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Semen analysis and sperm function parameters in patients with infertility in Navi Mumbai and Panvel region

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Background: Although semen analysis is routinely used to evaluate male partner in infertile couples, infertility and problems of impaired fecundity have been a concern through ages and is also a significant clinical problem today, which affects 8-12% of couples worldwide. Aim of the study was to study different semen parameters in male factor infertility (MFI) and thus increasing the awareness regarding same.Methods: This is cross sectional study conducted between period of September 2016 to December 2018. Semen of 150 patients were studied and results were analysed as per recent WHO (2010) criteria.Results: The present study included 150 patients whose age ranged from 24 to 51 years. Patients were divided into different age groups and sperm count was studied in each group. Abnormal sperm morphology was studied with respect to sperm head, neck, tail defects and combined defects. Sperm deformity index (SDI) and Teratozoospermic index (TZI) were calculated. Other parameters including semen volume, pH, liquefaction time, sperm vitality and motility were also studied which showed significant variations. Conclusions: Although semen analysis is first and most informative investigation for evaluation of male factor infertility, studying individual semen parameters and sperm function and increasing its awareness in general population especially in developing countries is equally important. Besides, it is necessary to acknowledge its limitation with respect to collection, processing, evaluation and biological variation of samples. Also, a normal semen analysis may not prove successful fertility potential of an individual.
November 2019 · Volume 8 · Issue 11 Page 4169
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Bhalekar S et al. Int J Reprod Contracept Obstet Gynecol. 2019 Nov;8(11):4169-4176
www.ijrcog.org
pISSN 2320-1770 | eISSN 2320-1789
Original Research Article
Semen analysis and sperm function parameters in patients with
infertility in Navi Mumbai and Panvel region
Surekha Bhalekar1, Shweta Ganorkar1*, Hemant Bhalekar2, Prakash Roplekar1
INTRODUCTION
The investigations of infertile couple mainly cater around
female partner, however male partner needs to be
screened alongside as male related factor is solely
responsible in about 20% of cases of infertility and is a
contributory factor in another 30% - 40%.1 Alterations in
normal physiology of reproductive organs affecting
sperm functions ultimately results in oligozoospermia
(low sperm count), teratozoospermia (abnormal
morphology), azoospermia (sperm’s absence in
ejaculation) asthenozoospermia (loss of motility). This
results in unsuccessful fertilization. Thus, pathogenesis is
multifactorial.2,3 Also when genderwise fertility or
fecundity is looked upon, women are fertile for certain
duration in their entire life thus offering a rate limiting
step because of the regulated monthly production of ova
and other barriers during and around pregnancy. Men on
the other hand have no such barriers and are regular
producers. This makes them fertile during their entire
reproductive life if fecundity is to be tested. Hence, any
abnormality in spermatogenesis can affect species
renewal and propagation.
ABSTRACT
Background: Although semen analysis is routinely used to evaluate male partner in infertile couples, infertility and
problems of impaired fecundity have been a concern through ages and is also a significant clinical problem today,
which affects 8-12% of couples worldwide. Aim of the study was to study different semen parameters in male factor
infertility (MFI) and thus increasing the awareness regarding same.
Methods: This is cross sectional study conducted between period of September 2016 to December 2018. Semen of
150 patients were studied and results were analysed as per recent WHO (2010) criteria.
Results: The present study included 150 patients whose age ranged from 24 to 51 years. Patients were divided into
different age groups and sperm count was studied in each group. Abnormal sperm morphology was studied with
respect to sperm head, neck, tail defects and combined defects. Sperm deformity index (SDI) and Teratozoospermic
index (TZI) were calculated. Other parameters including semen volume, pH, liquefaction time, sperm vitality and
motility were also studied which showed significant variations.
Conclusions: Although semen analysis is first and most informative investigation for evaluation of male factor
infertility, studying individual semen parameters and sperm function and increasing its awareness in general
population especially in developing countries is equally important. Besides, it is necessary to acknowledge its
limitation with respect to collection, processing, evaluation and biological variation of samples. Also, a normal semen
analysis may not prove successful fertility potential of an individual.
