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Study of Semen Analysis Patterns in Male Partner of In- Fertile Couple Koju S et al. Semen analysis pattern NJOG. Jan-Jun. 2021;16(32):57-60 Original Study of Semen Analysis Patterns in Male Partner of In- fertile Couple Attending Tertiary Level Hospital of Nepal Surendra Koju1, Suman Raj Tamrakar2, Ramita Shankhadev1 1Department of Pathology, Dhulikhel Hospital - Kathmandu University Hospital 2Department of Obstetrics & Gynecology, Dhulikhel Hospital - Kath- mandu University Hospital ABSTRACT Aims: The aim of this study is to analyze the pattern of semen abnormality in CORRESPONDENCE male partner of infertile couple in Nepal. Surendra Koju Methods: A retrospective study of semen sample of male partner of infertile couple analyzed in Department of pathology, Dhulikhel Hospital from January Department of Pathology, 2014 to December 2018. All semen samples were processed and analyzed ac- Kathmandu University cording to methods and standards outlined by World Health Organization la- Hospital, Dhulikhel, Nepal boratory manual for the examination and processing of human semen 2010. Results: A total of 520 semen samples were analyzed. Our study shows 221 Email: (44%) abnormal for different semen parameters and asthenozoospermia [email protected]; (39.3%) is the most common abnormality followed by azoospermia (28.8 %), Phone: +977-9841791258 Oligoasthenozoospermia (17.9 %), Oligozoospermia (8.7 %), Oligoasthenoter- atozoospermia (3.5 %) and teratozoospermia (1.8 %). Received: December, 2020 Accepted: May 1, 2021 Conclusions: Abnormal semen parameters remain significant causes in overall infertility in our set up with asthenozoospermia and azoospermia were common abnormalities in male partner. Semen analysis is an inevitable tool for evalua- Citation: tion of infertility in male partner. Further study is required to find out the possi- Koju S, Tamrakar SR, ble etiologies of male infertility for holistic management of infertility. Shankhadev R. Study of Keywords: azoospermia; infertility; oligospermia; semen Semen Analysis Patterns in Male Partner of Infertile Couple Attending Tertiary INTRODUCTION Most of the time, the exact etiology Level Hospital of Nepal. of male infertility is unknown. Few Infertility is inability to conceive even Nep J Obstet Gynecol. known factors for the male infertili- after one year of regular and adequate 2021;16(32):57-60. DOI: ty are sexually transmitted disease, sexual intercourse without use of any https://doi.org/10.3126/ reproductive tract infection, endo- contraceptive tools.1 Prevalence of njog.v16i1.37520 crine disturbance, immunological infertility is about 8-12% in world and problem, sexual dysfunction and 40-50% of cases of infertility are due ejaculatory problem. Oligozoo- to male partner in infertile couple.2,3 spermia is associated with environ- Infertility is very sensitive issue in ment and lifestyle factors like country with patriarchal society. Most chemical exposures, pesticide ex- of the time female partner is blamed posures, smoking, alcoholism, and punished for it; and male partners stress and obesity.8,9 This study are not usually evaluated during infer- will help in finding out the preva- tility evaluation thus underestimating lence of male factor and nature of male factor infertility.4 Actually male abnormal semen analysis pattern in factors are also equally responsible infertile couple attending tertiary for infertility and semen analysis is level hospital of Nepal. an indispensible investigation in a couple with infertility. Semen analy- METHODS sis considered as primary and stand- This is a retrospective study of sem- ard technique to assess male infertili- 5,6 inal fluid of infertile couple attend- ty. So, a proper interpretation of ing Obstetrics & Gynecology De- semen parameters can be effective partment of Dhulikhel Hospital tool in managing the male factor in- from January 2014 to December fertility.7 57 Koju S et al. Semen analysis pattern NJOG. Jan-Jun. 2021;16(32):57-60 Original 2018. Ethical approval was obtained from Institu- was asthenozoospermia followed by azoospermia tional Review Committee (IRC) of Kathmandu Uni- and oligoasthenozoospermia; and leukocyto- versity School of Medical Sciences (KUSMS). spermia was in 58 (11.1%) of semen sample. [Table-2] Semen samples were collected in a sterile universal plastic container by masturbation after 3 days of Table-2: Distribution of abnormal semen parame- sexual abstinence and the samples were delivered ters within one hour of semen collection. Semen analy- Semen abnormalities N % sis was done in the Department of Pathology, Asthenozoospermia 90 39.3 Dhulikhel Hospital. All semen samples were pro- Azoospermia 66 28.8 cessed and performed according to methods and Oligoasthenozoospermia 41 17.9 standards outlined by World Health Organization Oligozoospermia 20 8.7 laboratory manual for the examination and pro- Oligoasthenoteratozoospermia 8 3.5 cessing of human semen 2010. Teratozoospermia 