Semen Analysis Flashcards
What are the four fractions in the semen that are contributed by the testes
epididymis, seminal vesicles, prostate gland, bulbourethral glands
Function for the secretion of sperm
seminiferous tubules
This contributes to the lower scrotum
temperature that is optimal for sperm development
external location of the scrotum
Function for the production of spermatozoa and are located in the epithelial cells of the seminiferous tubules
Germ cells
Provide support and nutrients for the germ cells as they undergo mitosis and meiosis (spermatogenesis)
Specialized Sertoli cells
Percent of the spermatozoa in the semen
5%
Percent of the seminal vesicle in the semen
60%
Percent of the bulbourethral glands in the semen
5%
Percent of the prostate fluid in the semen
20% to 30%
Semen is composed of
-Spermatozoa
-Seminal fluid
-Prostate fluid
-Bulbourethral gland
When spermatogenesis is complete, the immature sperm (nonmotile) enter the?
epididymis
Where does the sperm mature and develop a flagella?
epididymis
The entire process of sperm maturation takes approximately how many days?
90 days
They receive both the sperm from the
ductus deferens and fluid from the seminal vesicles
Ejaculatory ducts
They produce most of the fluid present in semen (60% to 70%)
seminal vesicles
The transport medium for the sperm and contains a high concentration of fructose and flavin
seminal vesicle fluid
Provides energy needed for
the flagella to propel them through the female reproductive tract
Fructose
Without this, sperm will not display motility in the semen analysis
Fructose
Responsible for the gray appearance of semen.
Flavin
Surrounds the upper urethra and aids in propelling the sperm through the urethra by contractions during ejaculation
muscular prostate gland
The muscular prostate gland is located at?
located just below the bladder
How many percent of the semen volume is acidic fluid?
Approximately 20% to 30%
Acidic fluid is produced by the?
prostate gland
The milky acidic fluid contains
high concentrations of?
acid phosphatase, citric acid, zinc
proteolytic enzymes
The functions of acid phosphatase, citric acid, zinc, and proteolytic enzymes are?
coagulation and
liquefaction of the semen following ejaculation
Contribute about 5% of the fluid volume in the form of a thick, alkaline mucus that helps to neutralize acidity from the prostate secretions and the vagina
bulbourethral glands
In order to neutralize the vaginal acidity present as a result
of normal bacterial vaginal flora the semen must be?
alkaline
Without ______, sperm motility would be diminished.
neutralization
Most of the sperm are contained in
the?
first portion of the ejaculate
When part of the first portion of the ejaculate is missing
-sperm count will decreased
-the pH falsely increased
-specimen will not liquefy
When part of the last portion of ejaculate is missing
-semen volume is decreased
-sperm count is falsely increased
-pH is falsely decreased
-specimen will not clot
Specimens are collected following a period of sexual abstinence of?
at least 2 days and not more than 7 days
Specimens collected following prolonged abstinence tend to have
higher volumes and decreased motility
This organ is important for spermatogenesis
Seminiferous
tubules of testes
Organ responsible for sperm maturation
Epididymis
They propel sperm to ejaculatory ducts
Ductus deferens
They provide nutrients for sperm and fluid
Seminal vesicles
Provide enzymes and proteins for
coagulation and liquefaction
Prostate gland
These glands add alkaline mucus to neutralize
prostatic acid and vaginal acidity
Bulbourethral
glands
Containers used for sperm collection should be
Prewarmed sterile glass or plastic containers
Specimens awaiting analysis should be kept at ______ and delivered to the laboratory within ______ of collection.
37°C & 1 hour, respectively
Ideal method for sperm collection
Masturbation
The only type of condom used for sperm collection
non-lubricant containing rubber or polyurethane
condoms
Why are ordinary condoms not acceptable for specimen collection?
because they contain spermicides
This is not a reliable means of semen collection because the first portion of the ejaculate, which contains the highest number of spermatozoa, may be lost and the low pH of the vaginal fluid may affect sperm motility
Coitus interruptus
Why are standard precautions must be observed at all times during semen analysis?
Because all semen specimens are potential reservoirs for HIV and hepatitis viruses
What type of materials and techniques must be used when semen culture is performed?
Sterile
Parameters reported for semen analysis include
-appearance
-volume
-viscosity
-pH
-sperm concentration and count
-motility
-morphology
Characteristics of a normal semen
gray-white color, appears translucent, and has a characteristic musty odor
The specimen may appear almost clear if?
sperm concentration
is very low,
Increased
white turbidity indicates the presence of?
white blood cells
(WBCs) and infection within the reproductive tract
May be useful to screen for the presence of WBCs in semen.
leukocyte esterase reagent strip test
There presence in the semen is considered abnormal
Red coloration associated with the presence of red blood cells (RBCs)
May be caused by urine contamination, specimen collection following prolonged abstinence, and medications
Yellow coloration
This is considered toxic to sperm, thereby
affecting evaluation of motility
Urine
Reference Values for Semen Analysis: Volume
2 to 5 mL
Reference Values for Semen Analysis: Viscosity
Pours in droplets
Reference Values for Semen Analysis: pH
7.2 to 8.0
Reference Values for Semen Analysis: Sperm concentration
> 20 million/mL
Reference Values for Semen Analysis: Round cells
<1.0 million/mL
Characteristics of a fresh semen specimen
clotted and should liquefy within
30 to 60 minutes after collection
This is very essential for evaluating semen liquefaction
recording the time of collection
Failure of liquefaction to occur within 60 minutes may be caused by?
deficiency in prostatic enzymes and should be reported
Take note: Analysis of the specimen cannot begin until?
liquefaction has
occurred
Methods of specimen collection in semen analysis
- Masturbation
- Condom method
- Vaginal vault aspiration
- Coitus interruptus
Semen specimen must be kept at?