Keywords: Male factor infertility, Morphological defects, Sperm count, Sperm indices
1Department of Pathology, D. Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India
2Department of Pathology, Dr. Bhalekar’s Pathology Laboratory, Navi Mumbai, Maharashtra, India
Received: 13 September 2019
Accepted: 10 October 2019
*Correspondence:
Dr. Shweta Ganorkar,
E-mail: academicssdg@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20194840
Bhalekar S et al. Int J Reprod Contracept Obstet Gynecol. 2019 Nov;8(11):4169-4176
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 8 · Issue 11 Page 4170
Various studies have been published supporting a decline
in sperm quality or dismissing the same.4-8 The decline in
the semen quality coincides with an increasing incidence
of abnormalities of the male genital tract including
testicular cancer and cryptorchidism in various countries.9
Hence, semen analysis remains the single most useful and
fundamental investigation with a sensitivity of 89.6%.10 It
is a simple test that assesses the formation and maturity
along with sperm interactions in seminal fluid. It also
provides insight not only on sperm production (count),
but the sperm quality (motility, morphology) as well.11
Societal pressure and dilemma surrounds the
investigation of the male. A complete history and
physical examination of the male partner is mandatory in
cases of primary or secondary infertility. In most
instances, the next step will be to order semen analysis as
it is an easy non-invasive test which provides baseline
information and a path to further investigations.
The purpose of the study was to
Evaluate sperm characteristics in patients undergoing
infertility evaluation.
To help decide further modality of treatment.
METHODS
This is cross sectional study conducted between period of
September 2016 to December 2018.
Study population
Infertile couples in which the female partners had
normal results on fertility evaluation were included.
All of these couples had been unable to conceive for
minimum of 12 months
The women were required to have regular menstrual
cycle, normal results on laparoscopy and
hysterosalphingography and a luteal-phase
endometrial biopsy specimen that was histologically
consistent with menstrual dating
All the men were required to be between the ages of
20 and 55 years at the time of enrollment.
Semen collection and laboratory evaluation
Written informed consent was obtained from all
participants after recruitment
The study population comprised of 150 male
patients referred to the laboratory for semen analysis
for primary or secondary infertility. After providing
proper instructions to the person regarding semen
collection, samples were collected after a minimum
of 48 hours but no longer than 7 days of sexual
abstinence. Increased sperm concentration is
associated with prolonged abstinence while
improved motility is associated with shorter period
of abstinence but with lower sperm density. The
sperm morphology does not vary with length of
sexual abstinence.10
Semen samples were collected by masturbation at
the laboratory. All semen analyses were performed
manually within one hour after the sample was
collected
It included measurements of the volume, pH,
liquefaction time and presence of pus cells and
viable sperms in the ejaculate (vitality test) and
determinations of the sperm count, sperm
concentration and the percentage of sperm with
evidence of flagellar movement (percentage
motility). Sperm deformity index (SDI) and
teratozoospermic index (TZI) were also counted.
Fructose content of sample was also estimated.
Hypo-osmotic swelling test was also performed
Sperm count was done on 10-microns depth
chamber - sperm meter
(Product code SP/INT/001-A) of Sperm Processor
company.
10-microns depth chamber-sperm meter
Sperm Meter requires no dilution of semen, so only
a 'neat semen' is analysed resulting in more
accuracy. It is designed to achieve uniform smear of
10 micron thickness which allows free head
movements of sperms in all directions. This also
avoids overlapping of sperms
It has a micrometric grid of 100 squares; each of
100 micron. The number of sperms in any 10
squares of the grid, simply implies their
concentration in million per ml
The cases with nil sperms were re-evaluated on
three occasions before labeling them as
azoospermia. Sperm motility was assessed by direct
visualization under the microscope
Semen smears were fixed and stained at the
laboratory by the Papanicolaou method for
assessment of sperm morphology by light
microscopy. Sperms were classified as having
normal or abnormal morphologic features including
defective morphology of head, neck or tail
according to strict criteria.
