Spermatozoa are mobile without translational movement. Norms and disorders of sperm motility

One of the quality indicators of sperm, which is checked during evaluation, is sperm motility. Sedentary and sluggish male reproductive cells simply cannot reach the egg and die already in the early stages. In the medical literature, this problem is called. Consider its main causes and what can be done in such situations.

Causes of asthenozoospermia

It is impossible to reliably identify the cause of a decrease in sperm motility. There are a number of factors that can affect male sex gametes:

  • infectious and inflammatory diseases of the urogenital tract, both acute and chronic;
  • diabetes mellitus and autoimmune pathology;
  • overweight;
  • age-related changes in the genitals;
  • congenital and acquired disorders of the structure of the reproductive system;
  • genital trauma;
  • action of high temperatures;
  • varicocele;
  • unbalanced diet;
  • bad habits and lifestyle of a man.

Important! Sperm motility progressively decreases with prolonged sexual abstinence.

There are many factors that cause spermatozoa to become slow and lethargic. In some cases, it is not possible to know the exact cause and the patient is diagnosed with idiopathic (for an unclear reason) asthenozoospermia.

One of the factors that reduce sperm motility can be a harmful working environment.

How is this disease classified?

There are several degrees of asthenozoospermia. Depending on this degree, they choose the tactics of treatment, drugs, or recommend immediately taking advantage of the achievements of assisted reproduction:

  1. First degree. The number of active spermatozoa of class A and B is more than 40%. In this situation, a man is offered to adjust his diet, give up bad habits and recommend taking a number of natural medicines.
  2. Second. The number of active spermatozoa is about 30-39%.
  3. Third. Their number is less than 30%. In these cases, the patient may be advised to use assisted conception technology, as the chances of a natural pregnancy are very low.

How to check the mobility of male germ cells

A decrease in sperm motility can be found by performing a spermogram. This is the simplest study that allows you to evaluate the qualitative characteristics of sperm, including sperm motility.

There are four classes of mobility of male sex gametes:

  • A - actively mobile cells;
  • B - slowly progressively mobile;
  • C - incorrectly moving, inactive;
  • D - motionless.

Only spermatozoa of the first two classes can fertilize an egg. Normally, their number should be more than 50% of the total number of all sex gametes.

Important! Low sperm motility is not a reason to immediately take medication and try to improve it. Before treatment, the analysis is repeated several times to make sure that the problem is taking place.

How to increase sperm motility?

The question of how to increase sperm motility is very important for couples suffering from male infertility. To improve the spermogram, treatment should take place in several directions:

  1. Lifestyle changes, a balanced diet, giving up bad habits and regular sex.
  2. Therapy of infectious and inflammatory diseases of the reproductive organs;
  3. Surgical treatment of structural anomalies and strictures of the vas deferens.
  4. Taking pharmacologically safe and effective drugs.
  5. Prostate massage to improve the blood supply to this area;
  6. Physiotherapy.

Consider drugs that are actively used to improve the quality of sperm and the mobility of male sex gametes:

  1. Spermactin. Dietary supplement that contains fructose, carnitine and citric acid. Improves the quality and quantity of sperm. It is used in the complex treatment of male infertility, is recommended for asthenozoospermia, as well as at the stage of preparation for IVF and sperm donation. The average cost is 2500-3000 rubles. The course of treatment is from 3 months.
  2. Profitil. Contains carnitine, arginine, zinc, vitamin E and folic acid. This drug is also a bioactive food supplement. It is recommended to take it in the treatment regimen for idiopathic male infertility, with a decrease in sperm quality and with other reproductive disorders in a man. The course of treatment is from a month. The cost is within 8500 rubles. for 180 capsules.
  3. Speman. Combined herbal preparation based on medicinal herbs (orchid, lettuce, beans, argirea, etc.). Recommended for inflammatory diseases of the prostate and deterioration of sperm activity. The cost is about 300 rubles. for 100 tablets. The course of admission within six months.

With a lack of testosterone, a man can be prescribed hormonal drugs. In addition, the intake of complex vitamins and antioxidants gives a good effect.

Of the folk methods of treating asthenozoospermia, perga (beekeeping product), ginseng, garlic, walnuts and oysters are considered effective.

You can read about how to independently evaluate a spermogram in the article.

Sperma in Greek means "seed", gramma - "record", spermogram (or spermatogram) is a complete detailed analysis of sperm (physical properties, chemical and cellular composition, etc.), which makes it possible to assess a man's ability to fertilize.

We list the most significant indicators of spermogram (in parentheses are their normal values):

1. Amount of ejaculate(norm: 2-5 ml)

If the volume of semen is less than 2 ml, it will not have enough nutrients to ensure sufficient sperm activity.

2. Color (grayish white)

The transparency of the ejaculate indicates a reduced content or absence of spermatozoa in it, red color indicates the presence of blood in it.

3. Level of acid-base environment - pH(norm: 7.2-7.4)

If an inflammatory process occurs in the organs of the genitourinary system, the pH most often decreases (i.e., acidity increases). If there are abnormalities in the testes and/or prostate, the pH tends to rise (acidity decreases). Rarely, but it happens that the decrease / increase in pH occurs according to a different pattern, however, in any case, the deviation of pH from the norm indicates a “disorder” in the genitourinary system.

