Semen Analysis

Synonym/Acronym

N/A

Rationale

To assess for male infertility related to disorders such as obstruction, testicular failure, and atrophy.

Patient Preparation

There are no food, fluid, or medication restrictions unless by medical direction. Instruct the patient to refrain from any sexual activity for 3 days before specimen collection.

Normal Findings

Method: Macroscopic and microscopic examination.

Semen Analysis
Test		Normal Result
Volume		2–5 mL
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
pH		7.2–8
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

The number of normal sperm is calculated by multiplying the total sperm count by the percentage of normal forms.

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	Additional Test Ordered	Normal Result
Decreased count	Fructose	Present (greater than 150 mg/dL)
Significantly decreased count (less than 5 million/mL)	Genetic testing (karyotype for CFTR, AZF deletions)	Normal karyotype
Decreased motility with clumping	Male antisperm antibodies	Absent
Normal semen analysis with infertility	Female antisperm antibodies	Absent

Critical Findings and Potential Interventions ⬆ ⬇

Overview ⬆ ⬇

(Study type: Body fluid, semen from ejaculate specimen collected in a clean, dry, glass container known to be free of detergent; related body system: Reproductive system. The specimen should be promptly transported to the laboratory for processing and analysis. The specimen container should be kept at body temperature [37°C] during transportation.)

Semen analysis is a valid measure of overall male fertility. Semen contains a combination of elements produced by various parts of the male reproductive system. Spermatozoa are produced in the testes and account for only a small volume of seminal fluid. Fructose and other nutrients are provided by fluid produced in the seminal vesicles. The prostate gland provides acid phosphatase and other enzymes required for coagulation and liquefaction of semen. Sperm motility depends on the presence of a sufficient level of ionized calcium. If the specimen has an abnormal appearance (e.g., bloody, oddly colored, turbid) , the patient may have an infection. Specimens can be tested with a leukocyte esterase strip to detect the presence of white blood cells.

Indications ⬆ ⬇

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.

Interfering Factors ⬆ ⬇

Drugs and other substances that may decrease sperm count include arsenic, azathioprine, cannabis, cimetidine, cocaine, cyclophosphamide, estrogens, ketoconazole, lead, methotrexate, methyltestosterone, nitrofurantoin, nitrogen mustard, procarbazine, sulfasalazine, 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.

Other Considerations

Delays in transporting the specimen and failure to keep the specimen warm during transportation are the most common reasons for specimen rejection.

Potential Medical Diagnosis: Clinical Significance of Results ⬆ ⬇

Abnormal Findings Related to

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 (inherited, as in Klinefelter 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)

Nursing Implications ⬆

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

Review the procedure with the patient.
Discuss how this test can assess for infertility. A semen sample is needed for the test. There should be no discomfort during the procedure.
Instructions for specimen collection should be provided by the requesting health-care provider (HCP).
Discuss the importance of bringing the specimen to the laboratory within 30 to 60 min of collection and keeping it warm (close to body temperature) during transport.

Procedural Information

Ideally, the specimen is obtained from the male patient by masturbation in a private location close to the laboratory.

Ejaculated Specimen

When psychological or religious concerns about masturbation are expressed, 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.
Warning is given regarding the possible loss of the sperm-rich portion of the sample if coitus interruptus is the collection approach. If a condom is used, instruction is given to carefully wash and dry the condom completely before use to prevent contamination of the specimen with spermicides.

Cervical Vaginal Specimen

The patient’s partner is assisted into the lithotomy position on the examination table. A speculum will be inserted and the specimen 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 gauze soaked in saline or by soaking the material in a saline solution.

After the Study: Implementation & Evaluation Potential Nursing Actions

Treatment Considerations

Interventions/actions include the following: Provide a supportive, nonjudgmental environment when assisting through the process of fertility testing. Provide information regarding the clinical implications of the test results. Consider HCP-requested imaging studies to investigate other reasons for infertility (e.g., ultrasound scrotal, transrectal; vasography).

Clinical Judgement

Consider how to provide emotional support while discussing the implications of abnormal test results on lifestyle choices.

Follow-Up Evaluation and Desired Outcomes

Recognizes the value of seeking counseling and other support services related to infertility concerns.