Ethical consideration
The study was conducted in accordance with the
principles of Declaration of Helsinki (World
Medical Association) and Good Clinical Practice
guidelines issued by the ICMR. All the patient’s
confidentiality was maintained.
Statistical analysis
All data was entered in Microsoft Excel (MS office
version 2010) and tabulated. Data analysis was done
using Windows PC based software “MedCalc
Bhalekar S et al. Int J Reprod Contracept Obstet Gynecol. 2019 Nov;8(11):4169-4176
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 8 · Issue 11 Page 4171
Statistical Software” version 18.2.1 (MedCalc
Software bvba, Ostend, Belgium;
http://www.medcalc.org; 2018). Data for all analysis
was done at alpha 0.05 (95% confidence limits)
Data expression
The measurement data for the flow (mm) is
expressed as means with SD/SEM and median
Kolmogorov-Smirnov test was used for testing of
flow rate data for Normal distribution
Analyses methods
Since the data was no-normal, non-parametric test
Kruskal-Wallis test (non-parametric ANOVA) was
used to analyse the flow rates in the between the
three groups with sealer type as the factor.
RESULTS
The present study is cross sectional study conducted
between period of September 2016 to December 2018 in
association with Dr. Bhalekar’s Pathology Laboratory,
Navi Mumbai.
The study includes 150 patients with age range from 24
to 51 years. All semen parameters mentioned in table 3
are studied. Patients were divided in three main age
groups as, 20-30 years, 30-40 years and 40-60 years. The
maximum number of cases were in the age range 30-40
years accounting for 63.3% (n=95/150) of the cases. 30%
(n=45/150) cases and 6.7% (n=10/150) cases were seen
in the 20-30 years and 40-60 years age groups
respectively.
According to the latest WHO recommendations, 1.5 ml or
more was taken as normal semen volume. Out of the 150
subjects in the current study 16.7% (n=25/150) had an
ejaculate volume less than 1.5 ml. 83.3% (n=125/150)
had an ejaculate volume of 1.5 ml and above.
It is well known that sperm concentration is one of the
important predictor of fertility potential. The sperm
counts in the present study ranged from 0-280 million per
ml. Out of this 12% (n=18/150) of the cases had a sperm
concentration of less than 15 million/ml and a total of
82% (n=123/150) of the analysed population was in the
normal range. Azoospermia, that is no sperms in the
ejaculate, was seen in 6% (n=09/150) individuals.
Oligozoospermia were cases with counts less than 15
million/ml, normozoospermia were those with sperm
counts above 15 million/ml while azoospermia had no
sperms (Figure 1).
It is observed that 20.7% (31/150) cases alone constitutes
low sperm count category. Also 6.0% (09/150) cases fell
in category of sperm count between 15-20 million/ml
which forms borderline category. Fertility potential in
these cases is equivocal and are to be investigated as per
oligozoospermic cases.
Sperm motility being an important parameter and
determinant of male fertility it should be analysed as
early as possible and must be measured within 60
minutes of collection. According to the latest WHO
criteria a total sperm motility of 40% with progressive
movement of >32% is taken as cut off value.2
Figure 1: Distribution of cases in different sperm
count groups.
Individuals above this are taken to be normal. In the
present study, 80.7% (n = 121/150) of the cases were
above the reference motility and all these cases had >32%
of sperms with progressive movement. 19.3% (n=29/150)
of the cases showed non-progressive motility. These
cases were also distributed based on age group (Table 1).
Table 1: Sperm motility in different age groups and
sperm count groups.
N
Progressive
Non-
progressive
45
36 (80.0%)
09 (20.0%)
95
79 (83.2%)
16 (16.8%)
10
06 (60.0%)
04 (40%)
31
9 (7.4%)
22 (75.9%)
9
7 (5.8%)
2 (6.9%)
30
25 (20.7%)
5 (17.2%)
30
30 (24.8%)
0 (0.0%)
16
16 (13.2%)
0 (0.0%)
34
34 (28.1%)
0 (0.0%)
150
121 (80.7%)
29 (19.3%)
The morphology was assessed on fixed stained smears of
the semen samples. In the current study 6% cases had no
sperms in the ejaculate (azoospermia).