37°c
The specimen must be delivered to the lab within?
1 hour of collection
In fertility testing, how many samples must be tested?
2-3 samples at 2-week intervals
What are the dilution and the diluting fluid used in the microscopic examination of semen
1:20 using sodium bicarbonate in formalin, saline, or distilled water
Formula used when counting in the typical WBC squares
Sperm/mL = sperm counted (average of sides) × 100,000
Formula used when counting in the typical RBC squares
Sperm/mL = sperm counted (average of sides) × 1,000,000
Formula used to solve for total sperm count
Sperm/ejaculate = sperm/mL × specimen volume
Normal value for sperm concentration
> 20 million/mL
Normal value for sperm count
> 40 million/ejaculate
How many abnormal sample/s is/are considered significant?
2 abnormal samples
What is the clinical significance of gray-white or transparent appearance of the semen?
Normal
What is the clinical significance of a red or rust color appearance of the semen?
bleeding
An important part of patient preparation before semen collection
Emptying the bladder
Speed and direction of sperm motility are both evaluated using how many HPFs?
20 HPFs
What is the clinical significant of an abnormal sperm motility?
Midpiece & tail abnormalities
The normal viscocity of semen
Pour in droplets
If semen does not liquefy after more than 2 hours, what does this implies? (clinical significance)
Deficiency in prostatic enzymes
A semen specimen was delivered to the laboratory within 30 minutes of collection. Upon doing gross exam, you noticed that the volume of the specimen is less than 2 ml. What is the possible clinical significance of this?
Improper functioning of one of the semen-producing organs
The clinical significance of a semen specimen with a pH of <7.2
Increased prostatic fluid
The clinical significance of a semen specimen with a pH of >8.0
Infection within the reproductive tract
What is the normal pH value of semen?
7.2 to 8.0
The semen was clumped, stringy, or gel-like. What is its clinical significance?
Deficiency in prostatic enzymes
If the semen has a volume of >5 mL what is its clinical significance?
Prolonged abstinence
If the motility of the sperm is <50% after 2 hours of collection the patient possibly has?
Asthenozoospermia or infertility
The normal sperm motility
> 50% with forward progression
25% with rapid progression
Motility grading: rapid, straight-line motility
4.0
Motility grading: no forward progression
1.0
Motility grading: slow forward progression, noticeable lateral movement
2.0
Motility grading: no movement
0
Motility grading: slower speed, some lateral movement
3.0
The normal sperm morphology
> 14% with normal morphology (strict criteria)
30% with normal morphology (routine criteria)
Characteristics of normal sperm (morphology)
- oval-shaped head 5x3 um
- long, flagellar tail, 45 um
- unremarkable neck and middle piece
- acrosomal cap encompassing 1/2 of the head
Abnormal sperm tail characteristics
short, multiple, hairpin, broken, irregular width, coiled, with terminal droplets
Abnormal sperm head characteristics
large with small, tapering, pyriform, amorphous vacuolated, double
Abnormal cytoplasmic droplets characteristic
greater than 1/3 of the head
Abnormal neck and midpiece characteristics
absent or non-inserted/ bent tail; distended, irregular, bent, thin
Sperm morphology evaluation is done on a thin smear stained with?
Wright, Giemsa or Papanicolaou
Thee best and ideal stain to use for sperm morphology evaluation
Papanicolaou
______ is evaluated under OIO for abnormalities in the head, midpiece, and tail
200 sperm area
If there is a decreased motility with normal count what additional test would be done? And what is the clinical significance of an abnormal result?
Eosin-rigrosin stain: necrospermia
If there is a decreased count what additional test would be done? And what is the clinical significance of an abnormal result?
Fructose level determination: lack of support medium
What is the clinical significance of a yellow color appearance of the semen?
Pyospermia, contamination, prolonged abstinence, medication
What is the clinical significance of a turbid appearance of the semen?
Infection
A condition in which there is a complete absence of spermatozoa in the ejaculate
Azoospermia
Decreased numbers of sperm in the ejaculate (<15 million sperm/mL)
Oligospermia
A condition in which there is a low percentage of live and a very high percentage of immotile spermatozoa in semen.
Necrospermia
An infertility condition in which a person experiences reduced sperm motility
Asthenozoospermia
In this test, ovum penetration is evaluated
Hamster egg penetration
In this test, the ability to produce enzyme essential for ovum penetration is evaluated
In vitro acrosome reaction
In this test, the ability to penetrate the partner’s midcycle cervical mucus is evaluated
Cervical mucus penetration
In this test, membrane integrity and sperm viability is evaluated
Hypo-osmotic swelling test
Normal value for neutral alpha-glucosidase
> 20 mU/ejaculate
Normal value for citric acid
> 52 umol/ejaculate
Normal value for zinc
> 2.4 umol/ejaculate
Normal value for acid phosphatase (ACP)
> 200 units/ejaculate
What is the clinical significance of a decrease in the value of zinc, citric acid, and acid phosphatase?
Lack of prostatic fluid
What is the clinical significance of a decrease in the value of neutral alpha-glucosidase?
Disorder of the epididymis
If there is a decreased motility with clumping what additional tests would be done? And what is the clinical significance of an abnormal result?
MAR, Immunobead test, Agglutination with male serum: Male antisperm antibodies
If there is a normal analysis with continued infertility what additional test would be done? And what is the clinical significance of an abnormal result?
Agglutination with female serum: female antisperm antibodies
A condition in which there is an unusually high number of white blood cells in the semen
Pyospermia