4. Liquefaction time(norm: 20-30 min)

At first, the ejaculate has a high viscosity, but after a while it liquefies to the consistency of water. It has been established that the liquefaction time is related to the volume of sperm energy reserves. If it is low, it is very likely that sperm, even motile ones, will not have enough strength to reach the egg.

5. The number of spermatozoa in 1 ml(norm: 20-120 million/ml)

The lower this indicator, the less, of course, the probability of conception, although a low concentration of spermatozoa in the ejaculate does not necessarily indicate a disease of the genitourinary system - it may be the result, for example, of a very active sex life. If the number of spermatozoa in 1 ml significantly exceeds the norm, this also reduces the likelihood of fertilization: it is not easy for spermatozoa to "squeeze" to the egg.

6. The number of spermatozoa in the entire ejaculate(norm: 40-600 million)

This indicator is rather needed for clarity, rather than carrying an informative load, since, as mathematicians would say, it is a function of the values ​​​​of indicators (1) and (5).

7. Sperm motility classified by Latin letters: class A - actively moving (i.e. 20-25 microns / s), class B - slowly moving (5-15 microns / s), A + B = on average 60-70%, class C - with oscillatory movement in place (10-15%), class D - motionless (20-25%)

It is important that there are at least as many active-motile spermatozoa as there are weakly-motile and completely immobile ones.

8. Pathological forms (sperm morphology)- the total percentage of pathological spermatozoa - no more than 50%.

Pathological forms are certainly present - usually 20-30%; however, if there are more than 50% of pathological forms, one should “sound the alarm”.
The teratozoospermia index (ITZ) or the index of multiple anomalies is the norm from 0 to 1.6 (it can be from 1 to 3). If 1, each sperm has one defect, 3 - the sperm has three defects (head, body and tail).
Deformity index (SDI or sperm disorder index) - the average number of pathologies per spermatozoon. If the SDI value exceeds 1.6, problems may arise even with artificial insemination and patients need the IVF + ICSI method.

9. Leukocytes(norm: up to 10 per field of view or less than 1 million / ml.)

Leukocytes can enter semen from the testicles or prostate. A high content of leukocytes in semen is a sign of inflammation localized in the genitourinary system.

10. Agglutination and aggregation of spermatozoa(normal: no)

Agglutination (i.e. gluing) of spermatozoa occurs in inflammatory or allergic diseases. Normally, spermagglutination should not occur.

But drawing conclusions from any single figure is wrong. The spermogram has its own internal logic, the relationship of individual indicators. They confirm each other or refute if the analysis is wrong. Doctors call the principle of reading a spermogram "cross", i.e. to assess the state of the genitourinary system of a man and his ability to fertilize, a comprehensive analysis of all the characteristics of the spermogram is necessary.

Spermogram should be performed after a period of abstinence for 3 to 5 days.

The sample should be collected in the laboratory. If this is not possible, it should be delivered within 30 minutes to 1 hour from receipt to start of the study.

Most often, multiple studies (2-30) at weekly or biweekly intervals are needed for initial evaluation. Analysis of a single sample is inadequate due to the pronounced fluctuations in sperm production in the same individual.

Semen must be protected from exposure to temperatures (not lower than 30°C and not higher than 38°C) from the time of collection until the start of analysis in the laboratory.

The entire sample must be obtained by masturbation directly into a clean glass or plastic container, previously warmed to room temperature before use.

Rubber stoppers or condoms should not be used as they may affect sperm viability. Coitus interruptus is unacceptable due to the loss of part of the ejaculate.

If the semen analysis does not reveal any anomalies, and the patient does not have any obvious signs of malformations of the genitourinary system, then the examination of the man can be completed (it is necessary to examine the woman). If during semen analysis it is found that the content of spermatozoa in it is reduced or they are not viable enough, or there are changes in other indicators of the spermogram, then the patient is sent for additional. survey.

One of the most important indicators of male fertility is sperm motility. The characteristics of sperm cells are determined by a spermogram, but in order to get a reliable result, the analysis will have to be taken several times, since several factors can influence the activity of sperm movement. What to do and how to increase the speed of spermatozoa, why mobility is reduced - we will answer these and other questions.

Norms and disorders of sperm motility

When deciphering the results of spermogram analysis, attention should be paid to the following sperm parameters:

  1. The number of sperm moving forward at different speeds (A + B);
  2. The total number of mobile cells: good, weakly mobile and making oscillatory movements (A + B + C);
  3. Fixed (D).

In a normal ejaculate, there is always a certain proportion of sperm of any type. The production of male cells is a continuous process, some die off, some reduce activity. The ratio of groups determines the mobility standards:

  1. Norm of standards- 32% of spermatozoa are actively moving, of which at least 25% are progressively motile spermatozoa, the total number of mobile cells is at least 40%.
  2. Asthenozoospermia– decrease in cell activity: fluctuations, circular movements. If there are more than 2% of such sperm, dyskinesia is diagnosed.

Sperm disorders can be both pathological (due to inflammatory processes in the genitourinary system of men) and genetic:

  • uneven tail;
  • the presence of more than 1 tail;
  • anomaly in the development of the head;
  • more than 1 head;
  • curvature of the sperm shaft;
  • adhesion or adherence of cells.

With prolonged courses of infectious diseases of the male reproductive system, cell death is observed, which leads to loss of viability and necrosis of sperm.