One individual had a count of 5 million/ml and a
borderline case of 6 million/ml sperm count with 99%
abnormal morphology. In the study, five cases with count
less than 5 million/ml had abnormal morphology of
sperms ranging from 40 - 80%.
0-14 mill/ml,
(n=31), 20.7%
15-20 mill/ml,
(n=9), 6.0%
21-50 mill/ml,
(n=30), 20.0%
51-80 mill/ml,
(n=30), 20.0%
81-110 mill/ml,
(n=16), 10.7%
111-280
mill/ml, (n=34)
22.7%
Sperm count (%, n=150)
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Any defects of head, neck and tail were considered as
abnormal morphology. Maximum morphological defects were identified as head defects which was common
finding in all age groups (Table 2) and (Figure 3).
Table 2: Sperm defects in different age groups.
Age Group
20 - 30 years. (n=45)
30 - 40 years. (n=95)
40 - 60 years. (n=10)
Mean
Median
SD
Mean
Median
SD
Mean
Median
SD
Head defects (%)
42
35
30
54
47
34
35
24
24
Neck defects (%)
12
05
22
12
4
20
14
1
31
Tail defects (%)
08
03
08
10
08
07
11
3
18
Morphologically abnormal spermatozoa often have
multiple defects (of the head, midpiece or principal piece,
or combinations of these defects). A detailed study of the
incidence of morphological abnormalities may be more
useful than a simple evaluation of the percentage of
morphologically normal and abnormal spermatozoa.
Recording the morphologically normal spermatozoa, as
well as those with abnormalities of the head, midpiece
and principal piece, in a multiple-entry system gives the
mean number of abnormalities per spermatozoon
assessed. These indices have been correlated with fertility
in vivo (TZI) and in vitro (SDI), and may be useful in
assessments of certain exposures or pathological
conditions.2
Two indices were calculated from records of the detailed
abnormalities of the head, midpiece and principal piece in
a multiple-entry system.2
The teratozoospermia index (TZI)
The sperm deformity index (SDI)
Calculation of these indices.2
Each abnormal spermatozoon is scored for defects of the
head, midpiece and principal piece, and for the presence
of excess residual cytoplasm (volume more than one third
of the sperm head size). In Teratozoospermia Index
(TZI), a maximum of four defects per abnormal
spermatozoon is counted: one each for head, midpiece,
and principal piece and one for excess residual
cytoplasm.
The Sperm Deformity Index is the number of defects
divided by the total number of spermatozoa (not only the
abnormal spermatozoa). It incorporates several categories
of head anomaly but only one for each midpiece and
principal piece defect.
WHO lower reference limit for TZI and SDI of >4% was
considered as normal, 3 to 4 % was considered as
equivocal and values <3 was counted as abnormal. In
present study, TZI* was normal in 43.3% (n = 65/100)
cases and SDI was normal in 26% (n = 39/150) cases.
TZI* was abnormal in 23.3% (n = 35/100) cases with
mean value of 1.1 and SDI was abnormal in 74%
(n=111/150) cases with mean value of 0.5 (Figure 2).
*TZI values were available in 100 cases
Figure 2: Percentage of cases with abnormal TZI
and SDI.
Abnormal : F-6-3-Ab HD,HD,MD| F-6-4-Ab HD| F-6-5-Ab TD|
F-6-6-Ab HD,TD| F-6-1-Ab HD,MD| F-6-2-Ab TD, F- Figure,
HD- Head defects, TD- Tail defects, Ab-Abnormal
Figure 3: Vitality test using eosin-nigrosin method.
In present study, fructose was present in all cases, pus
cells were present in 29.5% cases, semen volume was
35.0%
74.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Abnormal TZI (n=100) Abnormal SDI (n=150)
Terratozoospermic and Sperm Deformity Index
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 8 · Issue 11 Page 4173
low (hypospermia) in 16.7% cases and liquefaction time
was normal in all cases. Cases in which pus cells were
found were subjected for culture. If culture was positive,
patients were cleared of infection and semen analysis was
repeated. Vitality of sperms was assessed by two
methods: Eosin Nigrosin method (Figure 3) and Hypo-
osmotic swelling (HOS) test.
