Question

A 30 y male was delivered to andrology department for medical evaluation due to ineffective sexual competency. His physical examination and interview with the specialized physician revealed some other symptoms that were related to wounds that won’t heal, unexplained weight loss, hair loss, lack of alertness and sometimes diarrhea. These symptoms were seen in the last 6 months only and nothing seen before.

Semen analysis and other tests were prescribed and the results were:

Semen analysis

Days of abstinence: 3 days

Time of collection: 9:30 am

Time of receipt: 9:45 am

Liquifaction time: 30 min

Volume: 4ml

Viscosity: normal

pH: 8.5

Sperm concentration: 12 million/ml

Sperm motility: marked decreased motility

Morphology: more than 50% normal forms

Spermatids and WBCs: less than 1 million/ml

Other tests

Fructose level was in normal range

Viability testing showed that most sperm are viable

Low serum testosterone

Discuss these results, what is the expected case, mention any confirmatory tests if required

Answer 1

The normal range for various parameters of s@men are:

Volume :- 2-5 mL

pH: - 7.5-8.5

Concentration:- lower threshold is 20 million/mL

Mobility/ viability- 50%

Liquifaction time: 20-30 min.

In the above result the volume, pH, liquifaction time, viscosity and morphology seems normal.

The Concentration of the sp@rm is observed lower than the normal. WHO defines 15 million sperm per milliliter as average. Therefore, the above report is identified as mild oligospermia.

Lower the WBC in s@men, the better because more WBC cause leukocytospermia account for increase ROS production which can potentially affcet the sp@rm cells. The report indicates the normal WBC level.

Therefore, the low sperm motility arises due to antisperm antibodies not due to leukocytospermia.

Diagnosis: Transrectal ultrasound, hormone tests, scrotal ultrasound can be done to find the possibilities of error occured. Two-strip  lateral flow immunochromatographic diagnosis is preferred for further analysis.