Introduction To Diagnostic Semen Analysis Flashcards
What does semen analysis involve?
1) . Macroscopic analysis - general analysis of ejaculate appearance, odour, consistency, volume and pH.
2) . Microscopic analysis - analysis of concentration (count), motility (sperm swimming ability), morphology (shape and size), viability, antisperm antibodies.
What instructions should be given to men prior to sample collection?
Simple written instructions should be provided to patients on an appropriate language that should:
Define the abstinence period required before sample production.
Describe cleanliness procedures.
Instruct them to use the container provided.
Give information on transportation to lab if required (temperature and time).
Tell them where and how to park their car.
Give information on appropriate labelling of sample with sufficient information for identification (name and time of production).
Tell them about registration at the lab.
Special cases such as disability, illiteracy and language barriers may need to be taken into account.
What are acceptable methods of semen sample production?
Masturbation,
Silastic condom collection.
What methods of semen collection are not deemed acceptable?
Coitus Interruptus,
Contraception condoms,
Lubricants should not be used.
What locations may it be acceptable to produce a semen sample and what should be taken into consideration?
Most centres have a location on site for men to provide a sample in. This is a dedicated room with washing facilities. It should be private. It may be acceptable for partners to be present. It may have to be suitable for special cases such as wheelchair bound patients.
If the patient produces his sample at home he should be given specific instructions to adhere to for providing the sample, transporting it to the lab, labelling etc. in certain circumstances where a third party delivers the sample for a patient it may be necessary to have a documented chain of custody form completed.
Centres should be sensitive of exposing patients to adult material, particularly adolescents that need to provide samples. There should be a general awareness of the law, particularly the obscene publications act.
What are the requirements of specimen containers?
Specimen containers are generally wide mouthed plastic pots of around 60ml volume. The should be previously tested to ensure they are not cytotoxic. This is done using a long term sperm motility study.
Specialised condoms can be used (e.g. The male factor pack from Microm).
60ml wide neck containers are generally polystyrene or polypropylene sterile containers. Each batch should be tested for toxic effects on sperm.
No other containers should be used.
Describe how semen samples should be treated/transported out production.
When samples arrive at the lab they should be kept at a constant temperature of 37C, preferably within an incubator. As they are transported to the lab extremes of temperature should be avoided.
If produced off site the sample should arrive within one hour maximum. Temperature on arrival should be close to body temperature. As an infection control measure the pot should be placed within a self-sealing bag and any relevant information should be recorded on delivery.
What information should be recorded regarding a semen sample?
Name, address, partners name, date of birth,
Days of abstinence,
Time of production,
Time of delivery and analysis should be recorded so that the interval between production and delivery can be recorded accurately,
Also record medical conditions, recent illnesses, drugs or medications, if the sample is complete, any spillages,
A third party should witness that the details on the pot and recording sheet match.
What are the objectives of the initial evaluation of a semen sample?
1) . Describe the appearance and consistency.
2) . Estimate semen volume and pH.
3) . How to assess liquefaction and viscosity.
4) . Recognise anomalies of macroscopic measures.
How can semen volume and appearance be measured?
Approved methods for measuring volume include volumetric pipettes, cytotoxicity tested syringes and preweighed containers. Syringes with needles / rubber plungers should not be used.
Describe normal semen appearance and consistency.
1) . Produced as a coagulum.
2) . Most samples liquify within 30 mins.
3) . Greyish opalescent liquid.
4) . Odour.
Describe abnormal semen appearance and consistency.
1) . Fails to liquify after 30 mins.
2) . May contain mucus or jelly.
3) . May be discoloured.
4) . May have strong or unpleasant odour.
Liquefaction and sample viscosity are related parameters. If a sample fails to liquify it will be very viscous.
Normal samples that have liquified will form droplets when semen is allowed to drop from a syringe or measuring pipette. Viscous samples will form strands. Both measures should be simply recorded on the report as high, medium or low.
How should semen pH be measured?
Approved methods include pH paper or sticks or a pH meter. Paper or sticks are favoured as they are more hygienic.
As pH changes with time it should be measured at a uniform time within 1 hour of ejaculation. Tends to become more acidic as sugars are respired by the sperm within the ejaculate.
Why might you get low volumes of semen in a sample?
Low volumes are regarded as semen volumes lower than 1ml. Low volume of sample may indicate a clinical condition or simple a procedural anomaly. The most common procedural anomaly is an incomplete sample because either the container has leaked or the patient has missed the pot. Low volumes may also indicate that the wrong collection method has been used (e.g. withdrawal).
It is imperative that procedural anomalies are excluded as a clinical condition (such as retrograde ejaculation) is important to diagnose.
Retrograde ejaculation is indicated by extremely small volumes and often the absence of sperm. It is caused by the bulk of the ejaculate entering the bladder due to some nerve neuropathy at the bladder neck.
What might be the significance of high semen sample volumes?
High volumes (more than 6ml) should be noted but rarely are of diagnostic or clinical significance. High volumes can lead to dilute sperm.
