Rodriguez The Semen Analysis

Transcription

1 RODRIGUEZ 2016

2 Rodriguez 2016 The Semen Analysis

3 DISCLOSURE "Yo divulgo que no tengo relación financiera con intereses comerciales". RODRIGUEZ 2016

4 Question1 Fill the Blanks with the Correct Statement SEMEN ANALYSIS NOMENCLATURE - SPERMIA REFERS TO SEMEN Aspermia Increased Ejaculate Volume Hypospermia Presence of WBC s in semen Hematospermia RODRIGUEZ 2016

5 Question 2 Fill the Blanks with the Correct Statement SEMEN ANALYSIS NOMENCLATURE - ZOOSPERMIA REFERS TO SPERM Azoospermia Decreased Sperm Count Asthenozoospermia Decreased Normal Morphology Necrozoospermia RODRIGUEZ 2016

6 The Semen Analysis in the Gynecologist s Office RODRIGUEZ 2016 Fernando Rodriguez, Ph.D. GENES fertility institute San Juan, Puerto Rico An Andrologist Perspective Rodriguez 2011

7 The Semen Analysis What is a Normal Semen Analysis? Is Semen Analysis just a Sperm Count? What is the Impact of an Inaccurate Sperm Count on Clinical Diagnosis? What would be the Implications of an Inaccurate Sperm Count for Clinical Decisions and Treatment? Rodriguez 2016

8 The Sperm Count Reports Rodriguez 2016

9 Is Semen Analysis just a Sperm Count? SA is nowadays an overall term encompassing a whole series of cytological, biochemical and immunological methods performed on the cellular and fluid components of fresh semen samples. Assessment of sperm numbers, sperm motility and morphology; simple functional and immunological tests. Seminal biochemistry and microbiology. Ultrastructural cell biology; cellular biochemistry and immunology, and sperm physiology. Rodriguez 2016

10 A clinical report brought to the office! Taken: 7:15 am Received: 7:40 am Evaluated (counted in a different laboratory): 2:30 pm Motility: at receiving 50% 1 hr 35% 3 hrs. 10% 6 hrs. 0% Rodriguez 2016 Vol: 2 cc Viscosity: Adequate ph: 8.0 Morphology: Normal (????) WBC: 4-6 HPF Test Units Results Flags Normal Range Sperm Count Millions/ml 45.9 Low For this clinical laboratory, reporting a sperm concentration of 46 million per milliliter is considered an abnormal sperm count. Is the patient then diagnosed as oligozoospermic?

11 Another Report! Collection Date: May 27, 2015 Test Performed: 5/28/2015 at 6:44 am (????) Test Units Results Flags Normal Range Sperm Count Millions Low For this clinical laboratory, reporting a sperm count (?????) of million (per milliliter????) is considered a low sperm count. Is this patient then diagnosed as oligozoospermic? Rodriguez 2016

12 ...A Sperm Motility Report Motility Test 1 hr 2 hr 3 hr 4 hr ACTIVE SLUGISH DEAD Rodriguez 2016

13 ...Another Sperm Motility Report Motility Test (%) NM Arrival Hour Hour Hour Hour = Spermatozoa moving but not forward progression 2+ = Spermatozoa moving aimlessly with slow forward progression 3+ = Spermatozoa moving at moderate speed with forward progression 4+ = Spermatozoa moving at high speed with straight line forward progression NM = Non-motile spermatozoa Rodriguez 2016

14 ..Another Sperm Motility Report MOTILITY (%) min hr hr hr hr hr hr hr hr hr Rodriguez 2016

15 Sperm Fructolysis mg. fructose/100 ml semen Buffered semen diluted with buffer (1:1) (control). Semen diluted with ½ volume of buffer Non-buffered/Nondiluted Semen Minutes of Incubation at 37C Rodriguez 2016

16 The Sperm Shape and The Total Functional Sperm Fraction Rodriguez 2016

17 The Semen Analysis Report What is included in an accurate Semen Analysis report? RODRIGUEZ 2016

18 RODRIGUEZ 2013 WHO 2010

19 Total Functional Sperm Fraction (TFSF) Must include the proportion of morphologically normal sperm in order to establish the relative functional capacity of the specimen. V x C x %M x %RFM (3+,4+) x %N Normal RODRIGUEZ 2016 TFSF (million/ejaculate) Abnormal } Where: V = volume of semen (ml) C = sperm concentration in the ejaculate (x10 6 /ml) M = overall sperm motility (%) RFM = Rate of Forward or progressive motility (% grades 3+ & 4+) N = proportion of normal sperm cells (%)

