Patient's question:
I went to the hospital yesterday for a semen analysis, and the results were as follows: Appearance: Grey-white, Volume: approximately 1 ml, Viscosity: (2 cm, 30 minutes to liquefy. Motility: Grade 6. Motility rate: 31%. Sperm count: 60x10^6Doctor's answer:
The first item refers to the volume of semen, which must be between 2 to 6 milliliters, roughly the amount of a small bottle cap.The second is sperm count. Generally, the sperm count should be between 40 million to 120 million per milliliter. In this case, it is considered a good sperm count. If it is less than 40 million, the chances of fertilization will significantly decrease. If it is less than 20 million, it is classified as oligospermia, as defined by the World Health Organization. However, in clinical practice, we aim for 60 million, as this increases the likelihood of normal fertilization.
Azoospermia is of two types: true azoospermia, which is very difficult to treat, and secondary azoospermia, which may be due to other reasons such as post-natal varicocele or traumatic causes. This is referred to as secondary, temporary, or pseudo-azoospermia, and in some cases, it can be restored through treatment. Recovery may occur gradually after surgery. Therefore, azoospermia is diagnosed when there is no sperm in three or more routine tests. A single instance is not sufficient, as temporary absence of sperm can occur due to factors like fatigue or severe illness. In clinical practice, it is necessary to conduct several consecutive tests to confirm the absence of sperm before making a conclusion.
This is about sperm count.
The third factor is the normal pH value of semen, which indicates acidity or alkalinity. The pH value should be between 7.2 to 7.8, as this is favorable for the acidic environment of the female vagina, enhancing sperm motility and making it easier for the woman to conceive. If the pH is too acidic, it may indicate inflammation, reducing the chances of pregnancy. Therefore, the pH value is included in every test result for this reason.
The fourth is viscosity. After ejaculation, semen transitions from a viscous to a liquid state. This is a very mysterious physiological phenomenon: semen becomes viscous upon ejaculation and then liquefies within 5 minutes, allowing sperm to become active. This is a highly orderly and profound physiological function. If semen does not liquefy within 1 hour, sperm cannot move, making fertilization impossible, which is also a significant cause of infertility.
The fifth aspect is the proportion of abnormal sperm, which should not exceed 20%. Some individuals may have a low sperm count but a high proportion of abnormal sperm. Abnormal sperm refers to sperm that are not properly developed, such as those with a large head, short tail, double tail, or no tail. Such sperm generally have poor motility and cannot fertilize an egg. If the proportion of abnormal sperm exceeds 20%, the chances of pregnancy decrease due to the lower number of normal sperm.
The sixth item is sperm viability, which refers to the percentage of sperm that are active among a given number. Generally, the viability must be above 60%. Even if the sperm count reaches 100 million, if the viability is only 20%, it is still not acceptable. Therefore, in addition to a sufficient number of sperm, there must also be a high viability rate, which should be at least 60% in clinical practice. Furthermore, there is also the motility rate, which is further categorized into four grades. According to the previous classification, the higher the grade, the better the sperm motility: Grade 0 indicates immobile sperm, Grade 1 indicates movement in place, Grade 2 indicates curved movement, and Grade 3 indicates linear movement. The current classification divides it into four categories: Grade A (best), Grade B (curved movement), Grade C (rotating in place), and Grade D (immobile). After classification, it is generally required that Grade A sperm account for more than 20%, or that Grade A and B sperm together exceed 50%. Only in this way can sperm with good motility increase the chances of pregnancy. If there is a high sperm count but only 60% of sperm are motile, and none are highly motile, the chances of pregnancy remain low.
The seventh item is whether white blood cells are present in the semen. Their presence indicates inflammation in the urinary or reproductive system. In normal conditions, the number of white blood cells in semen should be between 0 to 5 per field of view, and should not exceed 5. If it exceeds 5, it is abnormal and suggests inflammation, which can negatively impact fertility.
In summary, any abnormality in semen volume, sperm count, pH value, viscosity, sperm viability, motility, or inflammation can lead to infertility. Currently, semen analysis is a crucial basis for diagnosing and treating male infertility. Many men who have been infertile for years may say, "Have you been tested?" and respond, "No, I only consulted an old doctor." This is insufficient. In treatment, we always combine modern scientific diagnosis with traditional Chinese medicine's syndrome differentiation to achieve a balance between macro and micro perspectives, thereby improving efficacy. I have briefly explained the situation for your reference.