Fertility Section: Semen Analysis, Azoospermia, and Artificial Insemination

**73. How to interpret a semen analysis report?**

Many men who experience infertility after marriage will have a semen analysis done at the hospital. How should one interpret a semen analysis report?

(1) The normal semen volume is 2-6 ml per ejaculation. 1-2 ml is considered suspiciously abnormal, and less than 1 ml or more than 7 ml is also abnormal. The semen volume measurement is related to the abstinence period. The longer the abstinence period, the more semen volume there will be. Generally, abstinence for 3-7 days is advisable.

(2) Sperm density is generally expressed as the number of sperm per milliliter of semen. The normal sperm density is 20 million to 150 million per milliliter. A sperm density of less than 20 million per milliliter is considered oligospermia; a sperm density of more than 250 million per milliliter is considered polyspermia; if no sperm are found in the semen after multiple examinations or after centrifugation, it is considered azoospermia. All three of these are factors that can cause infertility.

(3) Abnormality rate: Normal sperm heads are flat and oval, and tails are long and curved, resembling tadpoles. However, some sperm heads are pointed, large, or double-headed, and the body and tail are short, forked, or double-tailed. If these abnormal sperm exceed 30%, it is called teratospermia, which can cause infertility.

(4) Liquefaction Time: Normally, after ejaculation, semen becomes gelatinous under the action of coagulating enzymes in the seminal vesicle, and then becomes a less viscous liquid after 5 to 30 minutes. If it does not liquefy within half an hour, it is called semen non-liquefaction, and the sperm cannot move freely, which leads to male infertility.

(5) Color: Normal semen is grayish-white or pale yellow. If there is blood in the semen, turning it red or pink, it is hemorrhagic semen. Under a microscope, a large number of red blood cells can be seen. This is commonly seen in inflammation of the accessory glands and posterior urethra, and occasionally in tuberculosis or tumors. If the semen contains yellow secretions, it is purulent semen. Under a microscope, a large number of pus cells can be seen, indicating inflammation of the reproductive tract or accessory glands.

(6) pH of normal semen is between 7.2 and 7.8. Too acidic or too alkaline is not conducive to sperm motility and metabolism.

(7) Inflammatory cells: There should be fewer than one "+" sign for white blood cells in normal semen. An increase in white blood cells indicates an infection in the reproductive tract or accessory sex glands.

(8) Survival rate: Within 1 hour after ejaculation, the number of motile sperm should be no less than 70% (generally 60% to 80%). If it is less than 60%, it is asthenospermia. If all the sperm in the semen are dead, it is necrospermia.

(9) Sperm motility is generally classified into four grades. Grade 0 refers to inactive sperm; Grade 1 refers to sperm that move in place; Grade 2 refers to sperm that swim slowly forward in a curved path; Grade 3 refers to sperm that swim forward in a straight line; and Grade 4 refers to sperm that swim rapidly forward in a straight line. Generally, only sperm of grade 3 or higher have the potential to fertilize an egg. It is generally required that grade 3 + grade 4 (sometimes labeled as grade a + grade b) sperm account for ≥50%.

74. What to do if you have no sperm?

"Of the three unfilial acts, the greatest is to have no offspring." In the eyes of traditional Chinese people, continuing the family line is of paramount importance. However, due to the excessive pressure of modern life and the increasing environmental pollution, many men are unknowingly suffering from "azoospermia".

Azoospermia, or "absence of sperm," refers to the absence of sperm in ejaculated semen. Clinically, it is usually defined as the absence of sperm in three consecutive microscopic examinations of the semen after centrifugation. As one of the most difficult types of infertility to treat, azoospermia has caused immense suffering for patients and presented numerous challenges for doctors. Azoospermia accounts for 15% to 20% of male infertility cases. Male infertility caused by sperm problems includes oligospermia, necrospermia, and low sperm motility, among others. Azoospermia is currently the most difficult to treat.

What can be done if a man has no sperm? To treat azoospermia, it's essential to understand its causes. The causes of azoospermia are as follows:

(1) Obstruction of the vas deferens: Obstruction of the vas deferens is one of the main causes of azoospermia. For patients with normal testicular size and normal FSH (male gonadotropin) levels, surgical treatment is possible. The success of the surgery depends on the location of the obstruction. Clinical studies have found that the success rate of surgery for patients with epididymal tail obstruction can be as high as 50%.

(2) Primary testicular insufficiency may be caused by genetic defects, undescended testes, physical damage to the testes, or mumps during puberty. The cause is usually unknown. Patients with primary testicular insufficiency usually have small, soft testes and elevated total plasma FSH.

(3) Lack of spermatogenic cells: Many men with azoospermia have only podocytes in their vas deferens. There are many reasons for this, including administration of cytotoxic drugs, radiation, or some factors during the fetal period.

Therefore, once azoospermia is diagnosed, a systematic examination at a specialized hospital is necessary to determine the cause and receive individualized treatment based on the specific cause. Avoid seeking treatment haphazardly in a panic, as this can lead to being misled and delaying proper treatment. Of course, it's also important to maintain an optimistic attitude and believe that with advancements in medicine, many complex and difficult-to-treat diseases can be effectively treated.

**75. How is artificial insemination performed?**

Artificial insemination (IUI) is suitable for male infertility, including oligospermia, asthenospermia, necrospermia, azoospermia, severe hypospadias, retrograde ejaculation, and erectile dysfunction. It involves inserting processed semen into the female reproductive tract through a catheter.

There are two types of artificial insemination: insemination between spouses and insemination between non-spouses.

(1) Artificial insemination between spouses refers to artificial insemination using fresh or frozen semen from the husband. The conditions for this procedure are: the husband's semen is normal, but he has an intractable sexual intercourse disorder that prevents sperm from reaching the uterine cavity, while the woman's reproductive tract is patent and her ovulation function is normal.

(2) Artificial insemination between unmarried men refers to artificial insemination using healthy, normal, fresh or frozen semen provided by a man who is not in a romantic relationship with his partner. Extreme caution must be exercised when considering artificial insemination between unmarried men. The prerequisite for artificial insemination between unmarried men is that the male has absolutely no hope of regaining fertility, and the examination should include a testicular biopsy to confirm the loss of spermatogenesis, while the female's fertility is completely normal.

For those who provide semen for artificial insemination between non-partners, the requirements are generally that they be under 40 years of age, in good health, and free from infectious diseases, sexually transmitted diseases, mental illnesses, endocrine disorders, diabetes, tuberculosis, cancer, blood diseases, congenital hereditary diseases, and drug addiction.

Artificial insemination must be performed in a hospital by medical staff in accordance with strict examination procedures and under strict sterilization, and under their specific guidance.

Assisted insemination, also known as artificial insemination, involves retrieving sperm or eggs from the body, processing or culturing them into embryos, and then implanting them into the human body. The most familiar treatment is in vitro fertilization (IVF). However, even the simplest form of artificial insemination, involving sperm washing and intrauterine insemination, is a type of artificial insemination. For mild infertility conditions, such as mild sperm motility issues, autoimmune diseases involving antisperm antibodies, or cervical diseases, artificial insemination treatment has a 20% pregnancy rate per session, and a 50% pregnancy rate after three sessions. Even men with severe oligospermia or azoospermia can have children through intracytoplasmic sperm injection (ICSI).