Sperm count

Approximate pregnancy rate varies with amount of sperm used in an artificial insemination cycle.
Values are for intrauterine insemination, with sperm number in total sperm count, which may be
approximately twice the total motile sperm count.Sperm count, or sperm concentration to avoid mixup,
measures the concentration of sperm in a man's ejaculate, distinguished from total sperm count, which is
the sperm count multiplied with volume.[7] Anything over 20 million sperm per milliliter is considered
normal.[1][2] Anything less is considered oligozoospermia. A vasectomy is considered successful if the
sample is azoospermic. Some define success with rare non-motile sperm are observed (fewer than
100,000 per millilitre).[8] Others advocate obtaining a second semen analysis to verify the counts are
not increasing (as can happen with re-canalization) and others still may perform a repeat vasectomy for
this situation.

The average sperm count today is around 60 million per milliliter in the Western world, having
decreased by 1-2% per year from a substantially higher number decades ago.[9]

Chips for home use are emerging that can give an accurate estimation of sperm count after three samples
taken on different days. Such a chip may measure the concentration of sperm in a semen sample against
a control liquid filled with polystyrene beads. [10]

[edit] Motility
The motility of the sperm is evaluated. WebMD defines normal motility as 60% of observed sperm, or at
least 8 million per millilitre, showing good forward movement.[2] The World Health Organization has a
similar value of 50% and this must be measured within 60 minutes of collection. A man can have a total
number of sperm far over the limit of 20 million sperm cells per milliliter, but still have bad quality
because too few of them are motile. However, if the sperm count is very high, then a motility of less
than 60% might not matter, because the fraction might still be more than 8 million per millilitre. The
other way around, a man can have a sperm count far less than 20 million sperm cells per millilitre and
still have good motility, if more than 60% of those observed sperm cells show good forward movement.

A more specified measure is motility grade, where the motility of sperm are divided into four different
grades:[11]

Grade 4: Sperm with progressive motility. These are the strongest and swim fast in a straight line.
Sometimes it is also denoted motility a.
Grade 3: (non-linear motility): These also move forward but tend to travel in a curved or crooked
motion. Sometimes also denoted motility b.
Grade 2: These have non-progressive motility because they do not move forward despite the fact that
they move their tails.
Grade 1: These are immotile and fail to move at all.
[edit] Morphology
The morphology of the sperm is also evaluated. With WHO criteria as described in the old manual of
1989, a sample is normal if 30% or more of the observed sperm have normal morphology.[1] If
morphology is evaluated using the Tygerberg strict criteria developed by Dr. Roelof Menkveld,
Tygerberg Hospital, South Africa, and disseminated by Dr. Thinus Kruger from the same hospital,[12] a
sample is normal if 14% or more of the observed sperm have normal morphology.[1]. The Tygerberg
strict criteria for morpology assessment are recommended in the most recent WHO manual on semen
analysis (WHO 1999). According to the above references, morphology was developed as a predictor of
success in fertilizing oocytes during invitro fertilization.

[edit] Volume
The volume of the sample is measured. WebMD advises that volumes between 1.0 mL and 6.5 mL are
normal;[2] WHO criteria specify that any volume greater than 2.0 mL is normal. Low volume may
indicate partial or complete blockage of the seminal vesicles, or that the man was born without seminal
vesicles.[1] In clinical practice, a volume of less than 2 mL in the setting of infertility and absent sperm
should prompt an evaluation for obstructive azoospermia. A caveat to this is be sure it has been at least
48 hours since the last ejaculation to time of sample collection.

[edit] Fructose level

The level of fructose in the semen is measured. WebMD lists normal as at least 3 mg/mL.[2] WHO
specifies a normal level of 13 μmol per sample. Absence of fructose may indicate a problem with the
seminal vesicles.[1]

[edit] pH
The pH of the sample is measured. WebMD lists a normal range of 7.1-8.0;[2] WHO criteria specify
normal as 7.2-7.8.[1] Acidic ejaculate (lower pH value) may indicate one or both of the seminal vesicles
are blocked. A basic ejaculate (higher pH value) may indicate an infection.[1] A pH value outside of the
normal range is harmful to sperm.[2]

[edit] Liquefaction
The liquefaction is the process when the gel formed by proteins from the seminal vesicles is broken up
and the semen becomes more liquid. It normally takes less than 20 minutes for the sample to change
from a thick gel into a liquid. An abnormally long liquefaction (more than 30 minutes at 37 24°C) time
may indicate an infection.[citation needed]

[edit] MOT
MOT is a measure of how many million sperm cells per ml are highly motile[13], that is, approximately
of grade 4, or sometimes also taking grade 3 into account. Thus, it is a combination of sperm count and
motility.

With a straw volume of 0.5 milliliter per straw, the general guideline is that, for intracervical
insemination (ICI), straws making a total of MOT40 is recommended. This is equal to 8 straws with
MOT5, or 2 straws of MOT20. For intrauterine insemination (IUI), straws making a total of MOT10 is
regarded sufficient.[14] In WHO terms, it is thus recommended to use approximately 20 million grade
3+4 sperm in ICI, and 5 million ones in IUI.

[edit] Total motile spermatozoa

Total motile spermatozoa (TMS)[15] or total motile sperm count (TMSC)[16] is a combination of sperm
count, motility and volume, measuring how many million sperm cells in an entire ejaculate are motile.

Use of approximately 20 million grade 3+4 sperm in ICI, and 5 million ones in IUI may be an
approximate recommendation.

[edit] Others
The sample is tested for white blood cells. A high level of white blood cells (over 1 million per
milliliter) may indicate an infe