Study of Semen Analysis in Male Partners of Infertile Couples at a Tertiary Care Hospital

Original Research Article

Study of semen analysis in male partners of infertile couples at a tertiary care hospital

Gowthami Shruthi M R1*, Vinit Anand2

1Assistant Professor, 2Professor and HOD, Department of Pathology, Subbaiah Institute of Medical Sciences, Shivamogga, INDIA. Email: [email protected]

Abstract Background: Infertility is defined as failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Semen quality has been commonly regarded as a measure of male fecundity, therefore semen analysis, being a very simple and fundamental test, remains the key investigation to study the impact of these factors in cases of male infertility. Present study was done to evaluate the abnormal seminal patterns in male partners of infertile couples and to identify possible contribution male factors to overall infertility problem. Material and Methods: This was a prospective, observational study conducted in male partners of infertile couples who were living together for more than one year and had regular unprotected sexual intercourse, underwent semen analysis. Results: In present study, total 82 male partners of infertile couple were evaluated for semen analysis. Most patients were from 31-35 years age group (36.59%), followed by 26-30 years age group (29.27%). Hypospermia (Volume < 1.5 ml) was noted in 24.39 % patientsand constitutes a significant proportion. Oligozoospermia (sperm count below 15 million/ml) was noted in 15.85 % patients. Mild, moderate and severe oligozoospermia in4.88 %, 4.88 % and6.10 % patients respectively. Total motility (< 40%) was noted in 13.41 %, progressive motility (< 32%) was noted in 15.85 %. Sperm agglutination was most common as tail to tail Grade 1+ (10.98%).Most common findings were Normozoospermia (63.41%), Normozoospermia with Hypospermia (14.63%) and Oligo-astheno-necro-zoospermia (3.66%).Conclusion:The present study revealed that majority of the cases of infertility in males is oligozoospermia followed by asthenozoospermia. Keywords: semen analysis, male partners, infertility, oligozoospermia

*Address for Correspondence: Dr Gowthami Shruthi M R, Assistant Professor, Department of Pathology, Subbaiah Institute of Medical Sciences, Shivamogga, INDIA. Email: [email protected] Received Date: 07/04/2021 Revised Date: 11/05/2021 Accepted Date: 02/06/2021 DOI: https://doi.org/10.26611/1051921 This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

(subfertility). Possible causes are reduced number of Access this article online spermatozoa (oligozoospermia), reduced sperm motility Quick Response Code: (asthenozoospermia), reduced sperm vitality Website: (necrozoospermia), abnormal sperm morphology

www.medpulse.in (teratozoospermia) or any combination of these. Majority of the cases of sub-fertility are caused by an intrinsic testicular disorder. The pathological causes for decreased

Accessed Date: sperm count arise from defect in the control mechanism of production of sperm cells at pre-testicular, testicular or 02 August 2021 post testicular level.3 Semen quality has been commonly

regarded as a measure of male fecundity, therefore semen analysis, being a very simple and fundamental test, INTRODUCTION remains the key investigation to study the impact of these Infertility is defined as failure to achieve a clinical factors in cases of male infertility. The semen parameters pregnancy after 12 months or more of regular unprotected have been found to be important determinant of functional sexual intercourse.1 The WHO task force on the diagnosis competence of the spermatozoa.4 Therefore, careful and treatment of infertility has shown that up to 15% of the evaluation of the semen parameters may point to the population suffers with either primary or secondary possible causes of the male infertility, institution of further infertility.2 The male infertility can be complete or partial investigation and the appropriate treatment targeted at the