What affects sperm motility?


Factors affecting the activity and viability of spermatozoa can be divided into natural, pathological and arising from external influences:

  1. Seasonality: in spring, doctors note a decrease in cell activity;
  2. Daily rhythm - the second half of the day is marked by increasing mobility;
  3. The frequency of ejaculations: the more often the process of renewal of seminal fluid occurs, the more noticeable is the increase in sperm motility;
  4. Varicocele, hydrocele - the cause of low cell activity in 25% of cases;
  5. Acute, chronic urogenital infections lead to cell adhesion, which causes the spermatozoon to lose mobility and quickly die;
  6. Blockage of the seminal vesicles causes a decrease in pH, which impairs the quality of the ejaculate;
  7. Epididymitis disrupts the ability of normal movement, sperm cannot fully move due to the inflammatory process of the epididymis;
  8. Pathological disorders of the structure and injuries of the organs of the reproductive system are the cause of infertility in men. Even if the injury was many years ago, an autoimmune process can be launched with the production of antibodies against the patient's germ cells;
  9. Endocrine disorders, metabolic disorders cause a decrease in the activity of the elements;
  10. Violation of the structure of germ cells. Syndrome "9 + 0" means that each sperm is non-progressive, there are no active ones in the ejaculate;
  11. Abnormal development in the form of the absence of dynein handles in the flagellum, which contribute to the connection of the tubules;
  12. A gene-type mutation that affects the mobility of the flagella of germ cells.


In most cases, medicine can get rid of the disease and increase sperm motility. Sometimes medication or surgery is enough. But if the mobility of the disorder is due to a genetic trait or due to a long-term lack of treatment for the patient, then an increase in cell mobility is impossible - the only option to conceive a baby is IVF or ICSI.

The most common causes affecting the speed of sperm movement:

  • Temperature regime. Overheating and hypothermia of the testicles are fraught with loss of cell mobility. Frequent trips to the bath or sitting in a bath with boiling water more than once a week, excessive heating of the car seat - all factors will lead to disease, less often - complete cell death.
  • A large inguinal hernia often descends into the scrotum and disrupts the thermoregulation regime. The result is a loss of sperm activity, complete atrophy of the testicles.
  • Bad habits. When smoking, drinking alcohol, the body undergoes intoxication, and this is a disruption of the endocrine system, a decrease in testosterone production and, as a result, minimal cell activity.
  • Excessive or prolonged use of drugs such as cytostatics, steroid hormone blockers - any agent causes a decrease in sperm activity. Anticonvulsants and antibiotics also have a bad effect.
  • Nutrition. An irrational diet with a large amount of fat, soy, soda leads to hormonal imbalance, metabolic disorders, causing the death of male germ cells, regardless of their level of mobility.

Important! To increase sperm motility due to a violation of the diet, medication, it is enough to eliminate the problem and after 1-2 weeks the activity of the cells will rise significantly. For other factors, please consult your doctor..

How to increase sperm motility?

If the percentage of sedentary sperm is low, then there is no reason to worry. The doctor will not offer treatment, but will only adjust the diet, lifestyle. In case of significant violation of the standards, more radical methods of therapy will be offered: medical, surgical (varicocele).

Medicines


In some cases, vitamin supplements are prescribed: zinc citrate, magnesium, selenium, as well as supplements with L-carnitine: PROfertil, Spermaplant, Spermaktiv.

In the case of a pathological infection, the patient will have to undergo a course of antibiotics, followed by rehabilitation to improve spermatogenesis. Hormonal imbalance is normalized by drugs prescribed depending on the cause of the pathology.

Important! Anti-inflammatory, antimicrobial, hormonal drugs always affect the motility of germ cells. Therefore, after curing the cause of the pathology, sperm motility should be increased through the listed drugs (vitamins, supplements). Self-treatment in violation of spermatogenesis - as a consequence of pathologies is prohibited! Prescribing the wrong drug will lead to cell death and complete loss of fertility..

Food


You can quickly and easily increase sperm motility on your own: adjust the diet. Preference is given to white meat, fish, cereals, vegetables, fruits and greens. Particularly useful for men are parsley, dill - herbs can quickly increase cell activity, increase volume and improve sperm quality.

Physical activity is the key to a normal sexual life. But the activity should be without overstrain, it is noticed that in athletes after a strong load, the viability of germ cells decreases.

What foods will be restricted?

  • fatty, smoked, very spicy and salty foods;
  • red meat;
  • alcohol;
  • flour products;
  • spices.

What will help to quickly improve sperm motility:

  1. dried apricots;
  2. carrot;
  3. oatmeal;
  4. spinach;
  5. broccoli;
  6. tomatoes;
  7. strawberry;
  8. asparagus.

It is very good to add avocados, oysters, nuts to the menu - products can increase cell activity by replenishing the volume of trace elements and vitamins. Pine nuts and hazelnuts are especially suitable for men. Beekeeping products bring even very inactive cells back to life, so bee bread, honey, drone milk should not be ignored.

