Microscopic semen analysis

Microscopic analysis of sperm (ejaculate) is performed after its complete liquefaction; the native preparation is studied, the number of spermatozoa is counted in the Goryaev chamber and the stained smear is analyzed. When studying the native preparation, the motility of spermatozoa is determined. Spermatozoa are counted in the following order.

• Actively mobile: performing translational movements and crossing the microscope's field of view in less than 1 s; normally, there are more than 50% of them.
• Low-mobility: with slow progressive movement; normally there are less than 50% of them, as well as with arena-like, oscillatory or pendulum-like movement (less than 2%).
• Immobile; normally absent.

A study of a native preparation gives an approximate idea of the number of spermatozoa. When counting spermatozoa in a Goryaev chamber, their number is determined in 1 ml of ejaculate and in all the obtained material. Normally, a healthy man has more than 20 million spermatozoa in 1 ml of ejaculate, and more than 80 million in all the ejaculate. A decrease in the number of spermatozoa to less than 20 million in 1 ml of ejaculate is considered oligozoospermia (grade I - 10-19 million in 1 ml, II - less than 10 million in 1 ml).

Pathological forms of spermatozoa are also detected in the Goryaev chamber, their content normally does not exceed 40%. On average, 81% of the sperm of a healthy man are normal spermatozoa, 15% of spermatozoa have pathology in the head area, 2% - pathology of the neck, 2% - pathology of the tail. An increase in immobile (dead) spermatozoa in the ejaculate is called necrozoospermia.

Spermatogenesis cells, which are normally represented by spermatids, are found in each ejaculate. Their content in sperm does not exceed 2-4%; an increase of 10% or more indicates a violation of spermatogenesis.

An increase in the content of pathological forms of spermatozoa in semen is teratospermia. Pathological forms include spermatozoa with huge heads, with two heads, with two tails, without a tail, with a thickened deformed body, with a deformed neck, with a tail bizarrely twisted around the head, with a loop in the upper third of the tail. Teratospermia sharply reduces the possibility of fertilization, and if it occurs, it increases the possibility of developmental defects in the fetus. Teratospermia is usually combined with a decrease in the number of spermatozoa and their mobility. A complete absence of spermatozoa in the preparation is azoospermia. If neither spermatozoa nor spermatogenesis cells are found in the ejaculate under study, aspermia is diagnosed. This pathology is associated with profound suppression of spermatogenesis (atrophy of the seminiferous epithelium in the convoluted tubules, thickening of the basement membrane or their hyalinization, absence of pituitary gonadotropins in the body).

When studying a native preparation, agglutination is sometimes detected - the formation of sperm clumps, glued together by their heads or tails. In a normal ejaculate, sperm do not agglutinate. A chaotic accumulation, a pile-up of sperm and their ability to accumulate around lumps of mucus, cells, detritus cannot be mistaken for agglutination; this phenomenon is called "pseudoagglutination". Agglutination is caused by the appearance of antibodies against sperm, its degree is assessed as follows:

• weak - in the native preparation, individual spermatozoa are glued together;
• average - up to 50% of sperm are glued together, but only in the head area;
• strong - spermatozoa are glued together by both heads and tails;
• mass - almost all sperm are glued together.

The study of spermatogenesis cell morphology and their differentiation with leukocytes is carried out in a stained preparation. Normally, the ejaculate contains 4-6 leukocytes per field of vision; an increase in their content (as a consequence of inflammation) is called pyospermia.

Erythrocytes are usually absent. The appearance of erythrocytes in the ejaculate - hemospermia - is observed with varicose veins of the seminal vesicles, stones in the prostate gland, papilloma of the seminal vesicle and neoplasms.

Lipoid bodies (lecithin grains) are a product of prostate gland secretion. They are present in large quantities in normal ejaculate.

Spermine crystals may normally appear when sperm is overcooled. The appearance of spermine crystals in the ejaculate indicates insufficient spermatogenesis. The detection of amyloid concretions in the ejaculate indicates a pathological process in the prostate gland (chronic prostatitis, adenoma).

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