A spermiogram (synonyms: sperm cell examination; ejaculate analysis) is a quantitative and qualitative analysis of spermatozoa (sperm cells). The spermiogram represents an important examination method in the context of infertility or fertility diagnostics.
The procedure
Ejaculate (semen) should be obtained after 2-7 days of sexual abstinence. Since spermatozoa motility (sperm motility) decreases after six days, a longer period of abstinence should be avoided. If two spermiograms are to be compared, ensure that the waiting time is the same. The following are important instructions that must be followed before ejaculate collection! Ejaculate collection
- Empty bladder
- Wash hands and penis thoroughly; avoid disinfectant substances (e.g., alcohol) and remove soap residue thoroughly
- Ejaculate in a sterile container “catch” or keep.
- Bring fresh to the laboratory
The ejaculate should be brought immediately to the laboratory for examination to avoid falsification of the test result. Important for the storage of the ejaculate during transport is that it is not stored in a commercial condom, as this usually contains spermatocidal agents, that is, substances that kill sperm. The ideal transport temperature for external delivery is 20-37 °C. The ejaculate should be liquefied after delivery and examined promptly (< 1 hour). Examination is usually computer-assisted microscopically using an image analysis program. Among the parameters assessed are: Motility (mobility), the concentration (number of spermatozoa per milliliter) and the morphology (shape; normally formed) of the spermatozoa. Furthermore, all admixtures of the ejaculate are described and assessed by the examiner (e.g., presence of erythrocytes (red blood cells), leukocytes (white blood cells), and bacteria, etc..Any bacteria are differentiated by bacteriological examination, that is, the germ type and its density [CFU/ml] are determined.
Normal values
The normal values of semen in microscopic examination (according to WHO guidelines 2010); (in round brackets, the 5th percentile and 95% confidence interval) [previously valid levies from 1993 in square brackets].
| Parameter | Reference range | Notes |
| Ejaculate volume | ≥ 1, 5 ml (1.4-1.7) [2 ml] | |
| Spermatozoa concentration | >15 million/ml (12-16) [20 million/ml] | |
| Total spermatozoa count | ≥ 39 million/ ejaculate (33-46) | |
| Motility | ≥ 32% (31-34) progressive motility. | A and B motility of the 1999 WHO classification. |
| ≥ 40% (38-42) total motility. | Sum of progressive and nonprogressive spermatozoa (according to WHO, 1999: A, B, and C motility). | |
| Morphology | ≥4% normally shaped | |
| Vitality | ≥ 58 % (55-63) [75 %] | Staining with eosin; avital spermatozoa are stained red. |
| pH | 7,2-8,0 |
|
| Peroxidase-positive cells (leukocytes). | <1 million/ml |
|
| Round cells | <1 million/ml |
|
In addition, other examinations of the ejaculate are performed, if necessary.Normal values
- MAR test (Mixed-Antiglobulin Reaction test): positive if > 10% IgG or IgA antibody-bound spermatozoa are detected; if > 50%, immunologically induced infertility is likely.
- Alpha-glucosidase (enzyme): ≥ 20 mU
- Carnitine* : ≥ 24 μg/ml
- Citrate: ≥ 52 µmol citrate contained
- Acid phosphatase: ≥ 200 U
- Fructose* * : ≥ 13 µmol (1.2-5.2 mg/ml)
- Zinc: ≥ 2.4 µmol
* Carnitine is a marker of epididymal function.In azoospermia due to bilateral obstruction of the ductus deferens (vas deferens), very low levels are found. Carnitine is also decreased in chronic epididymitis (inflammation of the epididymis). * * Elevated fructose levels are found in: Inflammation of the vesicular gland (glandula vesiculosa, vesicle seminalis).Decreased levels are found in: Occlusion of the ductus ejaculatorius (“squirt channel”) as well as in congenital (congenital) anlage disorder of the ductus ejaculatorius or the vas afferens or the vesicular gland.
Standard values or categories of sperm pathology (according to WHO guidelines 2012; previously valid levies from 1993 in round brackets).
| Spermatozoa count(million/milliliter) | Morphology(% normal) | Motility(%) | |
| Normozoospermia | > 15 (20) | > 4 (60) | > 32 (60) |
| Oligozoospermia* | < 15 (20) | < 4 (60) | < 32 (60) |
| Asthenozoospermia* | > 15 (20) | > 4 (60) | < 32 (60) |
| Teratozoospermia* | > 15 (20) | < 4 (60) | < 32 (60) |
| Oligo astheno-teratozoospermia syndrome(OAT syndrome). | * All three parameters are decreased | ||
| Necrozoospermia | Different | 4 (60) | All avital |
| Cryptozoospermia | <1 million spermatozoa/ml | ||
| Azoospermia | Spermatozoa are not detectable natively or in centrifugate. | ||
| Aspermia | No ejaculate | ||
| Hypospermia/parvisemia | Ejaculate volume <1.5 ml | ||
Microbiology of ejaculate
Conditions for antibiotic therapy:
- Positive ejaculate culture: >103 germs/ml (relevant germ species).
- Leukospermia: >106 leukocytes/ml.
A bacteriological ejaculate examination consists of: Determination of the germ type and germ count [CFU/ml] including a resistogram! Further notes
- In oligozoospermia, abstinence is not an advantage (compared with normozoospermia): with abstinence time, some quality parameters deteriorated significantly:
- Motile sperm:
- After up to two days 38%.
- After ≥ 8 days 27 %
- Proportion of progressively motile spermatozoa
- Decreases from 26% to 17% after up to two days
- After ≥ 8 days 17 %
- Vitality:
- After up to two days 39%
- After 5-7 days 33 %
- Motile sperm:
- Semen quality correlates with men’s health status in the long term: sperm concentrations < 15 million/ml showed a clear association with later hospitalization, that is, the likelihood of needing hospitalization for the first time (50% higher than men with > 40 million/ml).
