Male infertility concerns are rising and a lot of research is happening on these factors. Male infertility accounts for almost half of the infertility population all over the world. An effective fertilization of the egg by the Sperm is obviously the essence of the fertility process. The quantity, maturity forms and structures of both are of great importance. In case of the sperm, another critical aspect is the viscosity of it’s environment – the semen, which impacts it’s ability to swim and progress once it has entered the woman’s uterus, a world that is foreign and hostile to it. The Sperm is carried into the woman’s uterus through it’s carrier – the semen. Hyperviscous semen will slow down the motility of the sperms and limit their ability to progress into the fallopian tubes where they may encounter the woman’s egg.
Therefore it is the Semen whose quality, quantity & viscosity that also plays a very important role in enabling the forward progression of the sperm and may often be the culprit in cases of male infertility. Semen is secreted by the male accessory glands. On ejaculation it generally coagulates and then after 15 to 20 minutes it usually liquefies.
When an abnormal semen analysis is found to be the cause of infertility, fertility experts would review the semen analysis to know exactly where the problem lies.
In a standard semen analysis, two things are evident that is, semen and sperm. The lab evaluates the volume, consistency or flow of semen, sperm count, and the percentage of sperm who are good swimmers as well as the quality of forward motion along with sperm morphology.
Male semen analysis also reports Semen volume. Normal semen volume is described as roughly 1 to 5 ml per ejaculation. When there is low semen volume, there is not enough fluid which acts as a carrier vehicle to transport sperm into the female reproductive tract, which may pose a problem for fertility.
In case low semen volume is found, male infertility patients are evaluated for:
– Retrograde ejaculation: Simple urine test is performed to know, whether part or all of the semen flows backwards into the bladder, instead of exiting from the penis. Retrograde ejaculation could be a side-effect of bladder neck surgery, diabetes mellitus or drugs.
– Blockages in a seminal vesicle or ejaculatory duct sometimes happen due to a varicocele (varicose vein), or cyst.
– Hormonal abnormalities
Viscosity simply means the consistency or thickness of the seminal fluid. Low or moderate viscosity of a seminal fluid is considered normal and flows easily. If the consistency is too thick, the semen takes a longer time to leave the reproductive tract.
Viscosity is simply resistance to flow. The thickness of semen may be due to high concentration of white blood cells.
White blood cells (leukocytes)are the soldiers of the body. Semen with a high concentration of these white blood cells can be a sign of infection. A small number of leukocytes can be normal and are not a part of an infection.
Semen colour: semen colour is the reflection of age, diet and frequency of ejaculation. The normal colour of semen is white, cloudy fluid and quite thick. Colour is a temporary phenomenon. Semen with a yellowish-green marks a prostate infection.
What is normal semen thickness?
The fluid from the seminal vesicles often causes stickiness. This is a natural intelligence of the body, to hold the sperm near the cervical opening and protect them from the harsh vaginal environment.
The enzymes in the prostatic fluid further help semen to gradually liquefy, so, the sperm can enter the cervical canal. The viscosity of the sperm is measured, as the rate at which the semen liquefies. Viscosity (with a normal result being under 2) or liquefaction time (with normal ranging between 5 and 25 minutes) is considered normal.
Sometimes a semen analysis will show a longer liquefaction time (more than 30 minutes) or abnormal viscosity (over 2).that is why a repeat analysis is required. That is why semen testing especially one performed at a fertility-specific lab will show normal results. By this time, we will understand the real status of semen viscosity.
How is Semen Tested for Viscosity?
Viscosity is observed in a laboratory by semen liquefaction. After the liquefaction is complete, the sample is allowed to drop through a pipette. The length of the thread is then measured as the semen drops. In the case of normal viscosity, semen leaves a very small trailing thread. According to WHO guidelines, semen with abnormal viscosity leaves a thread more than 2 cm long.
What the persistently abnormal finding of semen means?
Abnormal semen analysis could signify one of the following problems:
1) Dehydration. Dehydration can lead to increased semen viscosity. Proper hydration beforehand is a must. A good goal is to drink enough water, so the urine is pale yellow.
2) Infection or inflammation of the genital area can increase semen viscosity. High levels of white blood cells are typically present if there is an active infection or inflammation. Just treating the infection will restore the viscosity.
3) Improper semen collection: Most of the prostate fluid is in the first third of the ejaculate, whereas, the seminal vesicle fluid is generally in the last part of the ejaculate. If part of the collection is missed, this can impact the specimen’s viscosity, depending on which part was lost.
Persistent high sperm viscosity or increased liquefaction times are common in cases of dehydration or infection. Repeating semen analysis with the patient well-hydrated and collecting the full specimen usually results in the normalization of the liquefaction/viscosity.
How does Viscosity Affect Male Fertility?
Viscosity simply makes sperms unable to move swiftly. If sperms are unable to move forward in the reproductive tract, there are reduced chances of fertilization of the ovum.
However, in those circumstances where the abnormality persists, it decreases the couple’s fertility potential. This problem can generally be treated with low-tech treatments like sperm washing combined with intrauterine insemination/IUI.
Very viscous semen showed impaired semen quality and negatively affect sperm parameters. Viscous semen could also be the result of an inflammatory condition, infection of the genital tract, and genetic and environmental factors. Such conditions affect several aspects of the semen, including its zinc, calcium, fructose, and ascorbic acid content.
Let’s understand, semen analysis even though appears simple to analyse and relate to infertility, excellent laboratory collection plays a very important role.