Important! Dietary changes often work much better than any medication. If the attending physician does not mind, there are no infectious pathologies, genetic and structural disorders, it is enough to revise the menu to achieve the desired.

ethnoscience

In addition to taking bee products, folk recipes offer a lot of options on how to increase sperm motility:

  1. 50 gr. crushed ginseng root pour 1 liter. vodka without additives. Infuse for 15 days and take 10 drops (no more) before each meal.
  2. Folk recipe with St. John's wort recommends 1 tbsp. l. hay pour 1 liter. boiling water overnight and put in a dark place. Drink without straining (let the grass infuse), 0.5 tbsp. twice a day. Having finished one infusion, prepare the next one, the course of treatment is 14 days.
  3. Dry elecampane root - a recipe for increasing sperm activity, reduced by excessive consumption of alcohol, tobacco. Pour 1 tbsp. l. raw materials 1 tbsp. water, boil for 10 minutes and leave for 30 minutes. Strain, drink 1 tbsp. l. 4 times a day for a course of 10 days.

It is much easier to prevent the disease than to look for an option on how to increase sperm motility. In order not to run into a problem, prolonged stress, overheating and hypothermia should be avoided. Remember that a man should visit a urologist regularly, and if the number of progressive male cells has decreased, the treatment must be completed. The general course of treatment can take up to several months, but this is the only way to prevent male infertility.

), which consists in the study of the entire ejaculate obtained to determine the quantitative, qualitative and morphological characteristics of sperm.

As a rule, a spermogram is prescribed in conjunction with other tests to identify the cause of infertility in marriage, as well as in case of male infertility and the presence of inflammatory or hormonal diseases of the male genital organs.

In addition, a spermogram is mandatory before IVF and artificial insemination.

Preparation for the delivery of ejaculate

In order for sperm indicators to be reliable, it is necessary to prepare for its delivery:

  • abstinence from 2 to 7 days (optimally 3-5 days);
  • refusal to drink alcohol, strong tea, coffee and drugs during the entire period of abstinence;
  • refusal to visit the bath, sauna, taking a hot bath and shower, a ban on the solarium and sunbathing for the above period of time.

Sperm is given directly in the laboratory (special room) by masturbation. It is possible to bring coitus interruptus ejaculate from home into a medical condom, but the delivery time should be no more than three hours, and the temperature of the delivered semen should be around 36°C (armpit). It should be borne in mind that ejaculate obtained outside the laboratory may spill on the way to it, which will affect sperm counts.

Spermogram norms

Volume

The norm of ejaculate is 3-5 ml. Reduced (less than 2 ml) indicates either a violation of the delivery of sperm to the laboratory, or a lack of functions of the gonads (prostate, seminal vesicles, and others). An increase in the amount of sperm indicates the presence of an inflammatory process in the genitals.

Colour

Normally, the color of the ejaculate is whitish, grayish or with a hint of yellow. The red or brown color of the semen indicates either an injury to the genitals, or stones in the prostate or chronic vesiculitis (the red tint is due to the admixture of red blood cells).

Acidity

The normal pH of sperm is 7.2-7.8 (alkaline). Deviations in one direction or another indicate the inflammatory process of the sex glands.

Liquefaction time

The time of semen liquefaction should not exceed 60 minutes. If the liquefaction time is prolonged, the sperm cells in the acidic environment of the vagina waste their energy and lose activity, which significantly reduces their ability to fertilize the egg. Most often, a long liquefaction time is observed in chronic prostatitis and / or vesiculitis.

Viscosity of semen

To determine the viscosity of the ejaculate, measure the length of the thread flowing down from the end of the pipette. Normally, it is no more than 0.5 cm.

An elongated thread (increased viscosity) indicates either chronic prostatitis or vesiculitis. Thick and viscous sperm significantly reduces the chances of conception, so it is difficult for sperm to move into the vagina, which further enhances the negative impact of the acidic environment on them.

The number of spermatozoa in 1 ml of ejaculate

Normally, 1 ml of semen should contain more than 20 million. spermatozoa.

A decrease in sperm density is called oligozoospermia, which indicates ineffective testicular function (reduction of androgens, inflammation of the testicles, a history of toxic damage to the spermatogenic epithelium of the testicles, weakened immunity, metabolic disorders, etc.).

Reduced concentration reduces the chances of fertilization. An increase in sperm density or polyzoospermia (more than 120 million in 1 ml) precedes oligozoospermia.

Total sperm count

The total number of spermatozoa in the studied ejaculate must be more than 60 million. The decrease in density is associated with the same factors as the decrease in the concentration of spermatozoa in 1 ml of semen.

Sperm motility

The chances of fertilization depend on sperm motility. There are 4 groups of sperm:

  • group A - active motile spermatozoa with rectilinear movement;
  • group B - sedentary spermatozoa with rectilinear movement;
  • group C - sedentary spermatozoa, the movements of which are oscillatory or rotational;
  • group D - spermatozoa are immobile.

Normally, there should be more than 25% of sperm from group A or 50% of sperm from groups A and B.

Reduced sperm motility is called asthenozoosperia and indicates inflammatory processes of the genital organs, toxic lesions and thermal effects on the male gonads (testicles).

Morphology

With the help of this indicator, the number of normal spermatozoa is determined.

Normally, unchanged spermatozoa should be more than 20%. Teratozoospermia is said to be when the number of normal sperm is less than 20%.

The morphology of spermatozoa is affected by toxic and radiation damage, inflammatory and infectious processes, as well as ecology.

Live spermatozoa

This indicator estimates the percentage of live sperm in the ejaculate. The smaller it is, the lower the chance of conception. Normally, live spermatozoa should be more than 50%.

