In Europe, about one in ten couples is infertile by choice, and worldwide the figure is one in six. In most cases, one of the partners has a fertility disorder that makes implantation difficult. In about half of all cases, the problem lies with the man. If the quality of the sperm is poor, the egg cannot be properly fertilised. Sperm quality is made up of several parameters. These include the number, shape and motility of the sperm. The rest of the ejaculate may also be included in the analysis, as it may also contain factors that could cause problems. The analysis of these parameters is called a spermiogram.

What is a spermiogram?

Firstly, this method is a snapshot in time. It is possible for a diagnosis to be made at your first appointment that would no longer apply at a second appointment six months later. So there is no need to panic.

A spermiogram involves taking a sample of ejaculate. The sample is then kept close to body temperature to avoid damaging the sperm. In the laboratory, the parameters that affect the ejaculate itself are examined first. These include volume, pH, appearance and consistency. The amount of sugar in the ejaculate and the presence of sperm antibodies or bacteria are also tested. Sugar (fructose) is important because this is what the sperm feed on. This part of the ejaculate is produced in the vesicle gland below the bladder. If there is not enough fructose, the sperm will not have the energy to move. Testing for antibodies is also important to rule out immune reactions.

The sperm themselves are also examined under the microscope. We look at their shape, number and motility. These three parameters also influence each other, as sperm with an abnormal shape, for example, are often less able to move. Most patients are therefore affected by all three parameters. These conditions are known as oligoasthenoteratozoospermia. This is also known as OAT syndrome.

Interpretation of the spermiogram

In medicine, there is a normal value for almost every parameter. This is the numerical value or range in which the parameter lies on average in healthy people. Such normal values also exist for all the above components of the spermiogram. Your results are then compared.

For example, the total volume of semen should be at least 1.5 ml and contain at least 40 million sperm. At least 60% of the sperm should be alive. Again, at least 30% of the sperm should be well motile and at least 4% should have a normal shape.

The ejaculate without the sperm is also examined. This is the environment in which the sperm live, and it should be as good as possible. The pH should be neutral to slightly alkaline, between seven and eight. A small number of white blood cells are also present in the semen. However, their number should not exceed millions per ml. If there are many white blood cells at once, this usually indicates an inflammatory reaction. This in turn has a temporary negative effect on fertility. The same applies to sperm antibodies, which should remain below 50%. This is more likely to be an autoimmune reaction that would damage the sperm. Finally, the consistency of the ejaculate is assessed. It should liquefy within an hour at room temperature.

As mentioned above, the motility of the sperm is also examined under the microscope. This is very important because the sperm must be able to move on their own through the uterus and into the fallopian tubes, where fertilisation takes place. In order to have a better overview, the sperm in a spermiogram are divided into four categories according to their motility. The first group is made up of fast-moving sperm. They move quickly and purposefully. This is followed by the progressive group, where the sperm move but are slower. This is followed by the non-progressive third group. The sperm move in an undirected and localised way. Many of them swim in circles. The last group is the immotile group, which does not move at all.

The doctor's visit procedure

There are usually two different groups of patients who want to have such an examination. On the one hand, there are those who have an unfulfilled desire to have children and, on the other hand, there are those who want to check the result of sterilisation. The spermiogram is carried out either by a urologist, an andrologist or in a fertility clinic.

The sperm sample is usually obtained by masturbation. There is a separate, quiet room for this. Sometimes it is allowed to bring the sample from home. However, this is usually not recommended as the sample can be tampered with during transport.

The sample is then sent to the laboratory. To be on the safe side, it is often recommended to repeat the test about three months later. This gives a clearer picture, as a spermiogram is only a snapshot in time.

Causes of infertility and what you can do about it

If abnormalities are found during the examination, it is important to find the cause. The list of possibilities is very long. For example, inflammatory reactions, hormonal imbalances, anatomical variations, any drug use, smoking, metabolic diseases such as diabetes, congenital defects or obesity are all possible causes. The good news is that you can do a lot about it. For many men, lifestyle changes can improve sperm quality to the point where IVF is no longer necessary. There are also treatments for most of the other causes. If the quality is still poor, IVF can help. For example, if the sperm are not motile enough, IVF can make it easier for them to reach the egg. For many couples, this is a good way of dealing with male infertility.