Interpretation And Quality In Semen Analysis Flashcards
What should a good report include?
Dr I.D. Patient I.D. Date, Semen parameters, Reference range, Specimen acceptance criteria, Checked against written report before issue.
Does an abnormal result always indicate clinical implications?
Results may have clinical implications or may be due to procedural errors. Therefore reliable results and good laboratory practice are vital to outcomes.
What might a low volume sample indicate?
A low volume sample may indicate clinical issues such as retrograde obstruction, abnormal accessory gland function and illness. However, may also simply be a result of procedural errors such as short abstinence period or a leaky container. This is why it is important to take account of specimen acceptance criteria.
What might a high semen sample volume indicate (more than 5ml)?
A high volume may indicate infection, abnormal accessory gland function and may be associated with reduced sperm counts. May also however be due to a long abstinence period, repeated collections, urine contamination, infection (note colour and odour). Errors on lab reports may also lead to a sample being recorded as a high volume accidentally. High volume samples rarely have any clinical implications.
What might a low pH of a semen sample indicate?
Clinically a low pH of less than 7.2 may indicate some form of obstruction of the sperm concentration is also low. However, it may also indicate inappropriate calibration or out of date pH test paper or sticks.
What might abnormal semen liquefaction indicate?
Clinically, abnormal liquefaction might indicate enzyme deficiencies in prostatic enzymes. May however simple indicate that the sample has been processed too quickly or at a low temperature.
What might abnormal semen viscosity indicate?
Abnormal viscosity may indicate the presence of mucus, or alternatively may result procedurally from inconsistent definition between samples.
What might be the reasons for severe oligozoospermia (low sperm count) in a sample?
May be clinically a result of obstruction, chemotherapy, endocrine issues, low serotoli cell number.
May result procedurally from wrong sample, incomplete sample collection, short abstinence period, poor methods, poor dilution mixing or maths or a transcription error on the report.
Describe the endocrinological signals that result in sperm production.
1) . Sperm production starts with GnRH message from the hypothalamus.
2) . GnRH signals the pituitary in the brain to release LH and FSH.
3) . LH acts on the leydig cells that lie in the ad luminal compartment of the testis and produce testosterone.
4) . FSH acts directly on the serotoli cells which then produce androgen binding protein (ABP). FSH also acts directly on the germinal epithelium.
5) . Together FSH and testosterone act on the germinal epithelium of the seminiferous tubules to begin sperm production.
All this activity is regulated by feedback mechanisms at the level of the pituitary and hypothalamus.
If the testis become insensitive or damaged occasionally these hormones will be sent out in greater and greater amounts. A man with no sperm may have a raised FSH level because the pituitary produces more FSH to compensate for the loss of those feedback mechanisms.
Briefly describe spermatogenesis and where it takes place.
Serotoli cells in seminiferous tubules are bound together with tight junctions to form the blood-testis barrier. The spermatogonia line the inside of the basement membrane of the seminiferous tubule. The leydig cells that produce testosterone lie outside of the seminiferous tubule basement membrane.
The spermatogonia are the stem cells that differentiate into spermatocytes»_space;> round spermatids»_space;> elongate spermatids»_space;> spermatozoa. The spermatozoa are then sent to the epididymis where they are stored and mature.
The entire process of spermatogenesis takes 10 weeks and this is known as a spermatogenic cycle. A clinician may ask for two semen samples to be tested 10 weeks apart in order to cover two waves of spermatogenesis.
Take a look at the process of spermatogenesis online.
Private study.
What might be the implications of asthenozoospermia (very poor motility)?
Severe asthenozoospermia may clinically be a result of immobile cilia syndrome, stump tail defect, mitochondrial defect, Y chromosome deletion or antisperm antibodies. However, it may due to the wrong sample, inappropriate sample collection, inappropriate transport to the lab, contamination, no heated stage used, the wrong production to analysis interval or prolonged abstinence causing stasis.
Motility is the most prone sperm factor to procedural errors.
What might clinically low morphology indicate?
Clinically low morphology (
What is the significance of particularly high morphology in a semen sample of >20%?
There may be no clinical significance. It may however cause the clinician to question the current laboratory definitions being used. From a procedural standpoint high morphology may be due to the failure of a lab to use new definitions of normal (WHO 1999), inaccurate calibration of eyepiece graticule, staining methods or pressure from doctors to ensure some samples are not scored too strictly so we don’t have such a high incidence of male infertility.
What factors should be considered when carrying out sperm analysis?
Diagnosis should not be made on a single variable. Concentration, motility, morphology, volume and presence of antibodies should all be considered when predicting fertility. This is an important point to get across to clinicians.
