Sperms & The Laboratory

Laboratories performing sperm "counts", in general, vary in the details that they provide the physician requesting the "count". A general sperm count as part of a fertility evaluation should include the total density or count (20 million per ml or above), and the motile density (8 million per ml or higher). The motile density is perhaps the most important part of the semen analysis, as it reports the total number of sperm thought capable of progressing from the site of sperm deposition to the site of fertilization. This value is essential in both allowing a determination regarding whether or not a semen analysis is "normal", as well as in providing prognostic information should advanced reproductive medical assistance be required. (Numbers in italics are what "normal" values should be.)

Definitions of "abnormal" counts:
• Polyzoospermia: Excessively high sperm concentration.
• Oligozoospermia: Sperm count less than 20 million/ml
• Hypospermia: Semen volume < 1.5 ml
• Hyperspermia: Semen volume > 5.5 ml
• Aspermia: No semen volume
• Pyospermia: Leukocytes (germ fighter cells) present in semen
• Hematospermia: Red blood cells present in semen
• Asthenozoospermia: Sperm motility < 40%
• Teratozoospermia: > 40% of sperm seen are of abnormal form
• Necrozoospermia: Nonviable ("dead") sperm
• Oligoasthenozoospermia: Motile density < 8 million sperm/ml

Sperm Morphology (Shape and Appearance)
The evaluation of sperm size, shape and appearance characteristics should be assesed by carefully observing a stained sperm sample under the microscope. The addition of colored "dyes" (stains) to the sperm allow the observer to distinguish important normal landmarks (characteristics) as well as abnormal findings. Several methods of staining sperm are used, and the method employed should be one with which the examiner is comfortable and experienced.

Several different shapes or forms of human sperm have been identified and characterized. These forms fall into one of four main categories: normal forms, abnormal head, abnormal tail and immature germ cells (IGC).
Normal forms
Normal sperm have oval head shapes, an intact central or "mid" section, and an uncoiled, single tail.

Abnormal heads
Many different sperm head abnormalities may be seen. Large heads (macrocephalic), small heads (microcephalic) and an absence of identifiable head are all seen in evaluations. Tapering sperm heads, pyriform heads (teardrop shape) and duplicate or double heads have been seen. Overall (gross) abnormalities in appearance may be termed "amorphous" changes.

Abnormal tails
Coiling and bending of the tail are sometimes seen. Broken tails of less than half normal length should be categorized abnormal. Double, triple and quadruple tails are seen and are abnormal. Cytoplasmic droplets along the tail may indicate an immature sperm.

Immature germ cells (IGC's)
White blood cells (WBC's, germ fighters) in the semen should rarely be seen. It is very difficult to distinguish between an immature germ cell and a WBC. Because the presence of WBC's in the semen (pyospermia) can be a serious concern, if a report of "many IGC's" is delivered, it becomes very important to assure that these cells are not, instead, WBC's.

Sperm "Motility" (Movement)
Sperm motility studies identify the number of motile (moving) sperm seen in an ejaculate specimen. Here again, as in many other sperm studies, many laboratories use "normal" values that are out of date and inaccurate. Many labs will assess sperm motility upon receipt of the specimen, and again at hourly time intervals for four to twenty four hours. It is well known that sperm motility is a temperature dependent sperm function, so the handling and processing of specimens is critical. It is for this reason that we, except in very rare instances, require that specimens be evaluated only in a laboratory such as our own, where we are able to tightly control laboratory conditions. We have found the repeated testing of sperm over time for motility adds little to the evaluation of motility over the initial sperm motility assessment. Sperm are known not to survive well for extended periods of time in semen, and in nature, sperm very rapidly leave the semen to enter the cervical mucus. Many laboratories consider "normal" sperm motility to be 60% or greater. Our own studies, in agreement with many others have found men with 50% or greater sperm motility to be "normal".

Asthenozoospermia
Decreased sperm motility. If found to be present, exam should be repeated to assure that laboratory conditions did not cause the problem. Frequent causes: abnormal spermatogenesis (sperm manufacture), epididymal sperm maturation problems, transport abnormalities, varicocele. These conditions should all be looked for if sperm motility is repeatedly "low".

Necrozoospermia
A total absence of moving sperm. It is vital, if sperm are seen, but are not moving, to carry out studies (vital stains) to see if the sperm seen are alive. It is possible to have sperm with normal reproductive genetics that are deficient in one or several of the factors necessary to produce motility. We have achieved several successful pregnancies employing microinjection of healthy, non motile sperm directly into the egg (ICSI).

