Why doctors request sperm analysis
Dr. Sylvester Ikhisemojie
Sperm analysis is usually described as seminal fluid analysis. It is one of the most commonly requested tests on bodily fluids in all hospitals and is frequently asked for in pursuit of the causes of infertility among married couples. Seminal fluid analysis is also sometimes called a seminogram. This is broadly speaking, the laboratory analysis of a sample of seminal fluid produced by a man. It analyzes the health, viability and characteristics of semen and it consists of the determination of the volume of semen produced by an adult male; the number of sperms contained in the fluid and the acidity or alkalinity of the semen produced. It also involves the examination of the shape, the motility and viability of the sperm. Semen, which is used here interchangeably with seminal fluid, is the thick whitish fluid produced by the male organ during ejaculation. In the laboratory, such a product is referred to as the ejaculate.
Seminal fluid varies in volume at ejaculation; it varies in volume between two and five milliliters but may be up to seven and a half milliliters in some men or as low as one and a half milliliters which is regarded as the lower limit of normal. Normal semen should contain a minimum of 15 million sperm cells in each milliliter of seminal fluid, a downward revision by the World Health Organisation from the old figure of 20 million.
The upper limit is in the region of 225 million per milliliter of seminal fluid. The total number of sperms in each ejaculate may therefore range between 45 and 950 million sperm cells. However, for clinical purposes, the sperm count is often expressed as a certain number of sperms per milliliter of fluid. Seminal fluid is itself made up of between 96 and 98 per cent of water. Therefore, one way of making certain that a man produces more sperm is to drink more fluids. Other ways of ensuring that are as follows; avoid genital tract infections; avoid frequent sex at less than 48 hours apart; do not engage too frequently in masturbation.
With these parameters in mind, a doctor who requests a seminal fluid analysis determines to see the above parameters reflected in the result after the man has avoided sex for at least 48 hours. Many clinicians want an even longer wait with the semen being produced on the fourth or fifth day of abstinence. In addition to the volume and the cell count, the doctor also wants to have an idea of the colour of the semen; its viscosity and whether or not it is compromised by a bacterial infection. A volume less than one and a half milliliters often means that the seminal vesicles, which transport the semen from the testes to the urethra, could be partly or completely blocked. It may also indicate the presence of an infection or certain problems with the prostate. The doctor’s knowledge of the various organisms active in that part of the body would show rather quickly whether there is a genuine infection or a contamination with bacteria. Such contamination can occur when the sample to be studied is not collected in the recommended way thereby allowing surrounding bacteria to get into the semen either within the collecting vessel or before it gets into it. When there is an established infection, such an infection is treated energetically with the required antibiotics based usually on the laboratory’s report.
The next characteristic of interest to the doctor is the physical nature of the various sperm cells also called their morphology. The prevalence of certain variants from what is considered normal is a predictor of the severity of infertility in a male. Therefore, if there are sperms with double heads; twin tails or other such abnormalities, they are not only considered as unable to fertilize an ovum but that they could even cause some damage to a foetus if such fertilisation occurs. Morphology considered acceptable is when at least 60 per cent of all the sperms are determined as normal. This is why increasingly; semen analysis is now one of the most commonly requested tests in men when investigating infertility. This is because abnormalities of the sperm are common while the test is relatively easy to perform. It is not considered to be an invasive kind of test; it is cheaply done and any trained laboratory scientist can do it reliably.
It is because of the reasons elucidated above that doctors often request the analysis of seminal fluid. Frequently, it is performed as a part of the investigation and treatment of infertility. In other cases, it is performed to determine the effectiveness or success of a vasectomy. Since the latter is very rarely performed on Nigerian men, it follows that seminal fluid analysis done in Nigeria are almost universally triggered by the investigation of infertility. Despite all of that, it remains a major task persuading many men to have that investigation done. One has worked before with senior colleagues who had to recourse to writing notes to husbands that insisted they were fine while feeling comfortable to have their wives undergo all kinds of investigations in pursuit of a pregnancy. Yet, there are some who would refuse.
The analysis of freshly ejaculated semen is one of the most useful investigations performed in the quest for unraveling the cause of a couple’s infertility. It should be performed early in the investigation of the couple. It is easy to perform and very convenient even though Nigerian men frequently resist that. It is when nothing wrong has been found with the seminal analysis that attention should turn to the woman. By a fresh ejaculate is meant one which is presented at a competent medical laboratory within one hour of being produced. At presentation in the laboratory, its colour, viscosity and volume are quickly noted as well as the time it takes it to liquefy. Only after all these are done should attention turn to the cellular count. The semen is usually produced either in the comfort of the couple’s home or at a suitable location within the laboratory or hospital. It may be the product of actual sex interrupted at the point of ejaculation to allow the emission into a sterile container; or the performance of some suitable sex act to bring the man to that point or through masturbation. In men who have become paralyzed as a result of a spinal cord injury or disease, and are unable to achieve an erection, it is possible to obtain their semen by aspiration using special needles for that purpose so that the specimen can be analyzed or used for assisted reproduction techniques.
It is important to know that semen is not the same thing as sperm even though the two terms are often used interchangeably. Seminal fluid is made up of sperm and water. The water component is made up of prostatic fluid in which the sperms swim. As we have seen above, the volume can be increased by taking in more fluids. This can also be boosted further by increasing the intake of vegetables and fruits as these will supply increased volumes of vitamin C for the increased motility of the sperms. Raised levels of the male hormone, testosterone, also promote the rise in the volume of seminal fluid. Prolonged fore-play during sexual intercourse is also thought to increase the intensity of an orgasm such that the volume of seminal fluid also rises.
Source: The Punch