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ejaculate volume,zero fructose,pH mostly acidic...

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Dear Doctor,
We've been married for 2+ years now. On finding out that we weren't conceiving, we both did a series of tests. I was 'ok' and my husband told to do a semen analysis test;he did a couple of them over the last year at different clinics.
Though sperm counts differed (increased over the year),some parameters remained unchanged-0.5 ml ejaculate volume,zero fructose,pH mostly acidic and high percentage of abnormal morphology sperm.
What do these recurring test results mean? How significant are they in evaluating our present medical condition and our hopes for having a baby?
I would greatly appreciate it if you would shed some light on this and help us find out what is going on. Our doctors have been pushing us to have an artificial procedure done for sometime now, but at the same time,we would like to know why.
I'm impressed with your replies to the numerous posts to other members of the forum. I would be grateful for your views and time on this.

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replied February 28th, 2011
Infertility Answer A20191
Welcome to ehealthforum.
The World Health Organisation (WHO) provides a definition for a 'normal' semen analysis. I will explain these and also what it means with regards to your partner’s semen analysis results.
1) The count or the concentration of sperms present in the semen is important. The concentration of spermatozoa should be at least 20 million per ml. Less counts usually indicate possibility of obstruction or infection.
2) The semen at the time of ejaculation is a thick gel. It has to liquefy to enable sperms to swim or be motile. It takes about 20 minutes for normal semen to liquefy. The liquefaction time measures this time needed for semen to liquefy. Abnormally long liquefaction time indicates infection. It should not be more than 60 minutes in any case.
3) The volume of ejaculate tells about how much of semen is present in each ejaculate. The total volume of semen should be at least 2ml (between 1-6.5 ml is considered normal). Less volume may indicate retrograde ejaculation, partial or incomplete obstruction in seminal vesicles, enlarged prostate gland, Varicocele, hydrocele etc. Causes for obstruction should be looked for and treated soon as it helps to improve fertility levels.
4) In a normal ejaculate, at least 75% of the spermatozoa should be alive (it is normal to have up to 25% to be dead). Dead sperms could indicate possibility of high acidity or obstruction or infection.
5) In a normal ejaculate, at least 30-40 per cent of the spermatozoa should be of normal shape and form. Abnormal sperms may not be able to penetrate the egg to fertilize it.
6) In a normal ejaculate, at least 25 per cent of the spermatozoa should be swimming with rapid forward movement. The motility is graded, grade 4 being the highest forward progressive motility and grade 1 being immotile and fail to move sperms. Grade 3 and 4 are considered to be normal to be able to father a child. At least 50 per cent of the spermatozoa should be swimming forward, even if only sluggishly (grade 3-4). The faster they swim up, the sooner they can get out of the acidic environment of vagina to find the egg.
7) The pH of the semen measures how acidic or alkaline it is. Acidic pH indicate blockage and alkaline pH indicate infection.
8) Presence of white blood cells is not normal. It indicates infection.
9) Fructose levels measure the amount of sugar known as fructose in semen. This provides the energy that they need to be motile and swim. Lower values could be due to infection or obstruction.
Discuss these with an infertility specialist. The IUI, IVF or ICSI are designed to help you get pregnant. IUI tackles the problem faced by sperms to get to reach to egg by bypassing the environmental problems of vagina or cervix. IVF helps to tackle the problem of fertilizing the egg by making strongest and fastest sperms come closer to egg. If IUI and IVF fail, then ICSI helps, by uniting the nuclear material. It is specially of use when sperms fail to penetrate the egg in IUI or IVF (usually due to lack of acrosomal protein that normally should be present in the sperm head to dissolve the outer wall of the egg and let the sperm enter to be able to fuse the nuclear material with that of the egg.
Hope this helps you to go ahead and decide the best possible option with discussion with your treating doctor. Take care. All the best.

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