Health care should involve taking care of the entire body. The male reproductive system has specialists and tests to assess the integrity of the structures, seeking diagnoses and options to maintain or restore male health.
The spermogram is an exam that analyzes the health of the prostate and the sperm produced by man through a semen sample collected through masturbation, following the guidelines of the World Health Organization.
The test is commonly requested by a urologist , but it can also be recommended by doctors who specialize in human reproduction and even by an endocrinologist.
It is also known as “semen analysis”, “sperm count”, “seminal cytology” or “study of sperm morphology”.
And it aims to point out data on the patient’s reproductive health, such as prostate conditions.
Doctors typically perform three independent spermograms to obtain more conclusive and reliable results.
The exams are usually done with an interval of one to two weeks between each other so that the same amount of material is collected for analysis.
In addition to being more practical and conclusive than the female infertility test, which can only be done in periods that coincide with the menstrual cycle, the spermogram is not an invasive test, it is painless and does not present health risks.
The spermogram is usually indicated when couples are having problems getting pregnant. Through counting and morphological analysis of the sperm, the exam will define the possible reason for infertility.
The test is also indicated for men who have had a vasectomy and seeks to indicate the success or failure of the operation.
Doctors typically instruct their patients to have the test taken once a month for three months to test the effectiveness of the procedure.
Read more: Is it possible to have a vasectomy by SUS?
Through a laboratory analysis of semen (fluid that contains sperm, sugar and proteins and is released by man through ejaculation), the spermogram also seeks to measure the following factors:
- Semen volume;
- Sperm concentration;
- Semen liquefaction (ability to become liquid);
- Number of sperm;
- Size and shape of sperm;
- Progression speed of sperm;
- Movement (or motility) of sperm.
Finally, the exam seeks to define if there is any physical, genetic or immunological reason that may be causing infertility in man.
First, you need to take a sample of seminal fluid to be analyzed in the laboratory. The collection should be done, preferably, already in the laboratory, although it can be done at home, and the sample must be stored in a wide-mouthed container properly sterilized.
Collection can be done through:
Masturbation (without lubricant): the seminal liquid sample is poured into the collection container.
Interrupted intercourse: when the man removes his partner’s penis just before ejaculation and pours the seminal fluid sample into the collection container.
Special condom: does not contain spermicide and is cleaned of lubricants that can interfere with the test results.
After the collection of the seminal fluid, the sample must be taken to the laboratory for the tests to be conducted.
To obtain the best possible sample, it is necessary to:
- Avoid any form of ejaculation two to five days before collection;
- Wash your hands and penis with soap and water and dry them well;
- Pass the antiseptic provided by the laboratory on the penis and on the tip of the penis (glans and urethral orifice) and dry with gauze to avoid any interference with the test result;
- Do not use any type of lubricant, including saliva.
The test results may not be conclusive if:
- The patient is using medications such as cimetidine, male or female hormones (testosterone and estrogen), sulfasalazine, nitrofurantoin or chemotherapy drugs;
- The patient is using caffeine, alcohol, cocaine, marijuana or tobacco.
- The sample is very cold, as sperm motility can be impaired;
- The sample is very hot, as the sperm count may decrease due to cell death;
- The patient has been exposed to radiation, chemicals (such as pesticides and spermicides), or prolonged heat;
- The seminal fluid sample is incomplete (it is more common to have collection methods other than masturbation)
- The patient has not ejaculated for many days, which can cause a very large variation in the volume of the collected seminal fluid;
- The patient takes the test sick or stressed.
When performing the spermogram exam, a series of levels are analyzed, such as:
- Volume in mL: measures the amount of seminal fluid harvested, in milliliters.
- pH: Measures the acidity or basicity of the collected seminal liquid sample.
- Color and appearance: it is an analysis of the color, opalescence, consistency and smell of the collected seminal liquid sample.
- Liquefaction time: measures the time it takes for the semen to move from its viscous gel state to its liquid state and its permanence in that state.
- Viscosity: it is an analysis of the adhesion of the seminal liquid in a test stick.
- Concentration per mL: a measure of the amount of sperm contained in 1 (one) mL of seminal fluid.
- Total concentration: the measure of the total amount of sperm contained in the sample.
- Morphology: it is an analysis of the shape of the sperm. It assesses whether they are all normal according to Krueger’s morphology, whether they present abnormal physical characteristics, such as more than one flagellum (tail), head or acrosome (organelle located in the head of the sperm, responsible for perforating the egg).
