Semen analysis

Causes

  • Impaired sperm production
    • Obesity, smoking, alcohol
    • Infection – chlamydia, gonorrhoea
    • Previous mumps or TB
    • Undescended testes
    • Chemotherapy
    • Klinefelter syndrome
    • Idiopathic
  • Obstruction (usually leads to no sperm in sample – azoospermia)
    • Epididymal
    • Seminal outflow

 

Clinical management

  • Ejaculate volume
    • <0.5 – indicates seminal outflow obstruction
  • Sperm concentration
    • 5-20 – possible to conceive naturally but may take longer
    • <5 – it will be difficult to conceive naturally
  • Motility
    • 20-40 – possible to conceive naturally but may take longer
    • < 20 indicates it will be difficult to conceive naturally
  • Total motile sperm count
    • volume x concentration x (total motility/100)
      • 5-39 million – referral may be appropriate
      • <5 million – refer
  • Morphology
    • Poor repeatability and difficult to interpret
  • Follow-up
    • Repeat sample
      • if abnormal results – sampling error, natural variations in men
    • Who to refer to
      • Male fertility clinic / Urology

 

Source: Practical tips on interpreting semen analysis – Dr Channa Jayasena