They speak of necrospermia with a decrease in the described indicator, which can be a temporary phenomenon in case of intoxication, infectious disease, stress. Permanent nercospermia occurs when the testicles are damaged by radiation, toxic substances, or thermal exposure.

spermatogenesis cells

The number of desquamated cells of the spermatogenic epithelium of the seminiferous tubules should be no more than 2%.

Agglutination and aggregation

Normally, there is no gluing of spermatozoa (agglutination) and accumulation of spermatozoa in clots.

Leukocytes and erythrocytes

Normally, there are no erythrocytes in the ejaculate, and the number of leukocytes does not exceed 3-4 per field of view. If there are more leukocytes, this indicates an inflammatory process in the male genital organs.

Slime

Normally, there is no mucus in the semen or it is in a small amount. The detection of a significant amount of mucus indicates an inflammatory process of the prostate and seminal vesicles.

Deviations from the norm

  • oligozoospermia - low sperm concentration;
  • asthenozoospermia - low sperm motility;
  • teratozoospermia - a reduced number of morphologically normal forms;
  • azoospermia - no sperm in the ejaculate;
  • aspermia - no ejaculate;
  • oligospermia - the amount of sperm is less than 2 ml;
  • leukospermia - an increased number of leukocytes;
  • akinospermia - all spermatozoa are motionless;
  • cryptospermia - a very low content of spermatozoa, which are determined only after centrifugation of the ejaculate.

Methods for improving sperm quality

In addition to eliminating inflammatory and endocrine diseases, the treatment of which is prescribed by a doctor (antibiotics and hormones), to improve the quality of sperm, you must follow simple rules:

Temperature regime

The testicles are the only organ that is outside the abdominal cavity. Therefore, heating the testicles contributes to the deterioration of sperm quality: the activity of spermatozoa decreases and pathological morphological forms appear.

Accordingly, it is worth refusing to take frequent hot baths / showers, visit the bathhouse and sauna less often, and give up the pleasure of soaking up in the jacuzzi.

In addition, clothing (underwear and trousers) should be loose, not squeezing the testicles or overheating them. It is recommended to abandon tight-fitting underpants, tight jeans.

avoid stress

Stressful situations “hit” not only the nerves, but also the spermatozoa. If possible, conflicts, overwork, and nervous tension should be avoided.

sex life

An equally important role in the quality of sperm is played by the rhythm of sexual life. Too rare sexual intercourse leads to a decrease in sperm motility, and, on the contrary, frequent intimate contacts make the sperm "liquid", that is, the content of spermatozoa in it is significantly reduced.

The optimal rhythm of sexual life is 4-6 times a week.

Weight and sport

Excess body weight is the accumulation of an excess subcutaneous fat layer that produces estrogen, which also negatively affects sperm activity.

Normalization of weight will help a balanced diet and regular (2-3 times a week moderate physical activity). Particularly useful are physical exercises aimed at strengthening the muscles of the pelvic floor and abdominals.

Balanced diet

It is necessary to abandon semi-finished products and products that contain preservatives and flavor enhancers.

Food should contain foods that contain large amounts of vitamins E, groups B, C, and trace elements selenium and zinc.

The listed biologically active substances have a beneficial effect on the quality of sperm.

The list of products should include seafood, greens (dill, parsley, cilantro, celery), carrots, pumpkin, garlic, asparagus, tomatoes, pomegranates, apples, bananas and avocados.

Also, the diet must include milk and dairy products, beef and veal, fish, nuts in large quantities, mushrooms, buckwheat, oatmeal, liver and legumes.

Bad habits

Bad habits have a very negative effect on the number and activity of spermatozoa. It is necessary to stop smoking and drinking alcohol (or at least reduce the amount), especially beer, which contains a lot of phytoestrogens.

And, of course, a complete abstinence from drugs. The same applies to excessive consumption of strong tea and natural coffee. These drinks are best replaced with freshly squeezed juices and mineral water.

Environmental factors

It is not possible for one person to normalize the environment around, but it is possible to minimize the impact of harmful factors. You should not keep the laptop on your knees (overheating of the testicles), try to reduce contact with toxic substances (varnishes, paints, household chemicals and other "harmful things"), breathe fresh air more often.

Spermogram deviations from the norm and IVF

Almost 50% of men have certain deviations from the normal spermogram. Some of them are enough to establish a day and rest regimen, rationalize nutrition, give up bad habits - this improves sperm quality and increases fertility (the ability to fertilize).

But in some cases, only IVF will help to conceive a child, the procedure of which includes a selection of active and without pathological deviations from the morphology of spermatozoa.

With pathological results of the spermogram (the presence of azoospermia, teratospermia, necrospermia, asthenozoospermia, and others), the IVF procedure is extended, one of the stages of which is ICSI.

ICSI is an assistive technology and consists of several stages:

  • obtaining viable sperm from the testicle using microsurgical operation;
  • spermatozoa cultivation;
  • selection of the best and most active sperm;
  • implantation of the spermatozoon with the help of intracytoplasmic injection into the egg;
  • freezing the remaining viable spermatozoa for the future.

In addition to deviations from the norm of sperm analysis, ICSI is performed in the presence of antisperm antibodies, both in women and in men.