- Leukocyte concentration: indicates whether leukocytes are caused by an infection in the testis.
- Concentration of round cells: indicates if there is the presence of undifferentiated cells, resulting from incomplete spermatogenesis, in the sample.
- Motility: Linear (count of sperm that can swim in a straight line and in a single direction); Non-progressive (count of sperm that can move the tail, but cannot move, or stand still or swim in random directions); Immobile (count of sperm that are unable to move).
- Vitality: seeks to tell the amount of live sperm in the sample. The test is used for patients who have 40% immobile sperm.
It is always important to take the exams for the doctor to evaluate, but in general what you have is:
- Volume in mL: the normal volume, in milliliters, of seminal fluid to be collected in the exam is greater than or equal to 1.5mL.
- pH: the normal pH of a sample of seminal fluid ranges from 7 to 8.2.
- Color and appearance: The seminal liquid has a whitish or slightly grayish color with transparent parts being liquefied, resembling an opal. After seven days, it may turn yellow. If you have this color before this time, the sperm is considered abnormal and may indicate some type of infection. In that case, a doctor should be consulted.
- Liquefaction time : The normal liquefaction time must be less than or equal to 60 (sixty) minutes.
- Viscosity: Viscosity can be normal, increased, decreased or zero. The normal reaches an average of 2.0 cm in height. The augmented one presents superior values, the diminished one, inferior and the null one does not even adhere to the stick.
- Concentration per mL: the normal value of sperm per milliliter of seminal fluid is equal to or greater than 15 million.
- Total concentration: the total number of ejaculated sperm must be equal to or greater than 39 million.
- Morphology: the lower the incidence of sperm with a morphology different from the Kroeger criterion, the better. Sperm with two or no heads, with two or no flagella (tail), must be unusual for the result to be good and in the pattern of fertile men. Healthy men have an incidence equal to or greater than 70% of normal sperm.
- Leukocyte concentration: the normal and considered healthy result is 1 every 1.60mL.
- Concentration of round cells: the normal and considered healthy result is 1 every 1.60mL.
- Motility: Linear (the normal result for considering a fertile man must be equal to or greater than 32% of sperm with progressive linear motility); Non-progressive (in healthy men, non-progressive or immobile motility should not exceed 40% of the total number of sperm. Higher values may indicate infertility);
- Vitality: the more live sperm the better. The normal data for a fertile man must be equal to or greater than 58% of live sperm.
The laboratory or clinic can influence the value of the spermogram test. But, in general, the exam has a price range between R $ 70 and R $ 200 reais. Private health insurance or low-cost clinics may have lower prices, covering part or the full amount of the procedure.
The spermogram may indicate the following problems:
By analyzing the viscosity and acidity of the samples, problems with the patient’s prostate can be identified.
If abnormal results are found, doctors may recommend digital rectal exams or prostate biopsy to accept or rule out possible diagnoses.
This is the absence of sperm in the seminal fluid sample.
Results like this are manifested in a small volume of collected seminal fluid caused by bacterial infections, STDs or obstructions in the seminal channels. Infertility indicator.
It is a concentration of sperm per mL lower than normal.
This low concentration can be caused by infections in the reproductive system, varicocele , STDs, or they can manifest themselves as side effects of medications such as ketoconazole or methotrexate.
It happens when the values of motility (progressive or non-progressive) and vitality are lower than the standard. It can be caused by excessive stress , alcoholism , or autoimmune diseases , such as HIV .
It is the malformation of sperm morphological changes. It can be caused by varicocele, drug use, or inflammation in the reproductive system.
Some terms that appear in the results of spermograms may not be understood by lay people. Understand:
- Hypospermia : the volume of semen ejaculated is less than 1.5mL.
- Oligozoospermia: sperm concentration is below 15 million / mL.
- Mild oligozoospermia : the concentration of sperm ranges between 5 million / mL and 14.9 million / mL.
- Moderate oligozoospermia : sperm concentration varies between 1 million / mL and 4.9 million / mL.
- Severe oligozoospermia : the concentration of sperm ranges between 0.1 million / mL and 0.9 million / mL.
- Astenozoospermia : progressive motility is below 32%.
- Necrozoospermia : the percentage of live sperm is less than 58%.
- Leukocytospermia : there is a high concentration of leukocytes in the sample.
- Teratozoospermia : there is less than 4% of sperm with the ideal shape.
- Azoospermia : there are no sperm in the semen.
- Cryptozoospermia : few sperm are found after centrifugation.