Vitality test using hypo-osmotic swelling is an alternative
to dye exclusion. Spermatozoa with intact membranes
swell within 5 minutes in hypo-osmotic medium and all
flagellar shapes are stabilized by 30 minutes.2
In present study, 17.3% (n = 26) cases showed abnormal
hypo-osmotic swelling test. This is useful when staining
of spermatozoa must be avoided, e.g. when choosing
spermatozoa for ICSI.2 An age specific comparative
analysis of the mean sperm counts, total motility and
normal morphology revealed a decline in the average
values of these parameters with age (Table 3).
Table 3: Semen parameters in different age groups.
20-30 years (n=45)
30-40 years (n=95)
40-60 years (n=10)
Total (n=150)
Mean (SD)
Mean (SD)
Mean (SD)
Mean (SD)
Age (years.)
28.00 (1.75)
34.42 (2.97)
44.10 (2.77)
33.14 (4.90)
Semen volume (ml)
2.93 (1.87)
2.75 (1.43)
2.00 (0.97)
31.37 (8.45)
Liquefaction time (min)
32.00 (13.71)
30.58 (4.24)
36.00 (6.58)
75.85 (71.58)
Sperm count (mill/ml)
88.64 (82.86)
71.42 (66.04)
60.30 (66.54)
73.01 (14.00)
Viable sperms (%)
76.13 (11.67)
71.84 (14.25)
70.57 (21.28)
70.18 (11.72)
HOS reactive (%)
72.83 (10.76)
69.23 (11.70)
67.43 (16.11)
22.55 (20.29)
Rapid progressive (%)
22.50 (16.54)
22.46 (21.23)
24.00 (29.33)
34.02 (14.33)
Slow progressive (%)
34.60 (13.03)
33.67 (14.38)
35.29 (21.87)
13.65 (8.55)
Non-progressive (%)
14.88 (10.02)
13.22 (7.49)
12.14 (12.65)
29.76 (14.34)
Immotile (%)
28.03 (11.60)
30.62 (15.51)
28.57 (13.45)
45.53 (27.99)
Normal morphology (%)
50.90 (28.06)
42.35 (27.39)
56.14 (32.23)
53.86 (28.33)
Abnormal morphology (%)
46.98 (28.79)
57.65 (27.39)
43.86 (32.23)
56.43 (29.54)
Defective morphology (%)
48.88 (29.33)
60.58 (28.68)
45.57 (34.93)
49.59 (33.05)
Head defects (%)
42.05 (29.57)
54.04 (34.37)
34.86 (24.45)
12.42 (20.75)
Neck defects (%)
12.35 (21.64)
12.35 (19.69)
13.71 (31.07)
9.11 (8.00)
Tail defects (%)
7.58 (7.89)
9.64 (6.78)
11.00 (18.47)
56.57 (19.20)
Sperm deformity index
0.62 (0.51)
0.78 (0.54)
0.60 (0.57)
0.72 (0.54)
Teratozoospermic index
1.35 (1.12)
1.22 (0.37)
1.20 (0.32)
1.25 (0.68)
DISCUSSION
Childbearing is considered as an essential part of living
and yardstick by which women’s worth is measured
especially in a developing country. So it invites social
stigma. It’s no longer a private sorrow instead it’s coming
out of the woodwork due to its social and interpersonal
ramifications. Besides, recent researches have proved that
problem is not gender specific. Semen analysis remains
the cornerstone to investigate male infertility.
