Semen Analysis

SEMEN ANALYSIS

Q. 1

A 25 year old infertile male underwent semen analysis. Results show : sperm count – 15 mil­lion/ml ; pH – 7.5 ; volume – 2 ml ; no agglutina­tion is seen. Morphology shows 60% normal and 60% motile sperms. Most likely diagnosis is :

 A

Normospermia

 B

Oligospermia

 C

Azoospermia

 D

Aspermia

Q. 1

A 25 year old infertile male underwent semen analysis. Results show : sperm count – 15 mil­lion/ml ; pH – 7.5 ; volume – 2 ml ; no agglutina­tion is seen. Morphology shows 60% normal and 60% motile sperms. Most likely diagnosis is :

 A

Normospermia

 B

Oligospermia

 C

Azoospermia

 D

Aspermia

Ans. B

Explanation:

Oligospermia

The Semen Analysis of the patient shows :

  • Sperm count is 15 million/ml.
  • PH = 7.5
  • Volume = 2 ml
  • Morphology = 60% normal

Normal should be at least 20 million/ml i.e. this patient is oligospermic (N = > 7.2)

N = at least 2 ml

N = 50% Normal Morphology

So, all criteria are normal except sperm count (to be specific sperm concentration) which is less than normal and therefore most likely diagnosis is oligospermia.


Q. 2

Which of the following is the best specimen for semen analysis :

 A

A condom specimen

 B

A specimen obtained by masturbation near the laborator

 C

A specimen obtained by colitus interuptus into a wide-vessel

 D

B + D

Q. 2

Which of the following is the best specimen for semen analysis :

 A

A condom specimen

 B

A specimen obtained by masturbation near the laborator

 C

A specimen obtained by colitus interuptus into a wide-vessel

 D

B + D

Ans. D

Explanation:

B + D


Q. 3 Which is a not an essential criteria according to WHO for normal semen analysis
 A Sperm count > 20 million/ml
 B Volume > 1 ml
 C Sperm with normal morphology (strict criteria) > 15%
 D Motility > 25% with rapidly progressive motility
Q. 3 Which is a not an essential criteria according to WHO for normal semen analysis
 A Sperm count > 20 million/ml
 B Volume > 1 ml
 C Sperm with normal morphology (strict criteria) > 15%
 D Motility > 25% with rapidly progressive motility
Ans. B

Explanation:

Volume > 1 ml [Ref William’s Gynaecology p. 449; http//www.gfiner.ch/end%•pgi/network]

THE W.H.O. RECOMMENDS THE FOLLOWING NORMAL VALUES

Volume

Sperm

Total sperm number

Percent mobility

Forward progression

Normal morphology

Round cells

Sperm agglutination

> 2 ml

concentration > 20 million / ml or more

> 40 million/ejaculate

> 50% with forward progression

> 25% with rapid linear progression

> 2 (scale 0-4)

> 30% normal (W.H.O. criteria)

> 14% normal (Kruger and strict criteria)

< 5 million/rnl

< 2 (scale 0-3),w.b.c fewer than I x106 / ml

  • The normal sperm morphology is currently being reassessed by W.H.O
  • In the interim the proportion of normal forms accepted by the laboratories in the U.K is either the earlier W.H.O limits of 30 or 15% based on strict morphological criteria.



Q. 4

Semen analysis of a young man who presented with primary infertility revealed low volume, fructose negative ejaculate with azoospermia. Which of the following is the most useful imaging modality to evaluate the cause of his infertility?

 A

Spermatic venography

 B

Retrograde urethrography

 C

Transrectal ultrasonography

 D

Colour duplex ultrasonography of the scrotum

Q. 4

Semen analysis of a young man who presented with primary infertility revealed low volume, fructose negative ejaculate with azoospermia. Which of the following is the most useful imaging modality to evaluate the cause of his infertility?

 A

Spermatic venography

 B

Retrograde urethrography

 C

Transrectal ultrasonography

 D

Colour duplex ultrasonography of the scrotum

Ans. C

Explanation:

Clinical diagnosis of ejaculatory duct obstruction is based on a triad of small ejaculate volume, azoospermia and absence of seminal fructose.

This condition is distinguished from congenital bilateral absence of the vas deferens by the presence of a palpable vas deferens on examination.

Transrectal ultrasound and seminal vesicle aspiration are investigations which help in confirmation of the  diagnosis. Transrectal ultrasound helps in the evaluation of seminal vesicles, ejaculatory ducts and prostate gland abnormalities.

Ref: Manual of Assisted Reproductive Technologies and Clinical Embryology By Pankaj Talwar, Page 825; Male Infertility: Problems and Solutions By Edmund S. Sabanegh, Pages 27-29; Male Reproductive Dysfunction By S. C. Basu, 2nd Edition, Page 310.