20 Estimated Total Functional Sperm Fraction Jose 60 million sperm per milliliter 5 ml in the ejaculate (volume) 50% motility 50% forward motility 30% normal morphology Juan 60 million sperm per milliliter 2.5 ml in the ejaculate (volume) 25% motility 25% forward motility 15% normal morphology Jose: 60 million x 5.0 x.50 x.50 x.30 = 22.5 million TFSF Juan: 60 million x 2.5 x.25 x.25 x.15 = 1.4 million TFSF RODRIGUEZ 2016

21 Tygerberg Strict Criteria Classification System Routine morphometric analysis using an eye-piece micrometer. Smooth oval shape with a well-defined acrosome comprising 40-70% of the head area. Sperm head must be µm long and µm wide. Must be no neck, midpiece, or tail defects and no cytoplasmic droplets of more than half the size of sperm head. All borderline forms are considered abnormal. Rodriguez 2016 Kruger et. al., Fertil Steril 46,1118

22 Morphology should never be performed on unstained specimens!! Numerous stains are available each with advantages and disadvantages. Sperm Morphology RODRIGUEZ 2016

23 OLIGO ASTHENO what? THE ODD, THE UNUSUAL; AND THE CREEPY NAMES RODRIGUEZ 2016

24 Semen and Sperm Disorders -SPERMIA refers to semen Aspermia no ejaculate volume Low volume (hypospermia) Increased volume (hyperspermia) Hematospermia (presence of RBC s in semen) Sperm antibodies (agglutination) Abnormal viscosity Abnormal liquefaction Leukocytospermia o pyospermia (WBC s in semen) Rodriguez 2016

25 Leukocytospermia? Large numbers of leukocytes (> 5/400HPF), possibly originating from the prostate, can become significant as it suggests a possible accessory sex gland infection. Such infection is likely to affect sperm motility. Leukocytes in semen produce oxidative stress (generation of oxygen radicals) and cytotoxic cytokines secretions (limphokines & monokines), which may interfere with sperm progression. Large numbers of bacteria usually suggests an infection of the reproductive tract, almost exclusively the prostate. Rodriguez 2016

26 Semen and Sperm Disorders -zoospermia Refers to sperm No sperm present - azoospermia Low sperm count - oligozoospermia Low sperm motility - asthenozoospermia Poor sperm morphology - teratozoospermia All spermatozoa dead - necrozoospermia What would Oligoasthenoteratozoospermia be??? Rodriguez 2016

27 Little Known Nomenclature Hypooopsospermia Decrease semen volume due to collection error. Polywhoopiezoospermia Increased sperm count due to enjoying the masturbatorium way too much. Asthenowww.sperm.comzoospermia Decreased sperm motility due to spending too much time surfing the Web. Teratomickeyzoospermia Abnormal sperm morphology in which all the sperm are shaped like Disney characters. Rodriguez 2016

28 What s a Clinical - and - Accurate Rodriguez 2016 Andrology Report?

29 The Clinical Andrology Report Anatomy of a Semen Analysis Report (analysis of the analysis) RODRIGUEZ 2016

30 The Clinical Andrology Report RODRIGUEZ 2016 This is a representative report that contains clinical information and recommendations of value for the referring physician.

31 Andrology Laboratory at GENES Assist the Ob/Gyn with the most current andrology testing and technology designed to evaluate specific male infertility treatments, Provide the Ob/Gyn - and the patient - with educational, counseling and consulting services to help throughout the diagnostic and treatment phases, Support the Ob/Gyn, through diagnosis of the male partner, in attempts to determine the cause of the fertility problem, RODRIGUEZ 2016 Provide the Ob/Gyn with information about the fertility potential of his/her patients.

32 Answers to Question1 Fill the Blanks with the Correct Statement SEMEN ANALYSIS NOMENCLATURE - SPERMIA REFERS TO SEMEN Aspermia No ejaculate volume Increased ejaculate volume Hypospermia Decreased ejaculate volume Pyospermia Presence of WBC s in semen Hematospermia Presence of RBC s in semen RODRIGUEZ 2016

33 Answers to Question 2 Fill the Blanks with the Correct Statement SEMEN ANALYSIS NOMENCLATURE - ZOOSPERMIA REFERS TO SPERM Azoospermia No sperm present Oligozoospermia Decreased Sperm Count Asthenozoospermia Decreased sperm motility Teratozoospermia Decreased Normal Morphology Necrozoospermia All sperm dead RODRIGUEZ 2016