- Normozoospermia : the patient presents a healthy sample.
- Hypokinesia : the sperm has reduced motility.
- Normokinesia : the sperm has normal motility.
- Hyperkinesia : the sperm has increased motility.
Complementary exams and treatments
Upon completion of the examination, the doctor will be able to prescribe tests and procedures that are complementary to the spermogram. Among the most frequent are:
The exam analyzes the rate of fragmented DNA, that is, released from sperm, contained in the seminal fluid. High rates of DNA fragments in the semen are related to spontaneous abortions and increased infertility.
It is like a normal spermogram, only made with lenses that increase up to 1,000 times and that allow a much more accurate analysis of the sperm morphology observed in the samples.
FISH (Fluorescent hybridization in situ)
It is an analysis of the chromosomes contained within the sperm. From this exam, it is possible to know the amount of deficient sperm that may be causing infertility.
This test is aimed at patients who have some type of viral infection that can be transmitted to the fetus, such as Hepatitis and HIV. After separating the spermatozoa by centrifugation, an analysis is made of them and, once the non-infection of the spermatozoa is proven, they can already be used for fertilization.
It is a process that aims to preserve the fertility of patients who wait to start a chemotherapy treatment. The semen is frozen in case the cells eventually stop being produced.
It is estimated that approximately 40% of lesions caused in sperm are related to antioxidant free radicals, which can even damage the genes.
The vitamins are organic compounds and nutrients that the body can not produce on its own. Its consumption can improve the production of sex hormones and help in the sperm count and quality. Check out the main ones:
Vitamin A is essential for the production of male sex hormones. The lack of this substance in the body can reduce the volume of semen, the quantity and the morphology of sperm.
The main sources of vitamin A include:
- Grilled beef liver steak;
- Pasteurized cow’s milk;
- Fish oil;
- Butter without salt;
- Fresh Minas cheese;
- Boiled egg;
- Raw carrots;
- Baked sweet potatoes;
- Cooked spinach;
The vitamin E has a significant antioxidant action that helps maintain the quality of the sperm cell membrane, preventing it from being damaged by the action of oxidizing free radicals.
Deficiency of this vitamin can lead to degeneration of testicular tissue.
The main sources of vitamin E are:
- Wheat germ oil;
- Sunflower oil;
- Peanut butter;
- Corn oil;
- Soy oil;
- Tomato Sauce;
- Sunflower seeds;
- Safflower oil;
- Olive oil;
- Dry apricot;
Vitamin C is another important antioxidant. It is vital for maintaining various functions of the body and also one of the essential vitamins for the development of healthy sperm.
This substance increases mobility and prevents sperm from accumulating, a factor of great importance for them to be able to reach the egg.
The main foods rich in vitamin C are:
- Green cabbage;
Selenium is an extremely important substance for forming well-shaped sperm and keeping them in a number considered normal. It is also an antioxidant that protects these cells from the action of free radicals.
It can be found at:
- Chestnut of Pará;
- French bread;
- Bovine meat;
- Sunflower seeds;
- Tuna fish;
- Whole grain bread;
Zinc is extremely important for the formation of healthy sperm.
It is the most important mineral in male sexual function and is used in almost all aspects of reproduction, such as testosterone metabolism, testis development and sperm production.
In addition, it is extremely important to regulate the mobility and quantity of sperm. Good sources of zinc are:
- Cashew nut;
- Flax seeds;
- Pumpkin seeds;
- Watermelon seeds;
- Egg yolk;
- Bitter chocolate.
In addition to bringing a number of health benefits, such as weight loss, physical exercise can help improve sperm motility by regulating hormones.
Control the weight
Manage and reduce stress
Stress can suppress and decrease sexual function, causing a major hormonal imbalance when felt in the long run. Whenever possible, take steps to manage stress, such as mindfulness techniques , deep breathing and other relaxing activities.
Avoid high temperatures
Situations that greatly increase the scrotal temperature, such as hot tubs, sauna, working with the notebook on your lap and wearing tight underwear can interfere with the synthesis of sperm.
Tobacco has been scientifically proven to double the number of free radicals, reduce the amount and mobility of sperm and increase the risk of abnormal sperm and genetic defects in the embryo.
Drink at least 2 liters of water a day, as semen is made up mostly of water.
Infertility is a serious problem that can affect the lives of many couples who wish to become pregnant, but which is often reversible. If you are having trouble getting pregnant, consult a doctor.
If you have more questions about the spermogram, comment below and we will be happy to answer them.