Spermiogram

Factor of Man (Sperm Anomalies)

Among the pairs applying to a doctor with a complaint of not having baby, 25% has sperm anomalies depending only on man and 30-35% has anomalies relating to both the woman and the man. Semen analysis (Spermiogram) is one of the leading examinations in these pairs. As well as number and motility of sperms, structure of sperm cells (morphology) is also very important. As different results may be obtained in sperm analysis applied to the same man in various timeframes (these values may sometimes be under normal limits), results of 2-3 spermiograms to be applied with intervals of several weeks may be needed to obtain reliable results.

Figure 1: Evaluation of sperms using Makler Chamber (sperm counter).

Normal values determined by World Health Organization (WHO) for spermiogram are:

In spermiogram analysis performed at least twice:

Volume: 2 – 4 ml

Ph : > 7.2

Number of sperms (concentration): > 15 millions /ml

Motility: ≥ 40%

Progressive Motility: > 30%

Morphology (normal structure) Kruger: ≥ 4%

Life: > 75%

Leukocyte: < 1,000,000/ml

Figure 2: Sperms dyed with diff-quick method for spermiogram evaluation.

Advanced Tests and Consultations in Male Infertility:

A consultation is requested from an urologist in order to research reasons for male infertility. If a man has problems such as varicosele, undescended testis, these problems should be researched and resolved.

Some blood tests are performed to research reason for male infertility.

Follicular stimulant hormone ( FSH )

Luteinizing hormone ( LH )

Testosterone ( T )

Prolactin (PRL)

The following tests are also applied to the men for whom genetic factors are considered in advanced examination stages:

Cariotype

Y Chromosome microdeletion determination

DNA fragmentation (TUNEL) tests

Treatment for Infertility Based on Factor of Man:

In infertility cases based on factor of man, drug therapy is only applicable for cases with hormonal anomalies. For anomalies other than this limited group, there is no defined drug today. Therefore, the drugs used for various sperm anomalies (especially morphology) don’t have any effect and also lead to loss of time and money.

In mild sperm anomalies, fertilization can be applied to the woman with ovulation induction.

Fertilization should be tried maximum 4-5 times. In order for success of fertilization, there should be minimum 2-3 millions motile spermatozoa in sperm analysis. If the values are under this limit, the patient is subjected to IVF implementation (IVF/ICSI/IMSI).

If a patient is diagnosed with “Azospermia”; that is, there are no spermatozoa in the semen, spermatozoa are obtained from epididym or testis with biopsy or aspiration. Azospermia may occur because of sperm production in testis or non-mixture of sperm cells with the semen due to obstruction. While approximately 80% of the patients subjected to TESE or TESA due to obstruction have sperms, this rate decreases to 40% in case of any problem about sperm production in the testis.
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