The spermiogram is the examination of the seminal fluid. Man must have 3-5 days of abstinence and must not take antibiotics, steroids or anti-inflammatories in the previous days.
The spermiogram first analyzes the macroscopic characteristics, that is, those that are seen with the naked eye. These are the volume, the external appearance, the viscosity, the PH and the color. Then we move on to the analysis of 3 fundamental things: concentration, motility and morphology.
We can find other cell types in the semen: the presence of immature forms (precursors of spermatozoa). In excess of 3% can indicate phenomena of cellular suffering. The reasons are exposure to heat, varicocele, prolonged fever, exposure to drugs, toxic or radiation.
The presence of blood cells (red blood cells, lymphocytes or neutrophils) is usually a sign of infection or inflammation of the seminal tract.
Here is the terminology used:
It is important that we must repeat an abnormal spermiogram. It is crucial before giving a definitive diagnosis, especially in cases where we are on the borderline between severe oligoasthenospermia and azoospermia.
Spermioculture and the microbiological examination of the seminal fluid allow us to see the presence of an infection. It is an easy exam to do. We ask for it in combination with the spermiogram. However, its interpretation requires attention. It very often reports false positives which tell us that there is an infection. Yet it does not exist and this often happens due to the incorrect execution of the test. It can also give us false negatives which tells us that there is no bacterium while there is.
If we evaluate a positive and valid result, we must certainly treat the patient. We will also have to evaluate the need to treat the woman. A germ that shows up in the semen of a patient can also be transmitted to the partner and may cause damage to the endometrium and tubes.
The bacteria often found are mycoplasma and ureoplasma. In these cases we must absolutely treat the partener.
There are the basic tests that we consider mandatory. These are the karyotype and cystic fibrosis and others that we do if there is an indication.
Karyotype is a chromosomal map, the representation of chromosomes and the morphological study of them. That is, the number and structure of chromosomes. These are those small structures that carry our genetic heritage. A normal male is 46xy ie 23 pairs of chromosomes including the y chromosome. We must always exclude mosaicism. This means the presence in the same individual of 2 or more cell lines. Mosaicism can cause problems to the fertilization, to the embryo and in the end not give a positive result.
Cystic fibrosis (often abbreviated as CF, also called mucoviscidosis or fibrocystic disease of the pancreas) is an autosomal recessive genetic disorder. It is the most common fatal inherited genetic disease in the Caucasoid population.
The symptomatology, which involves different internal organs, has to do with the secretion of very thick and viscous mucus and therefore not very smooth. The resulting obstruction of the main ducts causes the main symptoms (appearance of recurrent lung infections, pancreatic insufficiency, steatorrhea, liver cirrhosis, intestinal obstruction and male infertility).
Also, the df 508 mutation carries it to 60% of the world population.
If the partner carries the mutation in heterozygosity that is a carrier we must absolutely test the partner. In the case that she too is a carrier, the possibility that the child is sick is 25%. In these cases, pre-implantation diagnosis is mandatory.
Third genetic test to be done in humans only in case of severe oligospermia or azoospermia and the search for microdeletions of the Y chromosome. The microdeletions of the Y chromosome, ie losses of genetic material at the level of the male chromosome that are associated with infertility.
In these cases, a hormonal framework is also required, ie FSH LH and androgens
Testicular ultrasound is an instrumental examination based on the use of an ultrasound probe. This allows you to view the internal contents of the scrotum. For instance, the testicles and adjacent structures.
Testicular ultrasound is fast, not invasive at all, painless and very cheap. It is essential in the diagnosis of numerous conditions. Some of them are testicular cancer, hydrocele, hematocele, varicocele (abnormal dilation of the veins of the testicles), epididymal cyst, testicular torsion, hernia inguinal, cryptorchidism and pain in the scrotum.The scrotal ultrasound does not require any particular preparation in the days preceding it. It has a total duration of 20-30 minutes. Typically, the result of a testicular ultrasound is available a few minutes after the doctor performs it.
It is important to do this in cases of oligoasthenospermia. It is important because a tumor can manifest itself starting from an oligoasthenosmpermia. In addition, if an important grade 3 varicocele is diagnosed, which by the way is usually symptomatic, we understand that we must intervene. Parenthesis should not be treated for asymptomatic or low-grade varicocele.
Fragmentation is an interesting examination that can give us information but does not change our decisions as much. This test allows to evaluate the presence of any damage present at the level of the genetic material (DNA) of the spermatozoa, a possible cause of incorrect embryonic development.
There is currently no therapy to improve fragmentation apart from certain supplements for which there is no scientific company approval.
According to some studies, we consider it as a necessary examination. We use it in cases of severe oligospermia to lead us to testicular biopsy. As for me, faced with severe oligospermia, I often evaluate the need to proceed directly to the biopsy without waiting for the result of the fragmentation, which will surely be scarce.
The MAR-TEST allows to highlight the presence of anti-sperm antibodies. These antibodies could compromise motility and therefore the fertilization capacity.
According to the theory these antibodies are formed when there is a trauma to the testicular level. For instance trauma, testicular torsion or severe testicular infection. In the past these antibodies could compromise concentration and motility the studies. Today we also find them in men with normal semen that have children. Consequently, we do not request them systematically.
All men but as well as all women of our couples have to do the blood group and electrophoresis of the abnormal hemoglobins. Electrophoresis is the test that tells us whether one is a carrier of thalassemia (Mediterranean anemia) or sickle cell anemia.
Infectious that is hepatitis b c hiv and the like are made systematically and have a specific expiry date.