Forecasts

The prognosis after the IVF procedure in conjunction with ICSI depends on two factors. First, the chances of egg fertilization increase when active, viable spermatozoa are obtained from the testicle or ejaculate. And secondly, the higher the quality of the eggs received from a woman, the higher the percentage of their fertilization.

During ICSI, fertilization of eggs occurs in 60-70% of cases, which is significantly higher (by 30%) during the standard IVF procedure.

In addition, 90-95% of fertilized eggs develop into an embryo.

Sperm is the male seminal fluid or ejaculate. Spermogram is a semen analysis. A standard spermogram takes into account physical parameters: sperm volume, color, viscosity, pH; and microscopic parameters: the number and motility of spermatozoa, the content of other cells, etc. Based on the data obtained, it is possible to make an assumption about male infertility, prostatitis, and possible infections.

What is a spermogram?

Spermogram - analysis of ejaculate. Sperm analysis is based on determining the properties of male germ cells. Their physical properties, chemical and cellular composition of sperm are determined, and the number of spermatozoa is counted.

Why does the doctor prescribe a spermogram?

The spermogram shows the ability of a man to fertilize and, in addition, is the most important method for diagnosing urological diseases. Making a spermogram is fast, simple and inexpensive. But the result of a semen analysis is often enough even to make a diagnosis.

How is semen obtained for analysis?

Masturbation is recognized as the ideal method of obtaining sperm for analysis. This method is recommended by the World Health Organization. It is best to obtain sperm in the clinic, this will allow specialists to begin analysis immediately after liquefaction of the ejaculate. It is also possible to collect the material at home if the patient can ensure the delivery of the semen to the laboratory within 1 hour. Those wishing to bring ejaculate from home in good clinics are given a special transport container for sperm, but you can deliver the sperm to the laboratory and in the armpit within half an hour from the moment of collection.

Before donating sperm for analysis, sexual abstinence for 3-5 days is recommended. It is recognized that a shorter period of abstinence can lead to an underestimated volume of sperm and sperm count, a longer period to a decrease in motility and an increase in abnormal spermatozoa. However, this relationship is not always clearly seen.

How to pass a spermogram correctly?

In order to submit sperm for analysis and obtain reliable spermogram results, some requirements must be met:

  • refrain from sex and masturbation for at least 3-4 days
  • do not drink alcohol (even beer), drugs
  • you can not bathe in a bath or sauna, it is better to wash in the shower.
  • It is better to make a spermogram in the laboratory of a specialized clinic by masturbation or coitus interruptus. Moreover, it is better to donate sperm for analysis without using a condom, because when in contact with latex and the substances with which the condom is impregnated, spermatozoa lose their mobility, respectively, the results of the spermogram will be unreliable.

If you still decide to take a spermogram at home, avoid direct sunlight on the sperm, hypothermia of the sperm. Use sterile utensils to collect semen. Try to keep all the semen that comes out for analysis. The loss of part of the sperm, especially the first portion, makes the overall picture of the spermatogram inaccurate. For a correct diagnosis, it will be necessary to pass the sperm for analysis 2-3 times.

Spermogram norms:

INDICATOR NORM
Volume At least 2 ml

Color White grayish
Liquefaction time 10-40 minutes
pH 7.2-7.8

The number of sperm in 1 ml is 20-120 million.
The number of sperm in the ejaculate is 40-500 million.
Actively mobile (category A) Not less than 25%
Weakly mobile (category B) A + B at least 50%
Non-progressively movable (cat. C) С + D no more than 50%
Fixed (category D)
Pathological spermatozoa Not more than 50%
The number of rounded cells No more than 5 million.
Spermagglutination No
Leukocytes Up to 3-5 per field of view

When studying spermogram data, the doctor pays attention to the following spermogram indicators:

    the volume of sperm is normal - 3-5 ml (about 1 teaspoon). A decrease in the amount of sperm secreted usually indicates a reduced function of the testicles and gonads. Similar results of a spermogram indicate possible male infertility.

    the number of spermatozoa in 1 ml of semen. The norm of spermogram is 60-120 million / ml in 1 ml. A bad spermogram will show a lack of sperm in the semen (oligozoospermia) or their complete absence (azoospermia).

    sperm motility. Normally, a spermogram will show 60-70% active, 10-15% immobile and 20-25% immobile spermatozoa. The normal ratio will be 70-80% of live spermatozoa and 20% of dead ones, up to 20% of pathological spermatozoa is also considered the norm. The predominance of immobile spermatozoa in semen (necrospermia) is an alarming signal that indicates male infertility or the presence of inflammatory diseases of the male genital area.

    a normal spermogram shows the absence of any impurities, mucus in the semen. Blood in semen (hemospermia), microflora, erythrocytes, leukocytes (more than 10), epithelial cells (more than 2-3) are a deviation from the norm, which means symptoms of urological diseases.

    the spermatogram also takes into account other indicators (in brackets - the permissible norm): sperm viscosity (0-5 mm), pH (7.2-7.4), liquefaction time (20-30 minutes), fatigue (percentage of mobile forms after 1 an hour decreases by 10%, after 5 hours - by 40%), the speed of spermatozoa (3 mm / min) and many others.