How to cite this article: Gowthami Shruthi M R, Vinit Anand. Study of semen analysis in male partners of infertile couples at a tertiary care hospital. MedPulse International Journal of Pathology. August 2021; 19(2): 30-33. https://www.medpulse.in/Pathology/ MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Online ISSN: 2636-4697, Volume 19, Issue 2, August 2021 pp 30-33 aetiological factors. Present study was done to evaluate the the time to complete liquefaction noted. Sperm count, abnormal seminal patterns in male partners of infertile motility, and abnormal morphology are studied. The couples and to identify possible contribution male factors volume ofthe sample was measured in a graduated tube. to overall infertility problem. PH of semen was measured using PH paper. The viscosity was measured by gently aspirating it into a pipette allowing MATERIAL AND METHODS the semen to drop by gravity and observing the length of This was a prospective, observational study conducted in any thread. Motility was estimated by mounting a drop of department of pathology at a tertiary care hospital. Study liquefied semen on a slide and covering it with a cover slip. duration was 1 year June 2020 to May 2021. Sperm count was done in Neubauer chamber. Vitality test Inclusion criteria was done if total motility was less than 40%. After Male partners of infertile couples who were living together liquefaction, thin smears were prepared and Leishman for more than one year and had regular unprotected sexual staining done to study morphology of sperms. intercourse. WHO lower reference limits for semen characteristics5 Exclusion criteria  Patients having erectile dysfunction due to beta Parameter Lower reference limit blockers, Semen volume (ml) 1.5 (1.4 - 1.7) Total sperm number (106 per ejaculate) 39 (33 - 46)

 psychological causes like performance anxiety, Sperm concentration (106 per ml) 15 (12 - 16) stress, clinical depression. Progressive motility (PR, %) 32 (31 - 34)  Not willing to participate Total motility (PR+NP, %) 40 (38 - 42) Study was explained and informed consent was Sperm morphology (normal forms, %) 4 (3.0 - 4.0) taken. In all cases with abnormal semen parameters, Vitality (live spermatozoa, %) 58 (55 - 63) detailed history and clinical examination of the male PH 7.2 partner was performed. The findings were recorded and analysed as per WHO Semen was collected after a 3-day abstinence guidelines for semen analysis. period by masturbation into a wide mouthed clean Data was collected and entered in Microsoft excel sheet. container. The semen samples were allowed to liquefy and Statistical analysis was done by descriptive statistics.

RESULTS Table 1: Age wise distribution Age group Frequency Percentage(%) 21-25 10 12.2 26-30 24 29.27 31-35 30 36.59 36-40 15 18.29 >40 3 3.66 In present study, total 82 male partners of infertile couple were evaluated for semen analysis. Most patients were from 31- 35 years age group (36.59%), followed by 26-30 years age group (29.27%).

Table 2: Distribution according to volume of semen (ml) Volume of semen (ml) Frequency Percentage (%) < 1.5 20 24.39 1.5 -2 51 62.20 >2 11 13.41 Hypospermia (Volume < 1.5 ml) was noted in 24.39 % patients.

Table 3: Distribution according to total sperm count Total sperm count (millions/ml) Frequency Percentage (%) Oligozoospermia 13 15.85 Severe oligozoospermia (<1 million/ml) 4 4.88 Moderate oligozoospermia (1-5 million/ml) 4 4.88 Mild oligozoospermia (5-20 million/ml) 5 6.10 Oligozoospermia (sperm count below 15 million/ml) was noted in 15.85 % patients. Mild, moderate and severe oligozoospermia in4.88 %, 4.88 % and 6.10 % patients respectively.

Table 4: Characteristics of semen samples. General characteristic Frequency Percentage (%) Total motility ( < 40%) 11 13.41 Progressive motility (< 32%) 13 15.85 Normal morphologyAbnormalVitality 52 63.41 Immature germ cells (>6-8/hpf) 8 9.76 WBCs (>6-8/hpf) 17 2.44 Sperm agglutination Present, Tail to tail Grade 1+ 9 10.98 Present, Mixed Grade 2+ 7 8.54 Present, Mixed, Grade 1+ 1 1.22 Total motility (< 40%) was noted in 13.41 %, progressive motility (< 32%) was noted in 15.85 %. Sperm agglutination was most common as tail to tail Grade 1+ (10.98%). Fructose test was positive in all the cases.

Table 5: Distribution of men according to the type of seminal quality Impression Frequency Percentage Normozoospermia 52 63.41 Normozoospermia with Hypospermia 12 14.63 Oligo-astheno-necro-zoospermia 3 3.66 Oligoasthenozoospermia with Hypospermia 2 2.44 Oligozoospermia 2 2.44 Oligozoospermia with hypospermia 2 2.44 Asthenonecrozoospermia 1 1.22 Asthenozoospermia with hypospermia 1 1.22 Moderate Oligoasthenonecrozoospermia 1 1.22 Necrozoospermia with Hypospermia 1 1.22 Normozoospermia with delayed liquefaction 1 1.22 Normozoospermia with Hypospermia and delayed liquefaction 1 1.22 Oligoasthenonecrozoospermia with Hypospermia 1 1.22 Oligonecrozoospermia 1 1.22 Severe Oligoasthenoteratozoospermia with necrozoospermia 1 1.22 Most common findings were Normozoospermia (63.41%), Normozoospermia with Hypospermia (14.63%) and Oligo- astheno-necro-zoospermia (3.66%).

