Normal and Abnormal Semen

Sample of semen

1. This is preferred if the sample is collected in the lab.
2. Masturbation is preferred, and the entire collected semen should be submitted.
3. The accepted volume is 2 to 5 mL.
4. Collect the sample when the doctor or the technician should be available to evaluate the motility immediately.
5. 2 to 3 days of sexual abstinence is preferred.

Precautions for semen

1. Don’t use condoms, particularly with spermicide.
2. The specimen should be maintained at 37 °C during transport if brought from home and should be examined within 3 hours of collection.
3. A sterile container is needed, and the sample should be collected at a room temperature of 37 °C.
4. Plastic containers are not recommended.
5. Avoid extreme temperatures.
6. The analysis should be done immediately when the semen is liquefied.
7. Should be examined within 4 hours,
8. The sample should be kept at 37 °C.
9. Wait till liquefaction is complete for the examination.

Summary of the normal semen:

Volume	2 to 5 ml
Liquefaction	complete in 15 minutes
pH	7.2 to 8.0 average of 7.8
Count	60 to 250 million /ml
Morphology	more than 80% are motile and have normal morphology
Direct smear	No RBC or WBC seen

The following table shows normal and abnormal semen values:

Parameters	Normal values	Abnormal values
Volume	2 to 5 mL	<2 or >5 mL
Color	grey to white (Opalescent)	Brown to red
Sperm density  (count)	>2o million/mL	<10 million/mL
Total sperm count	20 to 250 million/mL	<20 million/mL
Motility	Active motile 60% to 80% >50% forward progression >25% rapid progression (within 60 min)	<50% after 2 hours
Motility score (evaluated 2 to 4 hours after ejaculation) Motility is graded as follows: 0= none 1= poor 2= moderate 3= good 4= excellent	3 to 4	0 to 1
Liquefaction	Immediate (within 10 to 30 min)	>60 min
pH	7.2 to 7.8	<7.2
Viability	>65% do not take stain and are alive	% of dead cells is more (than 65%) and take stains
Morphology	>70% normal   <4% immature form	>30% abnormal form
Immature form	<4 %	>4 %
Defective heads	<35 %	>60 %
Defective tails	<20 %	>25 %
WBC count	0 to 2000/mL	Increased number
The aggregate of >10 sperms	Absent	Seen in prostatitis
Fructose	150 to 600 mg/dL	Decreased level/absent
Acid phosphatase	200 to 300 mg/mL
Citric acid	>3 mg/mL
Zinc	>75 µg/mL
Magnesium	>70 mg/mL
Glucosidase	>20 mU per ejaculate
Prostaglandins	>20 mU per ejaculate
Inositol	>1 mg/mL
Carnitine	>250 µg/mL
Glycerophosphorylcholine	>650 µg/mL

•  The following table is modified from the WHO laboratory manual 1992.

Another source

Parameter	Normal	Pathological
Coagulation	Coagulates	Delayed
Liquefaction	Complete in 10 to 30 minutes	Delayed
pH	7.2 to 7.8
Volume	2 to 6 mL	<1.5 mL
Sperm density x106/mL	>20	<10
Total sperm count x106/mL/per ejaculate	>80	<20
Progressive motility score (after 2 to 4 hours of ejaculate)	3 to 4	0 to 1
Live spermatozoa	≥50%	<35%
One hour after ejaculating	≥70%
After 3 hours of ejaculating	≥60%
After 4 hours of ejaculating	>50%	<35%
Normal spermatozoa	≥60%	<35%
Defective heads	<35%	>60%
Defective mid-piece	≤20%	>25%
Defective tails	≤20%	>25%
Immature forms	<4%
Semen smear	Mostly no RBC and WBC have been seen.

 

Drugs that may decrease the count are:

1. Cancer chemotherapy ( Vincristine, methotrexate, procarbazine, and nitrogen mustard).
2. Estrogen therapy.
3. Cimetidine.
4. Methyltestosterone.

Important note:

• Single semen analysis is not conclusive because the sperm count varies from day to day.
• A semen analysis should be done twice or thrice for the best result.
  • Please see more details in semen analysis part 1.

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