Chapter 11: Semen- Urinalysis

What are the four components of semen?

Testes and epididymis, seminal vesicles, prostate, bulbourethral glands

What is required for normal semen specimens?

They must have all four components.

Where are the paired testes located?

In the scrotum

What temperature is optimal for sperm development?

Lower scrotum temperature

What do the seminiferous tubules of the testes produce?

Spermatozoa

What percentage of semen volume is made up by spermatozoa?

5%

What role do Sertoli cells play in the testes?

They provide support and nutrients for germ cells during spermatogenesis.

Where do sperm mature and are stored?

In the epididymis

What do seminal vesicles produce?

The majority of the fluid in semen (60% to 70%)

What do seminal vesicles provide for sperm metabolism?

Fructose and flavin

Why are sperm not motile without seminal fluid?

Because the fluid acts as a transport medium.

What percentage of seminal fluid is produced by the prostate gland?

20% to 30%

What enzymes are contained in the fluid produced by the prostate gland?

Acid phosphatase, citric acid, zinc, and proteolytic enzymes

What is the function of the enzymes produced by the prostate gland?

Coagulate semen prior to ejaculation and cause liquefaction after ejaculation

What percentage of seminal fluid is produced by the bulbourethral glands?

5%

What is the function of the fluid produced by the bulbourethral glands?

Neutralize acid from the prostate and the acidic pH of the vagina

What is the effect of the absence of fluid from the bulbourethral glands?

Diminished sperm motility

What is the function of the seminiferous tubules in the testes?

Spermatogenesis

What is the role of the epididymis?

Sperm maturation

What is the function of the ductus deferens?

Propel sperm to ejaculatory ducts

What do the seminal vesicles provide for sperm?

Nutrients and fluid

What is the function of the prostate gland?

Provide enzymes and proteins for coagulation and liquefaction

What do the bulbourethral glands add to the semen?

Alkaline mucus to neutralize prostatic acid and vaginal acidity

What happens if the first portion of the ejaculate is missing?

Sperm count will be decreased, pH is falsely increased, and the specimen will not liquefy.

What happens if the last portion of the ejaculate is missing?

Semen volume is decreased, sperm count is falsely increased, pH is falsely decreased, and the specimen will not clot.

What is the recommended period of abstinence before semen collection?

2 to 3 days, but no longer than 7 days.

How many samples does WHO recommend for semen analysis?

Two or three samples collected not less than 7 days or more than 3 weeks apart.

What should be done with the specimen if collected at home?

Deliver to the laboratory within 1 hour and keep the specimen at 37°C.

What information should be recorded with the semen specimen?

Patient name and date of birth, period of abstinence, and time of collection and receipt.

How should semen be collected?

Collected by masturbation; if not possible, use no lubricated, antispermicidal condoms.

What precautions must be observed during specimen analysis?

Standard precautions must be observed at all times.

How should specimens be disposed of?

Specimens are discarded as biohazardous waste.

What type of materials and techniques must be used when handling specimens?

Sterile materials and techniques must be used.

What is the normal appearance of a sample?

Gray-white and translucent (flavin)

What odor is associated with a normal sample?

Musty odor

What does white turbidity in a sample indicate?

Infection

What test can be used to confirm infection in a sample?

Culture

What does a red specimen reagent strip indicate?

Blood cells, abnormal

What does a yellow specimen reagent strip indicate?

Urine, prolonged abstinence, medications (Rifampicin)

How does urine affect sperm motility?

Urine is toxic to sperm, causing no motility

What is the expected time for fresh semen to liquefy after collection?

30 to 60 minutes

What causes a deficiency in liquefaction of fresh semen?

Deficiency in prostatic enzymes

When can analysis of fresh semen begin?

After liquefaction has occurred

What can be added to fresh semen to induce liquefaction?

Enzymes

What aspects of semen analysis may be affected by the liquefaction process?

Biochemical tests, motility, and morphology

What is the normal volume range for a semen sample?

2 to 5 mL

How should semen volume be measured?

In a graduated cylinder

What may increased semen volume indicate?

Periods of extended abstinence

What does decreased semen volume indicate?

Infertility or incomplete collection

What is considered normal viscosity for semen?

Droplets with thin threads from a pipette

What does it mean if semen forms threads longer than 2 cm?

It is highly viscous

What is the viscosity rating scale for semen?