Chemical and Biochemical Semen Characteristics
Semen acid-base balance (pH)
The pH of semen is measured using a specially treated paper blot that changes color according to the pH of the specimen that it is exposed to. The pH of normal semen is slightly alkaline ranging from 7.2 to 7.8. Prostatic secretions are acidic while the secretions of the seminal vesicles are alkaline. Therefore, alterations in pH may reflect a dysfunction of one or both of these accessory glands. The pH of semen has not been generally found to have a major influence on a man's fertility potential.

Color and Turbidity
Semen is normally translucent or whitish-gray opalescent in color. Blood found in semen (hematospermia) can color the semen pink to bright red to brownish red. The presence of blood in semen is abnormal and should be reported. The presence of particles, nonliquified streaks of mucus or debris requires further evaluation.

Liquefaction
Semen is normally produced as a coagulum. The specimen will ususally liquify within 30 minutes. The failure to liquify within one hour is abnormal. Excellent methods for correcting this problem in the laboratory are available.

Viscosity
Nonliquefaction and excessive viscosity are two separate conditions. Viscosity is measured after complete liquefaction has occured. Viscosity is considered "normal" if the liquefied specimen can be poured from a graduated beaker drop by drop with no attaching agglutinum between drops. The role of hyper (excessive) viscosity is being studied, but it seems possible that htis condition may interfere with the ability of sperm to travel from the site of deposition into the cervix or uterus.

Why men don't write advice columns

Dear Walter:
I hope you can help me here. The other day I set off for work leaving my husband in the house watching the TV as usual. I hadn't gone more than a mile down the road when my engine conked out and the car
shuddered to a halt. I walked back home to get my husband's help.
When I got home I couldn't believe my eyes. He was in the bedroom with a neighbor lady . I am 32, my husband is 34 and we have been married for twelve years. When I confronted him, he broke down and admitted that he'd been having an affair for the past six months.
I told him to stop or I would leave him. He was let go from his job six months ago and he says he has been feeling increasingly depressed and worthless. I love him very much, but ever since I gave him the ultimatum he has become increasingly distant. I don't feel I can get through to him anymore.
Can you please help?
Sincerely,

Mrs... Sheila Usk

-------------------------------------

Dear Sheila:
A car stalling after being driven a short distance can be caused by a variety of faults with the engine. Start by checking that there is no debris in the fuel line. If it is clear, check the jubilee clips holding the vacuum pipes onto the inlet manifold. If none of these approaches solves the problem, it could be that the fuel pump itself is faulty, causing low delivery pressure to the carburetor float chamber.
I hope this helps.
Walter

Chicken Soup For The Soul

Second Opinion

New Material Provides Constant Light For 12 Years Without a Power Source

MPK, a company that has made a name producing glow-in-the-dark paint, has developed self-luminous micro particles called Litrospheres. The new material is said to be inexpensive (Rs 15 to light up a 8 ½ x 11 piece of plastic that is 1/8" thick), non-toxic, and capable of staying constantly lit for over 12 years thanks to a betavoltaic technology that uses a radioactive gas.

Fortunately, the gas is involves a "soft" emission of electrons that cannot penetrate the glass or polymer wall of the microspheres. So theoretically, you don't have to worry about brain tumors or taking on super powers when using it.

The Litrospheres, which can be injected molded or added to paint, are not affected by the heat or cold and they can withstand up to 5000 pounds of pressure. They can also give off light that is equivalent of a 20-watt incandescent bulb in almost any color imaginable. As you might expect, the first applications of the technology will most likely involve safety equipment—or the clothing and accessories of frequent clubgoers.

Glow-in-the-Dark Cats Could Make For a Unique Home Lighting Solution

Scientists at the Gyeongsang National University in South Korea have cloned cats that have the ability to glow-in-the dark when exposed to ultraviolet light. By inserting a virus into the skin cells of a mother cat and placing those contaminated cells into the womb, scientists were able to prove that it was possible to clone an animal with a manipulated gene. Apparently, this development could allow for a better understanding of human genetic diseases in the future. But what about the benefits of glowing cats?
If you ask me, cats that could truly glow-in-the-dark would make for an unique and styilsh night-light. And, much like the new Litrospheres, they last for about 12 years (I will talk about this tomorrow). The only downside is that the latter requires no power source while cats require a steady diet. Still, the crazy cat lady down the street could have the most power efficient house in town.

