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Half of the barren marriage cases accounts for male infertility. Only a thorough examination can identify the reason of infertility. With parameters available, doctor prescribes spermogram along with some additional examinations, which would help to specify the diagnosis.

Spermogram is semen analysis conducted in an expanded form. This examination would be the first step in determining the male fertility. In infertile families, usually women are examined in the first place. Fertility Physician frequently asks her to provide her husband’s spermogram along with other test results.

Preparing for Spermogram

Before undergoing the spermogram, man needs to abstain from ejaculation for a few days. When this period is reduced to one day, the sperm quantity would not be enough, and when extending the period of abstinence for more than seven days, the sperm motility would reduce significantly. It is not recommended to go to the sauna or steam bath and drink alcohol. The spermogram results can vary for reasons beyond the control of man. Therefore, to have accurate indicators, in some cases the doctor prescribes an additional examination with semen delivery.

Sperm obtained through masturbation, is placed in a sterile container. "VITROMED" has a comfortable special room for this procedure.

Interpretation of Spermogram results

Examining the sperm under the microscope, experts determine the following parameters:

- Quantity of sperm per milliliter of ejaculate. Quality semen should contain not less than 15 million per milliliter according to the recent criteria of the World Health Organization (WHO) as of 2010. In case sperm is less than the above indicator, oligozoospermia is diagnosed; if sperm is completely missing, azoospermia is diagnosed.

- Sperm motility. Semen is considered normal, if 32 % of sperms or more are able to move rectilinearly. This very movement is made by them in the cervical canal, moving to the uterus and fallopian tubes. Good motoric activity helps the sperms to move through the cumulus cells and penetrate through the pellucida zone. With the sperm motility parameters less than 32%, asthenozoospermia is diagnosed. In this case, the chances to conceive are slightly reduced. The chances become even less, if the number of sperms in the ejaculate is below the norm.

- Morphology of sperms. Here the sperm structure and form should be considered. Healthy and quality sperms should have an oval head and a bit convoluted tail.

Every man has abnormally developed sperms. The belief that the latter can lead to conceiving a baby with birth defects is not true. Experts assure that abnormally structured sperms are not able to fertilize ovum. They are dangerous in other respect. If their number is too large, they can affect the chance of normal sperms to penetrate through the ovum and fertilize it. Reduced number of normal sperms is called teratozoospermia .

Sperm morphology is assessed by Kruger criteria

Morphology by Kruger criteria is a complex laboratory process, which is performed only in specialized clinics offering treatment for infertility to patients. In Armenia such examinations are offered only in "VITROMED" Clinic. /

According to Kruger criteria, normal semen contains 4 % of sperms with normal morphology. For the first method of the sperm quality assessment the figure is 50%. While examining the morphology of sperm, physician must also pay attention on the increased number of white blood cells, as their large number often points to the presence of infection in patient's genitourinary system.

Spermogram also shows other semen parameters: volume, acidity, viscosity and color. After ejaculation, sperm becomes gelatinous from liquid condition and again, after 20-40 minutes, it liquefies. That is why the viscosity of semen is assessed a bit later following the ejaculation.

When Spermogram shows that its parameters do not conform to the norm, re-examination should be performed approximately 2-4 weeks after the first procedure. To avoid the impact of external factors on the result of the analysis, one should abstain from taking strong drugs and alcohol during this period. Spermogram assessment may be inaccurate in case the patient has suffered cold-related diseases with fever during the preceding three months. In some cases sperm motility is reduced to zero due to high body temperature.

When the examination results show that the number of sperms in semen is small and they have low viability, the patient is offered to undergo a repeated procedure of delivery of medical tests.

Antispermal antibodies (MAR- test)

To understand how to improve the sperm quality, it is necessary to undergo a test for detection of antispermal antibodies, which affect the adhesion of sperm and reduce motility and the ability to fertilize an ovum. Such antibodies may be equally available in the bodies of both men and women. Antispermal antibodies are formed when the immune system, perceiving the sperm as a foreign body, begins to destroy them. The analysis for antispermal antibodies are taken from both spouses. Blood, semen and cervical mucus examinations are prescribed.

MAR-test is used to determine the presence of such antibodies in male sperm. Using this test, the percentage content of sperms linked to antispermal antibodies (for negative result there should be not more than 40% mobile sperms that are not linked to antispermal antibodies) is determined. In the same manner antibodies are detected in blood serum of spouses. Positive results of the analysis indicate that infertility in men is caused by immunological factors. In this case, vitro fertilization (IVF) is carried out, where intracytoplasmic sperm injection (ICSI) into ovum is applied.



Presence of Leucocytes in semen

The function of sperms will be essentially disrupted, if a large number of leukocytes are detected in semen. The round shape of leukocytes usually enables to easily determine them. However, in terms of Spermogram, this is not the case. Immature spermatozoids are very similar to leukocytes: To reveal their differences, it is necessary to use special strains, i.e. to conduct LeucoScreen test.

Detection of a large number of immature sperms in the ejaculate can cause infertility. The leucocytes in semen may diagnose the presence of infectious diseases in the genitourinary system. Semen bacterial swab test would be necessary, if the sperm contains more than 1 million/ml. leucocytes.

Sexually transmitted diseases

Urogenital infections, such as herpes and chlamydia, can affect sperms, cause their immobility, adhesion, and result in termination of pregnancy or fetal abnormalities.

To detect sexually transmitted infections, enzyme multiplied immunoassay (ELISA) is used in combination with semen culture and polymerase chain reaction. Such a diagnosis is necessary, if increased leucocytes level in semen, increase in the number of abnormal sperms, infertility caused by undiagnosed reasons, or miscarriage are detected.

Transrectal ultrasonography

This examination method is indicated for the detection of pathological lumps and modifications in the structure of the prostate, testicles and epididymis. Transrectal ultrasonography is indicated for azoospermia. It reveals modifications in the seminal vesicles in case of deferent canal obstructions.

Doppler ultrasound of the scrotum enables to detect venous reflux in the testicular blood supply and subclinical varicoceles.


Deferent canals are examined through vasography method. It enables to get a high-quality image of deferent canals and determine the obstruction sites.

Genetic testing

Where large morphological modifications are detected in the structure and shape of sperm, or if a patient is diagnosed with azoospermia, genetic testing should be prescribed.

Karyotyping (genetic analysis) reveals the modifications in the structure and number of patient’s chromosomes. AZF locus Y- chromosome testing is frequently used. In case of nonobstructive azoospermia, a few pieces of locus chromosome may drop.

Genetic testing provides a lot of information on congenital transmission of non-obstructive azoospermia. Doctor always tells the patient about the fact of hereditary disease.

Diagnostic testicle biopsy

When azoospermia is detected, diagnostic testicle biopsy is prescribed in "VITROMED" Clinic. With special medical tools, a piece of tissue is taken from the testicle or epididymis; it is processed by a special method and is examined under the microscope for the presence of sperms in it and spermatogenesis cells. If motile mature sperms are detected in the processed biopsy sample, after adding cryoprotectant those are cryopreserved for further use in reproduction programs.

The above mentioned diagnostics identifies:

- State of the seminiferous tubules and sperms;
- Lack of mature sperms (hypospermatogenesis);
- Lack of spermatogenesis.

Testicle biopsy is the final stage of identifying the causes of azoospermia. When being conducted through IVF program, it would be better for patients to decide whether they will use donor sperm for conception, provided that normal sperms are missing in testicles.

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