4 1.8 Different parameters like volume, pH, viscosity, liquefaction, sperm concentration, motility and mor- After excluding 66 cases of azoospermia, we ana- phology were assessed. Results of Semen analysis lyzed and compared normozoospermic and oligo- were analyzed based on reference value of World zoospermic male partners with different semen Health Organization (WHO), 2010. Data were ana- parameters. There were statistical differences in lyzed using SPSS16.0 version. The data were ana- parameters like mean age of infertile male part- lyzed for frequency and mean ± Standard deviation ners, total sperm concentration, progressive motili- calculated for total sperm concentration, volume, ty and total immotility of oligozoospermic male progressive motility, immotility and age of male partners and normozoospermic male partners, partner. 95% confidence interval was calculated for which was significant (p<0.005). But there were proportions and for means. Mean value were com- no significant differences in total semen volume of pared for statistical significant using t-test with the both group [Table-3] . level of significance set at p<0.05. Table-3: Comparison of semen parameters be- RESULTS tween normozoospermia and oligozoospermia A total of 520 semen samples were studied with Normospermia Oligopsermia P- 78.5% primary and 21.5% secondary infertility; 291 Mean±SD Mean±SD val- (56%) were normozoospermia and 221 (44 %) ab- (95% CI) (95% CI) ue normal for different semen parameters. Volume 2.5±0.9 2.4±1.0 0.34 (2.4-2.6) (2.1-2.6) Age range was 19-59 (30.3±5.3) years and majority Total count 46.6±21.7 7.0±3.8 0.00 (55.6%) at 21-30 years age group. By ethnicity, (44.4-48.8) (6.1-7.9) 36.9% were Brahmin-Chhetris followed by Newars Progressive 47.2±23.5 19.4±22.4 0.00 (32.1%) and other janajati (21.5%) [Table-1]. motility (44.8-49.5) (14.0-24.8) Immotility 32.7±20.2 55.5±26.9 0.00 Table-1: Demographic characteristics of male infer- (30.7-34.8) (49.0-69.0) tile partners (N=520) Age 30.3±5.2 28.9±4.4 0.04 (29.8-30.9) (27.9-30.0) Parameters N (%) Types of Primary infertility 408 78.5 p<0.05; Confidence Interval (CI) infertility Secondary infertility 112 21.5 DISCUSSION <20 8 1.5 21-30 289 55.6 This study showed the prevalence of primary Age group 31-40 200 38.5 infertility as 78.5%. In a study done by SN Aulia in years 41-50 20 3.8 et al6 showed 88.7% of men with primary >50 3 0.6 infertility and 11.3% of men with secondary Brahmin Chhetri 192 36.9 infertility but a Nepalese study by Subedi et al10 Madhesi 19 3.7 showed predominance of secondary infertility Ethnicity Dalit 30 5.8 (56.56%). Newar 167 32.1 Other Janajati 112 21.5 We found abnormal semen parameter in 229 (44 %) with most common abnormality as asthenozoo- Mean volume of semen was 2.48±0.917 (ranges 0.2 spermia (39.3%) followed by azoospermia (28.8 %) and oligoasthenozoospermia (17.9%). Adeniji - 6.0) ml; 36 (6.9%) had hypospermia; and mean 11 sperm concentration was 35.45±26.68 (range = 0 – RA et al. also found common abnoramility of 150) x 106 per ml. The most common abnormality asthenzoospermia (27.8 %), followed by oligo- spermia (18.9%) and azoopsermia (6.7%). Azoosp- 58 Koju S et al. Semen analysis pattern NJOG. Jan-Jun. 2021;16(32):57-60 Original ermia (28.8%) was an important finding in our help in managing the male infertility cases. Propor- study and this finding was almost double to the tionate representation was not assured for ethnic study findings of Diallo MS et al.12 in Senegal group distribution. (14.5%) but lesser to the study findings of Pant PR CONCLUSIONS in Nepal (38.9%).13 Asthenzoospermia, azoospermia and oligoasthen- Azoospermia may be related to obstruction of male zoospermia are major factors for contributing male reproductive tract or defective production. Sperm infertility. concentration may not be an only responsible pa- rameter in male infertility, other parameters like REFERENCES motility, semen viscosity, semen volume, and mor- 1. Practice Committee of the American Society phology may also be the important parameters for for Reproductive Medicine. Definitions of in- male factor infertility. fertility and recurrent pregnancy loss: a com- The mean sperm concentration for normazoosper- mittee opinion. Fertil Steril. 2013;99:63. mic and oligozoospermic group was 46.6±21.7 and 7.0±3.8 respectively while the mean percentage of 2. Kumar N, Singh AK. Trends of male factor progressive motility is 47.2±23.5 in normozoo- infertility, an important cause of infertility: A spermia and 19.4±22.4 in oligozoospermia. Both review of literature. J Hum Reprod Sci. these results were comparable to the the study find- 2015;8:191–6. ings of Abimibola N in Nigeria.9 3. Inhorn MC, Patrizio P. Infertility around the The mean ejaculated semen volume for normozoo- globe: New thinking on gender, reproductive technologies and global movements in the 21st spermic and oligozoospermic group was 2.5±0.9 and 2.4±1.0 respectively.
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