Deciphering spermogram

Ejaculate liquefaction time- the first studied parameter of sperm. Ejaculated semen is usually coagulum, that is, it is not completely liquid. After some time, the ejaculate becomes liquid under the action of prostate enzymes contained in the seminal fluid. Liquefaction is determined by the change in the viscosity of the semen. To do this, the ejaculate collected in a syringe is released through a special needle. Viscosity is measured by the length of the "thread" trailing behind the released drop. Sperm is considered liquefied if the "thread" does not exceed 2 cm. Normal semen liquefies after 10-40 minutes (in some laboratories, liquefaction within one hour is considered normal). If the liquefaction is delayed or does not occur at all, this may indicate a violation in the work of the prostate gland.

Ejaculate volume- one of the most important characteristics of sperm. Together with the concentration of sperm, this indicator gives an idea of ​​the total number of sperm ejaculated during intercourse. A volume of less than 2 ml can be considered as a cause of male infertility (oligospermia). It's not just that a small ejaculate contains few spermatozoa. Even if the concentration of sperm is high, and their total number far exceeds the required 40 million, there is still a threat to normal conception.

When erupting into the vagina, spermatozoa are exposed to aggressive conditions. The acidic environment of the vagina is detrimental to spermatozoa and most of them die within 2-3 hours. During this time, the most mobile and "healthy" sperm must have time to penetrate into the uterus, where the conditions for their life are favorable (sperm can remain mobile in the uterus and fallopian tubes for three days or more). Seminal fluid (or seminal plasma) alkalizes the vaginal environment for a while, making it less acidic, and allows active sperm to enter the uterus. It is believed that a small volume of seminal fluid "does not cope" with this task: the smaller the seminal fluid, the less time it will be able to restrain the acidity of the vagina.

In addition, seminal plasma locally suppresses the immunity of the spouse (after all, for the immune system of a woman, spermatozoa are foreign microorganisms). And from this point of view, volume also plays a significant role.

However, too much sperm does not give a man an advantage. As a rule, no more than 5 ml of ejaculate is placed in the vagina, while the extra milliliters flow out and do not participate in conception.

Due to the importance of determining semen volume, the patient should collect as much of the ejaculate as possible into the container. In case of loss of more than one fourth of the ejaculate intended for analysis, it is necessary to inform the specialist of the clinic about this. It should be borne in mind that the first part of the ejaculate is the richest in spermatozoa.

Unfortunately, in some cases there is no ejaculation at all, despite the sensations of orgasm. This may indicate the so-called "retrograde ejaculation" (ejaculation into the bladder). In such cases, it makes sense to examine the urine after orgasm, whether there are spermatozoa in it.

ejaculate color. Most men have "white-grayish" semen. Numerous shades: milky white, yellowish, transparent cannot clearly indicate any violations. The only exception is the ejaculate of a "pinkish" color, indicating hemospermia - an increased content of red blood cells in the semen.

Hydrogen indicator(pH), or, more simply, the acidity of the ejaculate - can often be an important clue in determining reproductive and sexual dysfunction. Normal ejaculate has a slightly alkaline reaction of the environment (pH 7.2-8.0). A change in this indicator in one direction or another from the norm, if there are no other deviations, cannot indicate any violations. But in combination with other signs, it affects the diagnosis. For example, an increased pH with an increased content of rounded cells and non-liquefaction of sperm will strengthen the opinion of a specialist about a possible violation of the prostate gland of an infectious nature; lower pH in azoospermia will give hope for its obstructive nature (there are spermatozoa, but the ejaculatory ducts are clogged), etc. And yet, the main properties of sperm can be found by examining it under a microscope.

Sperm count- the first thing experts pay attention to. Usually the amount is expressed as a concentration (so many millions per milliliter). In a normal ejaculate, there are at least 20 million spermatozoa per milliliter (at least 40 million in total semen volume).

Sperm motility just as important as their number, because what good is a lot of sperm if they do not move. It is customary to divide spermatozoa into 4 categories of motility.

Category A includes sperm with fast and rectilinear movement, the speed of their movement must be at least 0.025 mm / s (that is, at least half of its own length per second).
Category B includes sperm with slow rectilinear movement, the speed is less than 0.025 mm/s, but the movement trajectory is still straight.
Category C includes spermatozoa that do not move in a straight line (both those that barely flounder in place and those that are worn in circles).
Finally, category D - completely immobile spermatozoa.
All categories of mobility are always present in the ejaculate. Usually, most immotile spermatozoa of category D (from 40% to 60%), as a rule, are deceased or dying "of old age" spermatozoa. Therefore, the less abstinence before ejaculation, the less immobile spermatozoa in the ejaculate. There are also usually a lot of fast straight category A sperm (40-60%), these are healthy, "young" spermatozoa that have recently formed in the testicles. Category B non-progressively motile spermatozoa are usually 10-15%; as a rule, these are spermatozoa with violations of the structure of the neck and flagellum, or "aging". Also, there are usually few slow spermatozoa with direct movement of category C (5-15%).

In normal fertile sperm, progressively motile spermatozoa (A + B) should be at least half, or fast progressively motile (A) at least a quarter. Many factors affect sperm motility. An important factor is temperature: at body temperature (about 37C) the speed of movement is maximum, at room temperature it decreases, and at a temperature of less than 10C, spermatozoa almost do not move. It is not uncommon for spermatozoa classified as category B at room temperature to be classified as category A when viewed at 37°C. Therefore, in a number of laboratories, the spermogram microscope is equipped with a special heated “thermotable” adjusted to 37C.

