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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Lab report shows asthenoteratozoospermia based on total ejaculate concentration, motility and morphology. Explain

HI...
PLEASE GO THROUGH THIS REPORT AND HELP ME IN THIS REGARD...




ADVANCED ANDROLOGY LABORATORY

COMPUTER ASSISTED SPERM ASSESSMENT (CASA)

Name     MR. SURESH KUMAR.S      Age     34 Yrs     Hosp No     

Abstinence days      03     Volume → 2.6 ml
     Time of Collection     09.40 AM     Time of Evaluation     10.10 AM     Spillage:     No
Fructose → Positive     Pus cells→ 01/hpf Not Significant      Ph → 8.0     Liquefaction → Normal     Live → 39 %     Dead → 61 %

CONCENTRATION ASSESSMENT (5th percentile value)
Total Ejaculate
Millions      218 million
Total Ejaculate: Normal
(5th per: 40 75th per: 120)

Sperm Conc.
(millions / ml     84 mill/ml
               
MOTILITY ASSESSMENT (5th percentile value)
Sperm Motility     1 Hr     2 Hrs
Total Progressive       27%      12%
Non Progressive       08%      10%
Immotile       65%      78%
          
Total motility
(Total Progressive + Non Progressive)     35%     22 %


1 Hour Total motility: Sub Normal
(5th Per: 42 75th Per: 50)

Advanced CASA parameters     Micro mt/sec
Straight Line Velocity-VSL      00.0
Curvilinear Velocity –VCL      28.0
Hyper activation –H max assay      00.0


Advanced Total Progressive Motility Assessment (CASMA)
Rapid Progressive      00%
Slow Progressive      27%
Advanced Total progressive motility: Sub Normal
(5th Per: 10      75th Per: 15)


MORPHOLOGY ASSESSMENT (TYGERBERG KRUGER) (5th percentile value)
Morphology      %
Normal Forms      02%
Over all Defects      98%
Sperm Morphology: Sub Normal
(5th Per: 4 75th Per: 9)


Head Defects      67%
Mid Piece and Neck Defects      20%
Tail Defects      11%
Multiple Defects      33%

Excessive residual cytoplasm (ERC)      03%
Ex. residual cytoplasm: Not Significant




ADVANCED ANDROLOGY LABORATORY


ADDITIONAL PARAMETER ASSESSMENT

Round cells: Nil      Bacteria: Not significant
RBC: Nil Agglutination: Nil Cellular debris: Not significant

Special Comment :

Final Impression- ASTHENOTERATOZOOSPERMIA
1. Terminology used in final impression is on the basis of total ejaculate concentration, motility & morphology. Additional parameter reported needs to be evaluated independently by the physician.
2. Impression based on 5th percentile value, however, 75th percentile value may be optimum and treatment plan may be suitably
decided by the physician.
3. 75th percentile value was decided optimum instead of 90th percentile by our clinical database and international opinion - to avoid too large an indeterminate group.


CASA: Computerised semen analysis is done with sperm class analyzer (http://www.spermclassanalyzer.com/) which provides fast, accurate & objectively repeatable results. This sophisticated software reports concentration, motility, morphology, vitality & DNA Fragmentation Index with unmatched accuracy with inbuilt QC/ QA checks.

Useful information:

Percentile value represents a range where the upper and lower reference limits (obtained by high quality reference data - WHO 5th manual and Asian Journal of Andrology 2010) define threshold levels of minimum and optimal numbers. Statistically, if the threshold levels are below 5th percentile pregnancy possibilities are extremely low and similarly if the levels are above 75th percentile pregnancy possibilities reach near normal population levels. The reporting format (first in India) ensures planning of cost effective solutions for male fertility problems.

Note: CASA - Semen Analysis is a guide to fertility and facilitates planning management. The report needs to be interpreted by the treating physician with corresponding clinical factors and is not a proof of fertility.



