Sperm analysis

A 2-7 day period of sexual abstinence is recommended before any semen tests at our clinic. The optimum period of abstinence is 3-5 days. Keep in mind that both too short and too long of a period of sexual abstinence may affect the evaluated parameters adversely, consequently reducing the diagnostic value of the performed test.

The semen sample should be produced into a sterile specimen pot by masturbation. The patient may produce it at the clinic in a specially designed room which reduces the impact of external factors on evaluated parameters. Another possibility is to deliver material produced at home. In this case, it has to be kept in mind that the sample has to be delivered to the laboratory as soon as possible (within 40 minutes), and it has to be protected against cooling/overheating depending on the weather conditions. The optimum temperature for transporting the sample is 20–37 °C. In extreme situations, when the patient has great difficulty in donating sperm by masturbation, the couple can use the so-called perforated condom (to be purchased on their own), but the analysis of the donated semen entails certain limitations.

It is important that the patient has an identity document (an ID/a passport) with them.

At our clinic, the basic semen analysis is performed in accordance with the latest recommendations of the World Health Organisation – WHO 5th edition (“Laboratory manual for the Examination and processing of human semen 2010”). The basic analysis focuses on volume, appearance, pH, time of liquefaction, and stickiness. Sperm concentration, their total number, their motility, vivacity and morphology are assessed, including the percentage of sperm with normal morphology and with defects: head and acrosome, inserts, tail and cytoplasmic drops. Moreover, agglutination, spermatogenetic cells, leucocytes and bacteria are assessed.

Semen referential values according to WHO (dated 2010) are presented below:

• Volume > 1.5 ml

• Concentration ≥ 15 million/ml

• Total sperm count ≥ 39 million

• Sperm motility ≥ 32% sperms with progressive motility or ≥ 40% sperms with progressive or non-progressive motility

• Sperm vivacity : ≥ 58% live spermatozoa

• Sperm morphology ≥4% correct morphology spermatozoa

• Cell concentration of the spermatogenic lineage ≤ 5 million/mL

• Leukocyte concentration < 1 million/mL

Results below the referential values may suggest a fertility limitation. Similarly, good results in the semen analysis are not indisputable proof of fertility. The diagnostic value of the semen analysis is the higher the more the results deviate from the reference values.

For the most reliable analysis, the basic semen analysis shall be carried out twice with an interval of between two weeks and three months. It is also important to maintain a similar sexual abstinence period as before the first tests – it allows for precise comparison of the parameters.

In order to perform a detailed analysis of ejaculate, it is recommended to carry out additional tests to give a more complete picture of the semen quality. Please note that semen quality can be significantly improved by appropriate treatment.

Results of the basic semen analysis are available within 2 hours. They can be checked online without leaving your home or collected at the clinic on the same day.

Extended semen analysis – MSOME (Motile Sperm Organelle Morphology Examination) allows for the in vivo evaluation of the sperm structure at a very high magnification of 6000 to 8000 times. In comparison, during a standard semen examination sperm morphology is assessed as a magnification of 1000 times. The size and number of nuclear vacuoles are identified during the examination. Presence of large vacuoles might indicate disorders in sperm genetic material and hinder conception. The test is of particular importance for men with teratozoospermia, in cases of idiopathic infertility and miscarriages.

Results of the extended semen analysis are available within 4 hours. They can be checked on the Patient Portal or collected at the clinic on the same day.

The sperm chromatin integrity test is a significant test for male infertility diagnosis. We can encounter several names of the same test: DNA integrity, sperm genetic material fragmentation, DFI (DNA fragmentation Index), SCI (Sperm chromatin integrity). This test allows for identification of the percentage of sperm with incorrect/fragmented genetic material. The higher the percentage of integrity-impaired sperm, the lower the chance of natural conception.

The test is recommended in the following cases:

• Idiopathic infertility

• No pregnancy despite standard semen parameters

• Problems with embryo implantation (biochemical miscarriages)

• Reduced percentage of sperm with normal morphology

Note that there are numerous causes of sperm incorrect DNA integrity (including oxidative stress or varicose veins). If its source can be found, we can eliminate it with appropriate treatment and improve the DFI significantly.

Results of the extended semen analysis are available within 4 hours. They can be checked on the Patient Portal or collected at the reception desk.

Semen analysis with additional HBA testing (Hyaluronian Binding Assay) might be a valuable addition to the basic semen analysis. It to determine the ability of sperm cells to bind to hyaluronate. Its result demonstrates the percentage of sperm cells that are capable of fertilizing the egg cell.

Indications for the test include idiopathic infertility. It is also recommended before insemination and in cases of male patients with normal semen parameters preparing for an in vitro fertilisation the test might be helpful in deciding on the method of egg fertilisation (classical IVF or ICSI).

The test cannot be performed in cases of very low sperm concentration and significantly lowered mobility.

Results of the test are available within 4 hours. They can be checked on the Patient Portal or collected at the clinic on the same day.

More and more evidence suggests that the oxidation stress (excess of reactive oxygen species (ROS) plays an independent role in the etiology of male infertility. Moreover, it has been shown that as much as 80% of infertile men demonstrate higher level of reactive oxygen species which is a potentially treatable condition. Oxidant stress can adversely affect male fertility, it obstructs capacitation, may damage the sperm membrane and its DNA (chromatin integrity), and consequently, influence the ability of sperm to fertilize an egg cell and produce a healthy embryo. In addition, it may induce genotoxic and mutagenic by-products in semen, increasing the risk of disease in the offspring.

Small quantities of ROS are necessary for optimal cell functions, such as spermatogenesis. When the ROS levels become too high, the organism uses antioxidants provided with food and arising endogenously to restore homeostasis of the system. An imbalance of those two opposing forces in which ROS prevail over antioxidants might lead to oxidation stress. It can adversely affect male fertility, by obstructing capacitation, damaging the sperm membrane and its DNA (chromatin integrity), and consequently, limiting the sperm's ability to fertilize an egg cell and produce a healthy embryo. In addition, it may induce genotoxic and mutagenic by-products in semen, increasing the risk of disease in the offspring.

The issue of the oxidant stress is of key importance especially in cases of the so-called idiopathic fertility constituting 50% of male infertility cases. Therefore, a complex analysis of male fertility potential should also include this test.

The application of the MiOXYS test to measure the oxidation stress might provide a targeted approach to antioxidant therapy while minimising the risk of an antioxidant overdose. The test should be carried out before the commencement of an antioxidant treatment after eliminating other possible causes of raised levels of ROS. It is recommended to repeat the test after at least 3 months of antioxidant therapy.