fructose is absent, then it could be a cause of obstructive azoospermia whereas fructose is present then it is most probably a cause of testicular azoospermia. In cases of genital tract infection and presence of excessive leukocytes or pus cells and oxidative stress, in cases of partial obstruction of the ejaculatory duct, in varicocele where the temperature counter current mechanism is faulty and that is why the sperms are forced to live in a higher temperature which decreases their motility. After vasectomy reanastomosis, there could be autoantibodies at the anastomosis site and which could hamper the motility.
So, strict sperm morphology is the best available predictor of sperm function. Other than the sperms, there are round cells in the semen sample, which could be immature sperms that are also circular in shape spermatid, pus cells, leukocytes, debris, or epithelial or prostate cells. Semen analysis is the easiest non-invasive single best method for assessing male fertility. All parameters should be assessed and decisions should not be taken based on a single parameter. At least two samples at four weeks' intervals should be taken before labeling the patient as having azoospermia and sperm morphology has the highest prognostic value for fertilization potential of sperm.
You can find out more details by enrolling in Understanding Semen Analysis lecture by Dr. Aanchal Agarwal (MBBS, DGO, DNB, FNB, MNAMS), here, https://docmode.org/understanding-semen-analysis-dr-aanchal-agarwal/
