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Semen analysis
A semen analysis is an analysis of seminal fluid that enables an insight into a man's reproductive function and the choice of the appropriate method of infertility treatment.
Milenković Clinic uses the CASA system, a modern technology that enables precise analysis of sperm motility and morphology with the help of artificial intelligence.
Advance appointment is required.
Semen analysis in Gyn. Fertility Clinic Milenković
The semen analysis is done by an embryologist in the laboratory or computerized semen analysis (CASA) is performed.
The CASA system uses an optical microscope with a camera. The images that are taken are then analyzed by a computer system with the help of artificial intelligence algorithms. The advantage of the CASA system is that:
- It can determine sperm motility with high precision
- differentiate between "fast" and "slow”
- as well as to precisely identify irregular sperm shapes
Abstinence for 2-7 days is advised, primarily in order to eliminate some lifestyle habits that can affect the result of the analysis.
- It is necessary to keep the complete ejaculate in one container.
- The container for the sample is obtained at the Clinic.
- The sample can be brought from home or given at the Clinic.
- The analysis of semen starts no later than one hour after ejaculation.
Semen analysis is not performed if the patient has had an infection with an high fever in the previous two weeks.
- The result is obtained on the same day.
- When using the CASA system, the result is ready within a few minutes.
- The patient is informed about the result and advice is given if any additional hormonal, genetic and microbiological analyses, determination of DNA fragmentation or examination by a urologist are needed.
Advice on possible infertility treatment is given after a complete examination of both partners.
If it is necessary to repeat the semen analysis, you should wait at least four weeks.
What does semen analysis show?
The basic examination analyzes:
- appearance, volume, density and pH of the seminal fluid
- concentration, motility and shape of spermatozoa.
In the extended analysis of the semen analysis, the following can be analyzed:
- additional genetic analyses;
- DNA fragmentation of spermatozoa free radicals;
- sperm ion channels;
- acrosome reactions;
When there is a higher number of leukocytes in the seminal fluid, a microbiological analysis of bacteria-spermoculture is performed.
Sperm processing methods
Extended semen analysis includes the analysis of the concentration and mobility of spermatozoa after processing with the "swim up" or " concentration gradient methods", that is, after separating the spermatozoa from the seminal fluid, which may contain substances that affect the quality of the spermatozoa.
The concentration and mobility of spermatozoa after processing have a diagnostic value in the selection of the fertilization method (standard IVF or ICSI) in the procedure in vitro fertilization, as well as whether it will be done insemination or not.
In recent years, instead of "swim up" and "concentration gradient" seed processing, magnetic activation and sorting of spermatozoa (MACS) and microfluidic technology (CAO, ZyMot, Fertile Plus) are used.
Variability of the semen analysis: when and why to repeat the analysis?
There are biological variations and the semen analysis varies from sample to sample. If the semen analysis values deviate, it is necessary to repeat the semen analysis after a few weeks.
The isolated interpretation of the semen analysis has no prognostic value, but in combination with a clinical examination and laboratory analyses, a diagnosis can be made and a treatment plan can be made.
In the examination and treatment of infertility, the couple is always considered as a whole and both partners are examined simultaneously.
Reference values semen analysis WHO 6th edition
In 2021, the World Health Organization (WHO) issued the sixth edition of recommendations for the standardization of semen analysis, taking into account racial and geographic differences.
| Parameter | Reference values |
|---|---|
| Ejaculate volume | ≥ 1,4 mL |
| Sperm concentration per milliliter | ≥ 16 mil/ml |
| The total number of spermatozoa in the ejaculate | ≥ 39 miliona |
| Total sperm motility | ≥ 42% |
| Progressively motile spermatozoa | ≥ 30% |
| Non-progressively motile spermatozoa | ≥ 1% |
| Non-motile spermatozoa | < 58% |
| Normal sperm shape (morphology) | ≥ 4% |
Terminology
| Term | Description |
|---|---|
| Normozoospermia | A normal finding according to the official WHO parameters |
| Asthenozoospermia | Decreased sperm motility |
| Oligozoospermia | Decreased sperm concentration |
| Teratozoospermia | Reduced concentration of spermatozoa with normal shape |
| Azoospermia | Absence of spermatozoa in the ejaculate |
| Cryptozoospermia | Extremely low sperm concentration (after processing) |
| Leucospermia | A large number of leukocytes in the seminal fluid |
| Globozoospermia | A form of teratozoospermia where the spermatozoa are round in shape and do not have the ability to fertilize an egg cell |
Expert advice: frequently asked questions
Answers by: Milan Milenković MD, PhD
How to prepare for a semen analysis?
Abstinence from ejaculation is required 2-7 days before the planned semen analysis, primarily due to different lifestyle habits. Sperm concentration will be increased after prolonged abstinence, but motility will be reduced.
Is it possible to estimate the chance of pregnancy based on the semen analysis?
The chance of pregnancy cannot be predicted on the basis of a semen analysis. Men with deviant semen analysis results can achieve pregnancy, while pregnancy does not occur when semen analysis parameters are within normal values.
When is sperm culture performed?
Sperm culture, that is, microbiological analysis of semen, is performed when there are clinical symptoms of infection and when an increased number of leukocytes is found in the seminal fluid. In everyday practice, a sperm culture is often performed together with a semen analysis, but without clinical symptoms and leukocytes in the seminal fluid, this analysis has no clinical significance. Some bacteria are physiologically found in the body and do not need to be treated. When doing sperm culture, personal hygienic preparation is required before ejaculation.
What is the CASA method and what are its advantages over manual semen analysis?
Computer assisted sperm analysis (CASA) is a method where an autofocal optical microscope with the help of artificial intelligence analyzes the semen. The advantage of the CASA system is that it can determine the motility of spermatozoa with high precision, as well as distinguish between "fast" and "slow”. CASA also eliminates the subjectivity that exists in the manual semen analysis, especially in sperm appearance-morphology analysis.
What does seminal fluid consist of?
Seminal fluid (the terms semen and ejaculate are also used) consists of spermatozoa produced in the testicles, which are retained in the epididymis, and secretions from the prostate, seminal vesicles, and bulbourethral glands.
Which drugs affect the quality of the semen analysis?
Medicines from the group of alpha-blockers, which are used in the treatment of high pressure and enlarged prostate and anti-depressants (sertraline, fluoxetine, amitriptyline) reduce the concentration and volume of semen by affecting the transport of seminal fluid. Anabolic steroids also have a negative effect on semen quality.
Can a sample for semen analysis be brought from home?
The semen can be brought from home, but the analysis must be started no later than one hour after ejaculation. The sample during transport must be at a temperature of 20-37 °C.
Can a urine container be used to collect the sample?
The sample is collected in a bottle that you will receive at the Clinic. It is a special plastic bottle that does not contain toxic substances.