CASA sperm motility     CASA sperm morphology
     






ADVANCED ANDROLOGY LABORATORY



5th and 75th percentile reference values

Volume     1.7 ml – 2.0 ml
Ph      7.2
Liquefaction     30 min
Vitality     > 58 % of cells
Agglutination – MAR test     
Fructose     Positive
White Blood cells     
Peroxidase-positive leukocytes      
Seminal neutral glucosidase      Greater than or equal to 20 (mU/ejaculate)     

Test
      5th Percentile value
(Minimum numbers - WHO 5th manual)       75th Percentile value
(Optimum numbers)
Sperm Concentration Total Ejaculate     > 40 mill for total ejaculate     > 120 Million
Sperm Concentration / ml     > 16 mil / ml     > 40 Million
Motility Progressive      > 33 %      > 40 %
Total Motility (Progressive + Non Progressive)      > 42 %      > 50 %
          
Advanced Total Motility          
Rapid Progressive      10 %     15 %
Slow Progressive     23 %     25 %
          
Morphology     > 4% Normal forms      > 9 %
Acrosome Intactness Index     > 50 %     
Excessive residual cytoplasm (ERC)     
          
Testicular sperm producing capacity
per day per ml of testicular volume      0.25 million     1.25 million
          
VSL     17-67 micro mt/sec     
VCL     25-100micromt/sec     
H max assay     6.8 + 1.7     

QC / QA: Quality assurance (QA) and Quality control (QC) as per WHO 5th manual are strictly followed as Semen Analysis is a multivariate sample. Volume by weight/ computer assisted motility & morphology-CASMA & Peroxides stain for WBC with Tygerberg-Kruger morphology

Recent Andrological advances: Advanced Andrology tests: Our advanced Andrology laboratory performs the following unique tests for the first time in India, to aid in specific management of Male Fertility problems:

1. DNA fragmentation index assessment for internal sperm defects - DFI
2. Sperm Functional Integrity assessment - SFI
3. Reactive Oxygen Species estimation - ROS

The following tests will be introduced shortly:
1. Sperm Developmental Defect assessment – SDD
2. Biological Fertility Assessment (Men) - Spermatogenesis, Spermiogenesis & Functional fertility assessment - BFA

(BFA is a comprehensive test which can predict fertility and identify the site of problems in men) – Contact your doctor or our lab for specific information.

Copyright©2010 Ankur


Dr. Vasan S S          Mr. Ganesan K K
Director - UroAndrologist     Lab Manager
Andrology team: Chaitra suma , Ashwini, Gomathi, Chitra





ADVANCED ANDROLOGY LABORATORY

SPERM FUNCTIONAL INTEGRITY ASSESMENT - SFI
Flagellar Integrity - Hypo Osmotic Swelling                       41%
Osmotic Swelling Test
Normal               :     > 55 % spermatozoa with tail coiling
Significance          :     This test is a good index of healthy spermatozoa.
Clinical Relevance      : Decrease in HOS positive reaction indicates loss of viability                          hence may be an indication of degenerative changes occurring

Spermiation defects - Acrosome Reaction after Ionophore Challenge 04%
     
ARIC Test
Normal : > 15 % spermatozoa with halos having mean diameter of 10 m
Subnormal : > 10-15 % spermatozoa with halos having mean diameter of 10 m
Abnormal               :     
Significance :      This test evaluates the functional status of sperm acrosome and is
a good indicator of sperm’s ability to penetrate the oocyte.
Clinical Relevance      : Decrease in Acrosome positive reaction indicate the
                     Possibility of low or nil fertilization.

Seminal Vesicle marker - Zinc concentration NA

Zinc concentration Test

Normal               :     2.4 μmoL per ejaculate
Significance          : The function of the accessory gland is assessed by the content of Zinc and
                    Zinc has been found to be critical to spermatogenesis
Clinical Relevance      : Lower concentrations imply abnormal function of the accessory gland
High zinc concentrations have been reported to depress oxygen uptake in the sperm celL.
Wed, 21 Aug 2013
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Question is related to
Diseases and Conditions
Lab Tests ,  
Pathologist and Microbiologist 's  Response
Hello and welcome to HCM,
The semen analysis report is as follows:
1. The volume of ejaculate is within normal limits. In health, the volume should be atleast 2 ml/ ejaculate.
2. The sperm conc/ml of semen is within normal limits. In health, sperm concentration should be atleast 20 million/ml. In your case sperm conc is more than 20 million/ml.
3. Motility: At least 50 % perms should show progressive forward motion. In your case the motility is less than 50 %.
4. Morphology: In health, atleast 50 % sperms should have normal morphology. In your case, there are many structural defects and dead sperms and thus morphology is sub-normal.
5. Rest of the physical characteristics i.e. volume, pH, liquefaction of semen, viscosity are within normal limits.
6. There is no evidence of infection in the semen.

A repeat semen analysis should be done since, asthenoteratozoospermia suggests inability to bear children.

Thanks and take care
Dr Shailja P Wahal

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