Semen – Part 2 – Normal and Abnormal Pattern of Semen
- This is preferred if the sample is collected by the patient in the lab.
- Masturbation is preferred and the entire collected semen should be submitted.
- The accepted volume is 2 to 5 mL.
- Collect the sample when the doctor or the technician should be available to evaluate the motility immediately.
- 2 to 3 days of sexual abstinence is preferred.
- Don’t use condoms particularly with spermicide.
- The specimen should be maintained at 37 °C during transport if brought from home and should be examined within 3 hours of collection.
- The sterile container is needed and the sample should be collected at room temperature of 37 °C.
- Plastic containers are not recommended.
- Avoid extreme temperatures.
- The analysis should be done immediately when the semen is liquefied.
- Should be examined within 4 hours,
- The sample should be kept at 37 °C.
- Wait till liquefaction is complete for the examination.
- Normal spermatogenesis is under the control of the hypothalamus and Pituitary hormones.
- There is a formation of the spermatocytes in the seminiferous tubules.
- The chromosomes by meiotic division are 23 in one sperm.
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|
Active motile 60 to 80%
>50% forward progression
|<50% after 2 hours|
Motility score (evaluated 2 to 4 hours after ejaculation) Motility is graded as:
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|
|Glucosidase||>20 mU per ejaculate|
|Prostaglandins||>20 mU per ejaculate|
- The following table is modified from the WHO laboratory manual 1992.
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 normal morphology|
|Direct smear||No RBC or WBC seen|
|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|
|One hour after ejaculate||≥70%|
|After 3 hours of ejaculate||≥60%|
|After 4 hours of ejaculate||>50%||<35%|
|Semen smear||Mostly no RBC and WBC have seen|
Drugs that may decrease the count are:
- Cancer chemotherapy ( Vincristine, methotrexate, procarbazine, and nitrogen mustard).
- Estrogen therapy.
- Single semen analysis is not conclusive because the sperm count varies from day today.
- A semen analysis should be done twice or thrice for the best result.
- Please see more details in semen analysis part 1.