Future Consequences of Egg Donation

A recent report in the journal Nature investigated the ethics and economics of donating eggs for stem-cell research. Helen Pearson In 1989, a healthy 32-year-old woman offered her infertile younger sister some of her healthy eggs, and with them the chance to have a baby. Doctors at the Cromwell IVF and Fertility Centre in London gave the donor hormones that made a batch of eggs in her ovary mature, and collected six eggs for fertilization. Three embryos were transferred to the younger sister and two were frozen. One baby girl was born. Five years later, the doctors contacted the egg donor to ask whether to discard her frozen embryos. They discovered that she had been diagnosed with late-stage colon cancer that spread to her skull. She died just before her thirty-ninth birthday. Doctors don't know if the fertility drugs caused or accelerated the woman's cancer. But the possibility prompted Cromwell infertility specialist Kamal Ahuja to report the case as a reminder of how little is known about the risks of donating eggs (K. E. Ahuja and E. G. Simons, Hum. Reprod. 1998;13, 227-231; 1998). "It shook us all up," he says. Specialists in reproductive medicine say there is insufficient information about the long-term risks of drugs used to stimulate ovulation, a practice that has become more common in the past 25 years, with the proliferation of in vitrofertilization (IVF) and assisted reproduction. But some studies have suggested the drugs may be linked to the development of certain cancers.The question is receiving renewed scrutiny now that scientists are asking healthy women to donate their eggs forstem-cell research and exposing them to the potential risks of ovulation stimulation without the end result of a baby . The uncertainty makes it even more difficult to reach a consensus on whether women who donate eggs should be compensated, and if so by how much. "This discussion should emphasize long-term risk assessment rather than money," Ahuja says.During ovulation stimulation for IVF or egg donation, women are given drugs that encourage the ovary to ripen several eggs simultaneously, rather than the one egg normally ovulated each month. Doctors know that this can have side effects ranging from moodiness to infection. The most serious is ovarian hyperstimulation syndrome, which seriously affects about 6% of women receiving the drugs. Thirty or more eggs start to develop at once and fluid leaks out of blood vessels and collects in the abdomen, causing nausea, bloating and very occasionally kidney failure or even death.There is little information on how frequently ovarian stimulation has tragic side effects, says obstetrics and gynaecology professor Didi Braat of Radboud University Medical Centre in Nijmegen, the Netherlands, because doctors are often reluctant to report such cases and rarely have to. But deaths are thought exceptional: in a study reported at this year's meeting of the European Society for Human Reproduction and Embryology, Braat and her colleagues found only six deaths clearly linked to IVF from the medical records of some 100,000 women who underwent the procedure between 1984 and 2006.So some specialists are more worried about the long-term risks of fertility drugs. In the 1990s, for example, studies pointed to a link between fertility drugs and breast or ovarian cancer, although it's not clear how cancer would be promoted. One study suggested that women who took an ovulation-stimulating drug called clomiphene citrate for more than a year had 11 times the risk of developing ovarian tumours compared with the general population (M. A. Rossing et al. N. Engl. J. Med. 1994;331, 771-776).But these studies are controversial. It might be infertility, not fertility drugs, that predisposes women to disease. Other aspects of women's reproductive lives influence ovarian and breast cancer whilst pregnancy is thought to protect against tumours, for example. And ovarian cancer is so rare that it's hard to get a large enough sample to spot any connection.Louise Brinton at the US National Cancer Institute in Bethesda, Maryland, and her colleagues tried to control for these factors in one of the most comprehensive studies so far. They collected the medical records of more than 12,000 women who received ovulation-stimulating drugs between 1965 and 1988. The team did not find statistically significant increases in breast and ovarian cancer, but did find that the women were around 1.8 times more likely to develop uterine cancer (M. D. Althuis et al. Am. J. Epidemiol. 2005;161, 607-615).Such studies have reassured many specialists that the risks of ovulation stimulation are insignificant. But Brinton and others studying the issue say the picture is still incomplete. Brinton's study involved mainly women who took clomiphene citrate, rather than the gonadotropin hormones introduced for IVF in the 1980s. Researchers have only had a decade or so to study significant numbers of women taking the newer drugs, but extra cancers may not appear until the women reach 50 or 60. Researchers also don't know whether studies on infertile women can be generalized to egg donors, who are typically younger and healthier. Epidemiologist Mary Croughan at the University of California, San Francisco, has unpublished data suggesting donors are at lower risk of cancer. But "it's important to follow these women into the future", she says.She and other experts want more extensive studies to follow up women who have had IVF treatment or donated eggs. There is at least one large study of the long-term effects of ovarian stimulation under way in the Netherlands. But it's unclear who will drive the effort, particularly when private fertility clinics may have little interest in finding out the potential risks of the drugs they use. Ahuja suggests that an authority such as Britain's HFEA could coordinate such an investigation.Some argue that the researchers asking women for eggs should help pin down the health risks. Kevin Eggan of the Harvard Stem Cell Institute, for example, says that his group tells egg donors of the risks, and that they cancel the procedure if women show signs of ovarian hyperstimulation syndrome.If the risks aren't made clear upfront, one well-publicized tragedy could kill efforts to find donors, adds John Buster, professor of obstetrics and gynaecology at Baylor College of Medicine in Houston, Texas. "If a woman has a cardiac arrest while giving eggs for stem-cell research, it won't go down too well.