Examples of semen samples
Looking at some semen samples helps when explaining how the standard semen test works. As well as sperm numbers they can help indicate whether a problem with sperm lies in the testes or tubes, and what the issue is. Two examples of semen samples are here and measured against the two WHO reference ranges. The symbol ‘<‘ means ‘less than’, and ‘>’ is ‘more than’.
Sample 1.
This sample has results within the normal ranges.
| Patient’s values | WHO [Ref. 1999] | WHO [Ref.2009] | |
|---|---|---|---|
| Duration of abstinence [days] | 3 | 2-5 | 2-5 |
| Time for ejaculation [mins] | 40 | <60 | <60 |
| Macroscopic examination | |||
| Volume (ml) | 4.1 | 2 or >2ml | >1.5ml |
| Appearance | Normal | Normal | Normal |
| Liquefaction | Complete | Complete | Complete |
| pH | 8.0 | 7.2 – 8.0 | 7.2 – 8.0 |
| Viscosity | Normal | Normal | Normal |
| Debris | Not significant | ||
| Agglutination | None seen | ||
| Motility (% spermatozoa) | |||
| (a) Rapid progression | 45 | >24% | >32% |
| (b) Slow progression | 17 | (a) + (b) > 49% | (a) + (b) > 40% |
| (c) Non-progression | 4 | ||
| (d) Immotile | 34 | ||
| Vitality (%) | >50 | >50% | >58% |
| Antisperm antibodies | |||
| MAR test for IgA | <10 | [<10%] | [<10%] |
| MAR test for IgG | <10 | [<10%] | [<10%] |
| Concentration [x 10^6/ml] | |||
| Count/ml | 37 | >19 | >15 |
| Total count in sample | 152 | >39 | >39 |
| Other cells [x 10^6/ml] | |||
| Round cells | 0.3 | <5 | <5 |
| Leukocytes (WBC) | Not seen | <1 | <1 |
| Morphology [%] | |||
| Normal | 15 | >14% | >4% |
| Abnormal | 85 | ||
| Head defects | 85 | ||
| Mid-piece defects | 12 | ||
| Tail defects | 4 | ||
| Cytoplasmic droplets | 1 | ||
| Teratozoospermia Index [TZI] | 1.2 | <1.6 | <1.6 |
Sample 2.
This sample is abnormal and there are indications of an infection and/or inflammation. Although the semen volume and numbers of sperm are fine, many [show_to accesslevel=”free”]white blood cells (WBC) were found in the sample, and 99% of sperm have abnormal heads. This could be due to either:
- high oxidative stress levels
- a varicocoele
- heat exposure
- environmental toxins
- aging sperm
- hypo-osmotic stress
- genetic defects
The presence of the white blood cells indicate the heat and oxidative stress are almost certainly coming from an infection. The correct action is a course of antibiotics to clear the infection.
| Patient’s values | WHO [Ref. 1999] | WHO [Ref.2009] | |
|---|---|---|---|
| Duration of abstinence [days] | 3 | 2-5 | 2-5 |
| Time for ejaculation [mins] | 55 | <60 | <60 |
| Macroscopic examination | |||
| Volume (ml) | 5.8 | 2 or >2ml | >1.5ml |
| Appearance | Gel bodies | Normal | Normal |
| Liquefaction | Partial | Complete | Complete |
| pH | 8.0 | 7.2 – 8.0 | 7.2 – 8.0 |
| Viscosity | Normal | Normal | Normal |
| Debris | Not significant | ||
| Agglutination | None seen | ||
| Motility (% spermatozoa) | |||
| : center;” width=”154″>(e) Rapid progression | 59 | >24% | >32% |
| : center;” width=”154″>(f) Slow progression | 12 | (b) + (b) > 49% | (b) + (b) > 40% |
| : center;” width=”154″>(g) Non-progression | 5 | ||
| : center;” width=”154″>(h) Immotile | 24 | ||
| Vitality (%) | >50 | >50% | >58% |
| Antisperm antibodies | |||
| MAR test for IgA* | <10 | [<10%] | [<10%] |
| MAR test for IgG | <10 | [<10%] | [<10%] |
| Concentration [x 10^6/ml] | |||
| Count/ml | 33 | >19 | >15 |
| Total count in sample | 128 | >39 | >39 |
| Other cells [x 10^6/ml] | |||
| : center;” width=”154″>Round cells | 6.2 | <5 | <5 |
| : center;” width=”154″>Leukocytes (WBC) | 1.9 | <1 | <1 |
| : center;” width=”154″>Morphology [%] | |||
| : center;” width=”154″>Normal | 1 | >14% | >4% |
| : center;” width=”154″>Abnormal | 99 | ||
| : center;” width=”154″>Head defects | 99 | ||
| : center;” width=”154″>Mid-piece defects | 25 | ||
| : center;” width=”154″>Tail defects | 18 | ||
| Cytoplasmic droplets | 1 | ||
| Teratozoospermia Index [TZI] | 1.44 | <1.6 | <1.6 |
Interpretation of semen samples
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The different abnormalities in semen samples can indicate the cause of a fertility problem and where the problem is located. Male reproductive organs and sperm are useful references.
| Semen sample abnormality | Indicators to the clinician |
|---|---|
| Appearance and volume | Disease of the prostate or the genital tract |
| Liquefaction | Prostate or seminal vesicle dysfunction |
| Volume, pH, appearance, debris, viscosity and leukocytes | Infection or inflammation of the accessory glands |
| Agglutination, MAR test*, motility | Immune-based infertility |
| Count | Dysfunction of the hormone system, exposure to toxins, genetic defects |
| Count, volume, pH | Retrograde ejaculation, dysfunction of the genital ducts, some inherited disorders |
| Count, motility, progression, morphology | Fertility problems |
| Motility | Varicocoele, not ejaculating for too long, infection, inflammation, issues with the genital ducts, antisperm antibodies |
| Morphology – which can be linked to specific defects | Varicocoele, abnormal sperm development, genetic defects, heat exposure, environmental toxins, aging sperm, hypo-osmotic stress |
*The MAR test is the “mixed antiglobulin reaction” test that’s used to diagnose immune-based infertility.
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