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- volume less than or equal to 2.0 mL
- sperm count greater than or equal to 20 million per mL
- motility (movement of the sperm) value is greater than or equal to 50% with forward progression, or greater than or equal to 25% with rapid progression within 60 minutes of ejaculation
- morphology greater than or equal to 30% with normal forms
- white blood cell count less than 1 million per mL.
semen analysisLab medicine A procedure for evaluating possible ♂ causes of infertility; sperm are ↓ in some forms of infertility or post-vasectomy Ref range Count 20–200 x 109; volume 1.5-6.0 mL; morphology > 70% mature and without defects; > 60% motility; pH 7.5–8.5; liquefaction > 70%. See Post-vasectomy semen analysis, Sperm, Vasectomy.
se·men a·nal·y·sis(sē'mĕn ă-nal'i-sis)
SpecimenSemen from ejaculate specimen collected in a clean, dry, glass container known to be free of detergent. The specimen container should be kept at body temperature (37°C) during transportation.
|Color||White or opaque|
|Appearance||Viscous (pours in droplets, not clumps or strings)|
|Clotting and liquefaction||Complete in 15–20 min, rarely over 60 min|
|Sperm count||Greater than 15 million/mL|
|Total sperm count||Greater than 39 million/ejaculate|
|Motility||At least 40% at 60 min|
|Vitality (membrane intact)||At least 58%|
|Morphology||Greater than 25–30% normal oval-headed forms|
This procedure is contraindicated for
- Assist in the diagnosis of azoospermia and oligospermia
- Evaluate infertility
- Evaluate effectiveness of vasectomy
- Evaluate the effectiveness of vasectomy reversal
- Support or disprove sterility in paternity suit
There is marked intraindividual variation in sperm count. Indications of suboptimal fertility should be investigated by serial analysis of two to three samples collected over several months. If abnormal results are obtained, additional testing may be requested.
|Abnormality||Test Ordered||Normal Result|
|Decreased count||Fructose||Present (greater than 150 mg/dL)|
|Decreased motility with clumping||Male antisperm antibodies||Absent|
|Normal semen analysis with infertility||Female antisperm antibodies||Absent|
- Hyperpyrexia (unusual and abnormal elevation in body temperature may result in insufficient sperm production) Infertility (related to insufficient production of sperm) Obstruction of ejaculatory system Orchitis (insufficient sperm production usually related to viral infection, rarely bacterial infection) Postvasectomy period (related to obstruction of the vas deferens) Primary and secondary testicular failure (congenital, as in Klinefelter’s syndrome, or acquired via infection) Testicular atrophy (e.g., recovery from mumps) Varicocele (abnormal enlargement of the blood vessels in the scrotal area eventually damages testicular tissue and affects sperm production)
- Drugs and substances that may decrease sperm count include arsenic, azathioprine, cannabis, cimetidine, cocaine, cyclophosphamide, estrogens, fluoxymesterone, ketoconazole, lead, methotrexate, methyltestosterone, nitrofurantoin, nitrogen mustard, procarbazine, sulfa-salazine, and vincristine.
- Testicular radiation may decrease sperm counts.
- Cigarette smoking is associated with decreased production of semen.
- Caffeine consumption is associated with increased sperm density and number of abnormal forms.
- Delays in transporting the specimen and failure to keep the specimen warm during transportation are the most common reasons for specimen rejection.
Nursing Implications and Procedure
- Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
- Patient Teaching: Inform the patient this test can assess for infertility.
- Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
- Obtain a history of the patient’s immune and reproductive systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
- Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
- Note any recent procedures that can interfere with test results.
- Review the procedure with the patient. Instruct the patient to refrain from any sexual activity for 3 days before specimen collection. Instruct the patient to bring the specimen to the laboratory within 30 to 60 min of collection and to keep the specimen warm (close to body temperature) during transportation. The requesting health-care provider (HCP) usually provides the patient with instructions for specimen collection. Address concerns about pain and explain that there should be no discomfort during the procedure.
- Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
- Note that there are no food, fluid, or medication restrictions unless by medical direction.
- Potential complications: N/A
- Instruct the patient to cooperate fully and to follow directions.
- Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection.
- Ejaculated Specimen
- Ideally, the specimen is obtained by masturbation in a private location close to the laboratory. In cases in which the patient expresses psychological or religious concerns about masturbation, the specimen can be obtained during coitus interruptus, through the use of a condom, or through postcoital collection of samples from the cervical canal and vagina of the patient’s sexual partner. The patient should be warned about the possible loss of the sperm-rich portion of the sample if coitus interruptus is the collection approach. If a condom is used, the patient must be instructed to carefully wash and dry the condom completely before use to prevent contamination of the specimen with spermicides.
- Cervical Vaginal Specimen
- Assist the patient’s partner to the lithotomy position on the examination table. A speculum is inserted, and the specimen is obtained by direct smear or aspiration of saline lavage.
- Specimens Collected From Skin or Clothing
- Dried semen may be collected by sponging the skin with a gauze soaked in saline or by soaking the material in a saline solution.
- Promptly transport the specimen to the laboratory for processing and analysis.
- Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
- Recognize anxiety related to test results. Provide a supportive, nonjudgmental environment when assisting a patient through the process of fertility testing. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Encourage the patient or family to seek counseling and other support services if concerned with infertility.
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
- Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
- Related tests include antisperm antibodies, cancer antigens, Chlamydia group antibodies, estradiol, FSH, hysterosalpingography, laparoscopy gynecologic, LH, testosterone, and US scrotal.
- Refer to the Immune and Reproductive systems tables at the end of the book for related tests by body system.