Rate 0 (watery) to 4 (gel-like)

What is the normal pH range for semen?

7.2 to 8.0

What pH level indicates a potential infection in semen?

Over 8.0

What can decreased pH in semen indicate?

Increased prostate fluid, ejaculatory duct obstruction, or poorly developed seminal vesicles

When should pH be measured after ejaculation?

Within 1 hour of ejaculation

What tool can be used to check pH in a urinalysis?

pH pad of a urinalysis reagent strip

What is the formula for total sperm count?

Sperm concentration × specimen volume

What is the reference value for normal sperm concentration?

>20 to 250 million sperm per milliliter

What is considered a borderline sperm concentration?

10 to 20 million sperm per milliliter

What is the normal sperm count per ejaculate?

>40 million sperm per ejaculate

What does sperm concentration measure?

Number of sperm per mL

What does sperm count measure?

Number of sperm per ejaculate

What is the common dilution used for sperm concentration in a Neubauer chamber?

1 to 20

What diluting fluid is used in sperm concentration that must immobilize sperm?

Sodium bicarbonate and formalin

Where are sperm counted in the Neubauer chamber?

In the four corners and center squares of the large center square

What is the acceptable agreement percentage for sperm counts on both sides of the Neubauer chamber?

10%

How is the sperm concentration calculated from the count in the Neubauer chamber?

Multiply the number of sperm counted by 1,000,000 to get sperm/mL

What type of sperm should be counted in the Neubauer chamber?

Only fully developed sperm

What is the significance of WBC counts ≥ 1 million per mL?

It is associated with inflammation or infection and can lead to infertility.

What does the presence of ≥ 1 million spermatids per mL indicate?

It indicates disruption of spermatogenesis.

What are some causes of disruption of spermatogenesis?

Viral infections, toxic chemicals, and genetic disorders.

What type of movement is required for sperm motility?

Forward, progressive movement

What is the condition of the semen specimen needed for examination?

Well-mixed, liquefied semen specimen

How soon should the semen specimen be examined after collection?

Within 1 hour

How should the semen specimen be evaluated for motility?

Undiluted on a glass slide with a coverslip

What is the method to estimate sperm motility?

Estimate percentage with progressive, forward motion in 20 hpf fields

How many sperm should be examined per slide to count motile categories?

200 sperm per slide

What scale is used for grading sperm motility?

A scale of 0 to 4

What does a grading of 4 indicate in sperm motility?

Rapid, straight-line movement

What does a grading of 0 indicate in sperm motility?

No movement

What is considered normal motility for sperm after 1 hour?

A minimum motility of 50% with a rating of 2.0

What rating scale does the World Health Organization (WHO) use for sperm motility?

a, b, c, and d

According to WHO, what percentage of sperm should be motile within 1 hour in categories a, b, and c?

50% or more

According to WHO, what percentage of sperm should show progressive motility in categories a and b within 1 hour?

25% or more

How does the World Health Organization (WHO) grade sperm motility?

Progressive motility (PM), non-progressive motility (NP), and immotility (IM)

What must motility be specified as according to WHO recommendations?

Total motility (PM and NP) or progressive motility (PM)

What instrumentation is available for analyzing sperm motility?

Computer-assisted semen analysis (CASA)

What is the significance of sperm morphology?

Critical to fertilization

What are the main parts of sperm that are evaluated in morphology?

Head, neck, midpiece, tail

What is the shape and size of the sperm head?

Oval, 5 μm long and 3 μm wide

What is contained in the sperm head that aids in fertilization?

Enzymes for ovum penetration

How long is the neckpiece of the sperm?

7.0 μm long

What surrounds the midpiece of the sperm?

A sheath of mitochondria for tail movement

How long is the flagellar tail of the sperm?

Approximately 45 μm

What stains can be used to observe sperm morphology?

Wright's, Giemsa, Shorr, or Papanicolaou stain

How many sperm should be counted to report abnormalities in morphology?

200

What are some abnormalities in sperm head structure?

Double heads, giant heads, amorphous heads, pinheads, tapered heads, and constricted heads

What are common abnormalities found in sperm tails?

Doubled, coiled, or bent tails

What are Kruger's strict criteria for sperm morphology?

Measuring head, neck, and tail size; measuring acrosome size; evaluating for the presence of vacuoles.