"Male factor" infertility (MFI) is considered as a change
in sperm concentration and/or motility and/or
morphology in at least one sample of two sperm analyzes,
collected 1 and 4 weeks apart.12 Most recent WHO
(2010) manual for semen analysis have changed
nomenclature from “normal” to “reference values” with
respect to sperm concentration, motility, morphology and
all other semen parameters. Males with sperm parameters
below the WHO normal values or reference values are
considered to have male factor infertility.13
The study was a cross-sectional study with a population
of 150 individuals. Maximum number of cases were in
the age range 30 - 40years. A relatively higher mean age
of 36.8years and 34 years has been reported by other
authors.14,15 However, a mean age of 30 years in
concordance with our finding was observed by Jajoo S et
al.16 Male fertility usually peaks at around 35 years of age
and declines after 45 years of age.17 The changes
associated with aging are moderate, but significant,
although the capacity to fertilize is maintained.18
According to the latest WHO recommendations, the
lower reference value for semen volume is 1.5 ml2 with
reference to this 16.7% of our study population had low
volume while the remaining 83.3% was within the
normal range. Precise measurement of volume is essential
in any semen analysis as it allows the total count of
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 8 · Issue 11 Page 4174
spermatozoa and non sperm cells in the ejaculate to be
assessed.
Volume is generally assessed in a graduated glass
cylinder with a flared top. Ineffective collection may
adversely affect volume assessment. In addition, a
variable relationship exists between the frequency of
emissions, continence and seminal volume.19,20 Ejaculated
seminal volume is a parameter that reflects abnormalities
in accessory sex glands fluid synthesis i.e. seminal
vesicle which forms a bulk. Low semen volume is
characteristic of obstruction of the ejaculatory duct or
congenital absence of the vas deferens.2 High semen
volume may on the other hand reflect exudation in cases
of active inflammation of accessory organs.2
Sperm concentration is often proposed to be predictors of
fertility potential. In recent years there have been reports
of declining sperm concentration in men around the
world.21,22 The new WHO 2010 guidelines has taken
lower reference limit of 15 million/ml with values above
these taken as normal.2 Oligozoospermia (sperm counts
<15 million/ml) in the present study was seen in 12% of
the cases while higher rates of 23.2%, 32% and 25.6%
are reported.23-25 Although lower values of 11.11% have
also been observed.10
It has been suggested by authors that low sperm counts
are among the most common cause of male infertility.23
Association of oligozoospermic semens with increased
morphological abnormalities has been suggested by Butt
et al.10
Azoospermia, defined as absence of spermatozoa in the
ejaculation was seen in 6% of the cases which was lower
compared to those seen in other studies such as 14.8%,
12.3%, 28.6%.10,26,27 The problem of azoospermia is
thought to be associated with sperm production or sperm
transport.10
82% of the analyzed subjects had normal sperm counts,
which was higher than reported by Butt et al.10 However
these values are much higher than other reports such as
20%, 36.7% and 51.8%.26-28 More so, it may be noted that
normal semen counts are a common event in infertile
males, where the cause may be other factors such as
immune related and marked biological variation.29
Assessment of sperm motility is essential as the
spermatozoa have to travel in the female genital tract to
fertilize the oocyte, a requisite of normal pregnancy.10 It
is a critical parameter which indicates semen quality and
fertility potential. As per the WHO 2010
recommendations, samples having 40% motile sperms
with 32% showing progressive, motility are considered
normal.2 In the present study 121 (80.7%) cases were
above the reference motility and all these cases had
>32% of sperms with progressive movement. This was in
concordance with 76% as reported by Okon E et al, and
higher as compared to value of 62.02% reported by
Alemnji.26,14
Sperm morphology along with motility and sperm count
is also an important contributing factor in male fertility.