Q. 5

A 30-year-old man consults a gynecologist for the cause of his infertility. On questioning, he informs the doctor that he never suffered from any major illness in the past and also got married 5 years back. However, his physical examination reveals failure of testes to descend down in the scrotum. The semen analysis shows absence of spermatozoa. The blood lab report shows plasma gonadotrophins, 12 Ru/24 hrs; Plasma testosterone, 7 ug/l and semen 2 ml. The factor responsible for the absence of spermatozoa in this patient is?

 A

Degeneration of the epithelium of seminiferous tubules

 B

Decreased secretion of gonadotrophins

 C

Decreased concentration of testosterone

 D

Hypofunctioning of the pituitary gland

Q. 5

A 30-year-old man consults a gynecologist for the cause of his infertility. On questioning, he informs the doctor that he never suffered from any major illness in the past and also got married 5 years back. However, his physical examination reveals failure of testes to descend down in the scrotum. The semen analysis shows absence of spermatozoa. The blood lab report shows plasma gonadotrophins, 12 Ru/24 hrs; Plasma testosterone, 7 ug/l and semen 2 ml. The factor responsible for the absence of spermatozoa in this patient is?

 A

Degeneration of the epithelium of seminiferous tubules

 B

Decreased secretion of gonadotrophins

 C

Decreased concentration of testosterone

 D

Hypofunctioning of the pituitary gland

Ans. A

Explanation:

Primary infertility affects 15-20% of married couples.
Apart from case history and physical examination, endocrine profile and semen analysis are essential to disclose the underlying cause.
The testes have two distinct but related functions, both of which are under adenohypophyseal and hypothalamic control.
The first one is the production and storage of viable spermatozoa, and the second one is the synthesis and secretion of androgenic hormones.
Various factors that can induce sterility in men are: trauma, infections like mumps, environmental factors like excessive heat, medications, and drugs.

Because of the failure of testes to descend into the scrotum, seminiferous tubules remain infantile in structure and due to greater temperature of the inguinal canal, they degenerate. However, the secondary sexual characteristics are not affected. 

 
Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 20. Treatment of the Infertile Couple. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e. 

Q. 6

A 25 year old married male presents with infertility. He had undergone retroperitoneal lymphnode disection at age of 15 years for embryonal carcinoma of right testis. Semen analysis shows-quantity-0.5 ml, no. sperm, no fructose. Biopsy of testis shows normal spermato genesis. Best treatment here would be ‑

 A

Artificial insemination of donor

 B

Penile-prosthesis

 C

Microtesticular aspiration and intracyto plasmic injection

 D

None of the above

Q. 6

A 25 year old married male presents with infertility. He had undergone retroperitoneal lymphnode disection at age of 15 years for embryonal carcinoma of right testis. Semen analysis shows-quantity-0.5 ml, no. sperm, no fructose. Biopsy of testis shows normal spermato genesis. Best treatment here would be ‑

 A

Artificial insemination of donor

 B

Penile-prosthesis

 C

Microtesticular aspiration and intracyto plasmic injection

 D

None of the above

Ans. C

Explanation:

Ans. is ‘c’ i.e., Microtesticular Aspiration and intra-cytoplasmic injection

  • Absence of sperms in presence of normal spermatogenesis along with absence of fructose is suggestive of an obstruction in the ejaculatory duct (as described in previous chapter – Prostate & seminal vesicles)
  • “Sperm aspiration techniques are indicated in men in whom the transport of sperm is not possible because the ductal system is absent or surgically unreconstructable. Aspiration procedures can involve microsurgery to collect sperm from the sperm reservoirs within the genital tract (vas deferens, epididymis or testicle)” – Smith’s Urology 17/e, p 710
  • Microtesticular aspiration of sperm with In Vitro Fertilization can help this couple to achieve pregnancy. (Intracytoplasmic injection is a form of IVF)

Q. 7

First test for a couple presenting with infertility:

March 2013

 A

Post coital test

 B

Chromosomal studies

 C

Sperm penetration test

 D

Husband’s semen analysis

Q. 7

First test for a couple presenting with infertility:

March 2013

 A

Post coital test

 B

Chromosomal studies

 C

Sperm penetration test

 D

Husband’s semen analysis

Ans. D

Explanation:

Ans. D i.e. Husband’s semen anaylsis


Q. 8

A couple presents with infertility. On investigation, the husband is found to have azoospermia on semen analysis. Vas was not palpable on per rectal examination. Semen had low volume, high viscosity and fructose was present. What will you do next?

 A

Karyotype

 B

PSA

 C

Trans-rectal ultrasound

 D

CFTR gene mutation analysis

Q. 8

A couple presents with infertility. On investigation, the husband is found to have azoospermia on semen analysis. Vas was not palpable on per rectal examination. Semen had low volume, high viscosity and fructose was present. What will you do next?

 A

Karyotype

 B

PSA

 C

Trans-rectal ultrasound

 D

CFTR gene mutation analysis

Ans. D

Explanation:

Ans. d. CFTR gene mutation analysis



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