There are methods to find out how many spermatozoa among the immobile are alive. To do this, the sperm is stained with eosin. This red substance cannot penetrate the membrane of the sperm, but the membrane of the dead sperm is quickly destroyed, and it turns red. It makes sense to use this method for akinozoospermia - the complete immobility of spermatozoa, in order to find out whether this immobility is associated with death or violations of the flagellar apparatus. Accordingly, a fertility treatment plan can be developed.

The proportion of abnormal spermatozoa is determined by two methods. The first is the study of the morphology of spermatozoa in the native ejaculate, that is, the sperm, as it is (native), is examined under a microscope. At the same time, they try to count how many spermatozoa out of 100 are abnormal. This method is very inaccurate, because, firstly, not all pathologies can be seen without special processing of sperm, and secondly, spermatozoa move and are difficult to examine in detail. If abnormal spermatozoa exceed the barrier of 50%, the study of the morphology of spermatozoa is carried out on a stained smear. To do this, a drop of sperm is smeared on a glass slide, dried in a stream of air, treated with alcohol, dried again, immersed in several different dyes, washed off excess paint and enclosed in a special microscopy balm. After this treatment, the spermatozoa are immobilized, stained and glued to the glass. They can be easily examined and counted, and violations that are invisible with the first method (for example, the absence of an acrosome) can be detected.

To assess the quality of sperm, not only the proportion of abnormal spermatozoa is considered (it should be less than 85% in a stained smear), but also the average number of pathologies per spermatozoon (the so-called sperm disorder index, SDI) and the average number of pathologies per one abnormal spermatozoon (the so-called teratozoospermia index, TZI). If the TZI value exceeds 1.6, sperm is considered abnormal, and if the SDI value exceeds 1.6, problems may occur even with artificial insemination.

Spermagglutination, or agglutination of spermatozoa- a signal of formidable immune disorders, which, unfortunately, is not always given due attention. It is often misunderstood that agglutination prevents sperm from moving freely and reaching the egg. This is not true. By itself, gluing usually affects a small part of the spermatozoa, and does not prevent the movement of the majority, but the presence of agglutination may indicate the presence of antisperm antibodies in the ejaculate, which may be the cause of infertility. True spermagglutination is not always easy to recognize, sometimes special methods are required to distinguish it from spermaggregation.

Sperm aggregation- this is a bonding caused not by immune causes, but by the mucus contained in the seminal fluid. Sperm aggregation does not affect sperm fertility.

Antisperm antibodies(ACA, or ACAT) are the body's antibodies against spermatozoa. Connecting with the flagellum, ASA inhibit the movement of the spermatozoon. Sticking to the head, prevent fertilization. ASA can be formed both in the body of a man and in the body of a woman, causing infertility. Various methods are used to diagnose ASA in semen, the most common of which is the MAR test (Mixed Immunoglobulin Reaction - “mixed immunoglobulin reaction”).

In addition to spermatozoa, there are so-called rounded cells in the ejaculate. This collective name refers to leukocytes and immature spermatogenesis cells, that is, cells from which mature spermatozoa are formed in the testicles. Fine leukocyte concentration should not exceed 1 million / ml. It is generally accepted that a high concentration of these immune cells may indicate inflammatory processes in the accessory sex glands (prostate or seminal vesicles). It is difficult to distinguish leukocytes from immature spermatogenesis cells without special staining, so WHO recommends staining if the total concentration of all rounded cells exceeds 5 million/ml.

What terms are used to describe sperm disorders?

There are various terms to describe sperm disorders.

Normospermia - all the characteristics of the ejaculate are normal, normal sperm.
Normozoospermia - all characteristics associated with sperm fertility are normal, but deviations are acceptable that do not affect infertility (increased content of rounded cells, abnormal pH, abnormal viscosity or non-liquefaction of the ejaculate).
Oligospermia - insufficient volume of ejaculate (less than 2 ml).
Oligozoospermia - insufficient number of spermatozoa (concentration less than 20 million / ml).
Asthenozoospermia - insufficient sperm motility (A<25% или A+B<50%).
Akinozoospermia - complete immobility of spermatozoa.
Teratozoospermia - increased content of abnormal spermatozoa (more than 50% when examining native ejaculate or more than 85% when examining a stained sperm smear).
Necrozoospermia is the absence of live spermatozoa.
Leukocytospermia - the content of leukocytes is increased (more than 1 million / ml).
Hemospermia is the presence of red blood cells in the ejaculate.
Azoospermia is the absence of sperm in the ejaculate.

Every single characteristic of sperm varies greatly over time. If the volume of semen during the analysis was 3 ml, then at the next ejaculation it may have completely different values, it will also have different values ​​after a month, especially after six months. The same principle applies to the rest of the parameters. That is why it is generally recognized in reproductive medicine that for analysis it is necessary to examine the semen twice with an interval of at least two weeks, and in the case of significant differences in the parameters - three times.

Of course, the results of a spermogram are individual for each person. Do not try to self-diagnose yourself on the basis of the results of the spermogram, only a doctor can comprehensively evaluate the sperm analysis data and draw the right conclusion about your state of health.

How to improve sperm quality?

Giving up bad habits and proper nutrition will help, read more in the relevant topics.