DISCUSSION negative association of semen volume, total sperm count, Semen analysis is considered as the surrogate marker for sperm motility, and morphology with age. There was a male fecundity while assessing infertile men. There are significant fall in total sperm count, sperm motility, and several reasons for altered semen quality. The major causes morphology after the age of 35 yr. Ageing is an important of infertility identified to be testicular failure, obstruction, factor responsible for the decline in semen quality. 90 % of cryptorchidism, low semen volume, sperm agglutination, seminiferous tubules in men in their twenties and thirties idiopathic infertility, varicocele, erectile or ejaculatory contained spermatids, whereas men in their forties and dysfunction, abnormal viscosity, endocrine disorder, high fifties had spermatids in 50 % of the seminiferous tubules. density of sperm, congenital abnormalities and Semen motility and morphology appear to decrease with environmental causes.5 Lifestyle factors, including age advancing male age.10 Cigarette smoking has detrimental when starting a family, nutrition, weight management, effects on spermatogenesis and they thereby impair exercise, psychological stress, cigarette smoking, fertility. Excessive alcohol consumption has been recreational and prescription drugs use, alcohol and associated with poor reproductive function including caffeine consumption, may impact fertility.7 Umashankar ejaculatory dysfunction.11 Alcohol has profound effects on KM et al.,8 studied 100 cases of male infertility, 64% of Leydig cell function by reducing the testosterone synthesis the patients are in the age group 25 to 35 years, 31% of the and its metabolite, acetaldehyde, leading to membrane patients are in the age group of >35 to 45 years, 4% of the damage and the formation of Leydig cell autoantibodies.12 patients are in the age group of more than 45 years, and 1% Apart from sperm count, sperm quality is an important of the patients are in the age group of <25 years. Similar factor. The studies conducted in Indian perspective also findings were noted in present study. In study by Naina K showed a qualitative and quantitative defect in the sperm et al..,9 analysis of semen records revealed the significant production and declination in sperm count approximately, 30% to 40% men in reproductive age group.13 A study

MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Online ISSN: 2636-4697, Volume 19, Issue 2, August 2021 Page 32 MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Online ISSN: 2636-4697, Volume 19, Issue 2, August 2021 pp 30-33 conducted by Mehta et al.14had documented that 4. Dohle GR, Diemer T, Kopa Z, Krausz C, Giwercman A, prevalence’s of azoospermia in Kurnool and Jodhpur, et al.. European Association of Urology guidelines on respectively, was 38.2% and 37.3% incidences of vasectomy. Eur Urol 2012, 61:159-163. 14 5. Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker azoospermia. Oligozoospermia was observed in 32.1% HW, Behre HM, et al.. World Health Organization 15 of cases in study by Chitturi Ramya et al., whereas by reference values for human semen characteristics. Hum Kalavathi et al.16 in 24.8% cases. Azoospermia was found Reprod Update. 2010;16(3):231-45. in (6.75%) in study by Chitturi Ramya et al.15. whereas 6. Bayasgalan G, Naranbat D, Radnaabazar J (2004) Male Kalavathi et al.16 in 8.4% of their study. In study by infertility: Risk factors in Mongolian men. Asian J Androl E.Hariharan17 it was observed that majority of men 6: 305-311. 7. Sharma R, Biedenharn KR, Fedor JM, Agarwal A (2013) belonged to the 31-35 years of age group. The mean age of Lifestyle factors and reproductive health: Taking control the study group was 35 yrs. The Mean values of the semen of your fertility. Reprod Biol Endocrinol 11: 66. volume, sperm concentration and motility in the study 8. Umashankar KM, Mukherjee J, Cristy R, Seal B, Karim R, group were 2.11ml, 31.19 million and 20.19% Ray CD, Bandyopadhyay S, Biswas J. Epidemiology of respectively. Asthenoteratozoospermia (38%) was the Male Infertility at a Tertiary Hospital in Eastern India. J most common abnormality observed in this study group South Asian Feder Obst Gynae 2016;8(2):101-106. 9. Naina Kumar, Amit K Singh, Ajay R Choudhari, Impact followed by oligoasthenoteratozoospermia (26%), of age on semen parameters in male partners of infertile teratozoospermia (24%) and azoospermia (10%). In study couples in a rural tertiary care center of central India: A by Bhaduri N et al..,18 7.45% samples were of inadequate cross-sectional study, Int J Reprod BioMed Vol. 15. No. 8. quantity. 19.87 % of cases had oligozoospermia, 12.42% pp: 497-502, August 2017 had azoospermia and 4.35% of males had 10. Harris ID ,Frenczak C , Roth L , Meacham RB . Fertility asthenozoospermia. Pus cells were found in 12.42% cases. and the ageing male . Rev Urol. 2011 ; 13 : 184-190. 11. A. Jungwirth (Chair), T. Diemer, G.R Dohle, A. Majority of the cases of infertility in males is due to Giwercman, Z. Kopa, C. Krausz, H. Tournaye. Guidelines oligozoospermia followed by azoospermia while less on Male Infertility, Male Infertility - Update March 2014, sperm motility or less amount of semen are also European Association of Urology 2015. responsible in some cases. Semen analysis remains the 12. Kumar N, Singh AK. Trends of male factor infertility, an most basic and fundamental evaluative test to diagnose and important cause of infertility: A review of literature. assess the severity of male infertility. It is an inexpensive, Journal of human reproductive sciences. 2015; 8(4):191. 13. Shamsi MB, Kumar R, Dada R (2008) Evaluation of easily done test which can provide valuable information on nuclear DNA damage in human spermatozoa in menopting various semen parameters. However, a systemic approach for assisted reproduction. Indian J Med Res 127: 115-123. should be made performed to obtain the diagnosis of 14. Mehta RH, Makwana S, Ranga GM, Srinivasan RJ, Virk infertility. SS, Prevalences of oligozoospermia and azoospermia in male partners of infertile couples from different parts of India. Asian J Androl 2006, 8: 89-93. CONCLUSION 15. Chitturi Ramya, IV Renuka, P. Premalatha, K. Madhavi, Male infertility is multifactorial. The present study Patterns of semen analysis in male partners of infertile revealed that majority of the cases of infertility in males is couples at a tertiary care hospital, Indian Journal of oligozoospermia followed by asthenozoospermia. Pathology and Oncology, October-December Hypospermia was seen in significant number of cases. 2017;4(4):536-539 536 Asthenozoospermia was seen more in oligozoospermic 16. Kalavathi D. Biradar: Male factor in infertility: Study from a tertiary care hospital. International Journal of males compared to normozoospermic males. Reproduction, Contraception, Obstetrics and Gynecology. 2016 June; 5(6):2022-2025. REFERENCES 17. E.Hariharan,.Shanthi Ethirajan, K.Jayashree Srinivasan, 1. Zegers – Hochschild F , Adamson GD , de Mouzon J , Study on pattern of abnormal semen parameters among Ishihara O , Mansour R ,Nygren K et al.. International male partners of infertile couples attending fertility centre Committee for Monitoring Assisted Reproductive in a tertiary care referral hospital, European Journal of Technology ( ICMART ) and the World Health Molecular and Clinical Medicine, 07(8), 2020 Organisation revised glossary of ART terminology , 2009. 18. Bhaduri (Bhattacharyya) N, Sarkar AP, Dewasi N, Ghosh FertilSteril .2009 ;92:1520-4. TK. Abnormalities in semen analysis among male partners 2. WHO (1999) Laboratory manual for the examination of of infertile couples: a study in a tertiary care level hospital human semen and sperm-cervical mucus interaction (4th of West Bengal, India. Int J Reprod Contracept Obstet edn), Geneva, World Health Organization, Switzerland. Gynecol 2015;4:100-2. 3. Joshi P, Gopal N, Bhat V. Study of semen analysis patterns in infertile males. International journal of pharmacy and Source of Support: None Declared biological sciences. 2011; 1(1):44-9. Conflict of Interest: None Declared