The total number of morphologically normal spermatozoa
in the ejaculate is of biological significance, the lower
reference limit for normal sperm morphology is 4% as
per the latest WHO guidelines.2 The WHO criteria for
morphology has seen a marked change over the years
from 50% and above to as low as 4% in the 5th edition.30
Sperm morphology is assessed by microscopic
examination. Normal sperm contains head, middle piece,
and tail. Morphological changes (teratozoospermia) were
defects in the head, neck, midpiece and tail of
spermatozoa. The details of the type of defects were
recorded in present study. Some studies show that these
defects have a prognostic bearing as some defects are
irreversible, and others which are due to
acquired/environmental factors can be reversible.31,32
Most of the studies describe the association of low sperm
count and abnormal morphology. They studied that sperm
morphological defects increases with decreasing sperm
count.33 Only few studied the defects with normal sperm
counts also.34 Defects in the head are the most common
defects.35
Clinical significance of some of these defects described
by many authors such as tapering and megaloheads are
reversible defects. It is mainly due to ongoing stress or
some medication. After stopping the precipitating factor,
most of them revert back. These defects increase with
decreasing sperm count.33 Amorphous head is a defect
with genetic aberration, so this is a severe form and
incapable of fertilization. Globozoospermia small round
head with no acrosome are also genetically determined
and due to the absence of acrosin unable to bind to zona
pellucida. Small head spermatozoa also have very small,
abnormally formed acrosome. Large head spermatozoa
have severely abnormal megaloheads.32
Teratozoospermia has a deleterious effect on the rate of
fertilization.36
Most common morphological defects were observed in
head of sperms which is in concordance with
Goyal et al.37 Present study was limited by availability of
proper environmental factors and other relevant history
and follow up. Some have noted the association of
multiple defects with increased chances of spontaneous
abortions.38 In present study, many cases with multiple
combined abnormalities was also found. However, the
study is limited owing to lack of follow-up.
Semen is normally ejaculated as a liquid, immediately
gels, and liquefies within five to 20 minutes. Less than
one percent of specimens will fail to liquefy. Such an
event makes the analysis difficult, but is not clearly
related to infertility. Viscosity is assessed by pouring the
specimen from the collection bottle into a graduated
cylinder, and grading on a scale of zero (normal) to four
Bhalekar S et al. Int J Reprod Contracept Obstet Gynecol. 2019 Nov;8(11):4169-4176
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 8 · Issue 11 Page 4175
is done. A normal sample is capable of being poured in
single, small droplets; grade 4 specimen remains as a
solid blob. As with non - liquefaction, high viscosity
makes analysis extremely difficult but does not interfere
with fertility. 39 In present study, liquefaction time was in
normal range in all cases.
The pH of fresh semen will be 7.3-7.7. This will shift to
the more alkaline range when the sample is left standing.
With further passage of time the accumulation of lactic
acid will make the sample more acidic. In present study,
pH was in normal range only in 3 cases. Fructose is
produced by the seminal vesicles. It will be absent from
the semen in three clearly defined circumstances: in a rare
form of retrograde ejaculation, when both ejaculatory
ducts are obstructed and in azoospermic men with
congenital bilateral absence of the vas deferens.40 In
present study, fructose was present in all cases.
Reproductive quiescence in women is seen between 45-
55 years of age. This is not the case with men, who age
gradually. Still, they commonly do not experience
complete reproductive senescence and maintain
spermatogenesis well into old age.13 However, increasing
age significantly influences semen parameters required
for healthy male fertility.13 Age related changes on the
seminal parameters were also evaluated in present study,
it was noted that mean sperm counts, total motility and
normal morphology revealed a decline in the average
values of these parameters with age, this was in
concordance to similar studies conducted in past.13
CONCLUSION
Although semen analysis is first and most informative
investigation for the evaluation of male factor infertility,
studying individual semen parameters and sperm function
and increasing its awareness in general population
especially in developing countries is equally important.
Besides, it is necessary to acknowledge its limitation with
respect to collection, processing, evaluation and
biological variation of samples. Also, a normal semen
analysis may not prove successful fertility potential of an
individual. Poor sperm function is usually associated with
high proportion of abnormal spermatozoa. Besides
morphologically normal-appearing spermatozoa should
also be further investigated for normal sperm function
and DNA content as morphological normal sperms does
not necessarily imply normal sperm function. In addition,
male fertility and various semen parameters are seen to
decline with age in this part of India.
ACKNOWLEDGMENTS
Authors would like to thank Mrs. Rupali Suryawanshi
(BSc. DMLT) and Mrs. Akshata Rikame (HSC CMLT),
Laboratory Technician for their support during study.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: Not required
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Cite this article as: Bhalekar S, Ganorkar S,
Bhalekar H, Roplekar P. Semen analysis and sperm
function parameters in patients with infertility in
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Contracept Obstet Gynecol 2019;8:4169-76.
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