Semen Analysis

Semen analysis measures sperm count, motility, morphology, and semen quality to assess male fertility. It helps identify reproductive issues, guide treatment decisions, and support accurate diagnosis in fertility evaluations.

Introduction

Male factor infertility is diagnosed by observing sperm abnormalities during semen analysis.

Definition

Semen analysis is a laboratory test to assess the sperm count, motility, morphology, vitality, concentration, and volume.

Purposes

• To aid in diagnosis of infertility.
• To determine the cause for primary or secondary infertility (obstructive, nonobstructive, or coital).
• To confirm sterility after a vasectomy.

Specialized Semen Test

• Semen culture: Identification of bacterial infection if leukocytes are present in the semen.
• Sperm-cervical mucus interaction: Detects antisperm antibodies.
• Computer-aided sperm analysis: Computer program that predicts the fertilizing capacity of sperm based on its motility.
• Acrosome reaction: Indicated for couples planning in vitro fertilization (IVF).

Indications

• Couples who have been trying to conceive for 1 year after frequent (every 2-3 days), unprotected sexual intercourse.
• Couples older than 36 years as a referral for infertility investigation.
• Vasectomy.
• Assisted reproduction [intrauterine insemination (IUI), IVF, or intracytoplasmic sperm injection (ICSI)].

Role of Nurse in Preparation of Patient for Semen Analysis

• Assess the fertility history; sexual history; health history related to comorbid illness such as DM, HTN, and CAD; and personal history such as diet, exercise, occupation, smoking, alcohol, and mental health.
• Review the male patients’ USG and hormone analysis (testosterone, FSH, LH, and prolactin level).
• Inform general preparation for the procedure as per the physician’s order such as the following:
• Abstain from sex/masturbation for 3-7 days before a semen sample is collected to maximize the quantity of the ejaculate and concentration of the sperm.
• Semen is collected after self-masturbation into a sterile container in a private room near the laboratory.
• Instruct the patient to collect all fractions of the ejaculate and report if there is any loss of fraction of the sample.
• Semen analysis should be performed within an hour of sample collection, so that dehydration and temperature changes do not affect the sperm quality.
• Semen analysis should be repeated in 12-week intervals (minimum of two separate samples).
• Ensure that the sperm container is kept at ambient temperature between 20°C and 37°C.
• Note the name, age, UHID, the period of abstinence, the date and time of collection, the completeness of the sample, any difficulties in producing the sample, and the interval between the collection and the start of the semen analysis.
• Label the container with the name and identification number, and the date and time of collection.
• For collecting semen for microbiological analysis in a sterile container, instruct the patient to;
• Empty the bladder.
• Wash hands and penis with soap, to reduce the risk of contamination of the specimen.
• Rinse away the soap.
• Dry hands and penis with a fresh disposable towel.
• Ejaculate into a sterile container.
• Follow safety guidelines while handling semen samples at the laboratory; they should be handled as a biohazard.

Interpretation of Findings

Pathological Conditions

• Aspermia: No ejaculate.
• Hypospermia: Low ejaculate volume (<1.5 mL).
• Cryptozoospermia: <1 million sperm per milliliter.
• Oligospermia: <15 million sperm per milliliter.
• Teratospermia: <4% normal morphologyst.
• Asthenospermia: <32% sperm motility.
• Azoospermia: No sperm found within the ejaculate.

Special Considerations

• No lubricants, saliva, or non-sterile containers. These can affect motility and morphology.
• Document recent fevers, infections, medications, alcohol, tobacco, or drug use—all of which can impact sperm quality.
• If collected at home, the sample must be delivered to the lab within 1 hour, kept at body temperature, and not exposed to extreme heat or cold.
• Masturbation into a sterile container is standard. Special condoms may be used for collection during intercourse if needed.
• Ensure the entire sample is collected, especially the first portion, which contains the highest sperm concentration.
• Due to natural variability, 2–3 tests spaced weeks apart are often needed for accurate assessment.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
4. Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
5. Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
6. Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
7. AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
8. Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/

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