Semen Analysis is most commonly performed test for the male factor although the importance given to it is lately questioned by the fertility experts. It is a laboratory test that does not have body environment. It is more important to learn how the sperms behave in the body of woman. All the details in the reports provided by the laboratories are not relevant to the clinical practices of the fertility. Semen analysis is still important but the emphasis should be limited. It is a frequent observation in clinical practice that with the minimal count and motility of sperms women have been impregnated. On the other hand with the highest values of the semen analysis there have been difficulties in the married couples to own child.
World Health Organization (WHO) has recommended the criteria of the semen analysis. Percentages of Motility and morphology are observed. >20 millions sperms/ml with >50 % normal motile sperms are considered satisfactory. The motility is graded into four (0 to 3) and documented in the percentage of grades. Grade-4 is best with the actively moving sperms in forward direction. Grade 3-sperms move in situ. Grade-2 has circular activity. Grade 0 is motionless dead sperms. Prof Rana has graded the results of the semen analysis into 5 according to the fertility potential. Grade-1 has the best and Grade-5 the least potential.
Semen is collected by masturbation. The counting is done on special Makler’s sperm counting chamber. Abstinence is not enforced for the first test so that natural course of events is studied. If the values are unsatisfactory, the test is repeated after 5-7 day’s abstinence.
Swim Up Technique In oligospermia, swim up technique is used to assess the fertility potential of the semen for ARTs. It helps to retrieve the highly active motile sperms for use in ART procedures. The technique is also used for evaluation of semen before the procedure is attempted. In this technique semen is washed with special medium. This removes the debris and contaminants. If sperms are to be used for ART antibiotics are added to the medium to make the specimen bacteria free.
Normal Semen Variables
Variable Normal Value
Ejaculate Volume. > 2.0 ml
Ejaculate Appearance Grey -Opalescent
Ejaculate liquefaction < 60 minutes
Sperm Concentration > 20 millions Sperm / ml
Total Sperm Count > 40 millions Sperms
Spermatozoa Motility >50 % with Forward progression
Morphology > 30% spermatozoa with normal forms
Descriptive Terminology for Semen
Normozoospermia Normal ejaculate
Oligospermia < 20 million Sperms/ml
Asthenospermia < 50% sperms With forward Motion.
Teratospermia < less than 30% with normal morphology
Azoospermia No sperms in ejaculate
Aspermia No ejaculate
Prof Saad Rana’s Grading of Postcoital Test: Sperms per HPF |
Grade |
Grade-4 Motile |
Immotile Sperms |
Significance |
G-I |
> 20 |
< 5 |
No cervical Hostility. High quality semen |
G-II |
> 10 |
< 5 |
No cervical Hostility. Good semen values |
G-III |
< 10 |
> 10 |
+ Cervical Hostility. Low semen values |
G-IV |
0 |
All |
Cervical Hostility? Low semen values |
G-V |
0 |
0 |
Azoospermia possible. See Semen analysis |
Prof Saad Rana’s Grading of SEMEN |
Grade |
Semen Count Millions/ml |
Grade-4
Motility |
Morphology
Normal |
Significance |
G-I |
> 50 |
> 80 % |
> 80 % |
Excellent fertility potential |
G-II |
> 20 |
> 50 % |
> 50 % |
Good Fertility Potential |
G-III |
10-20 |
> 50 % |
> 50 % |
Satisfactory Potential |
G-IV |
< 10 |
> 50 % |
> 50 % |
Fertility Possible |
G-V |
0 |
0 |
0 |
Evaluate for ICSI |
| 
