Semen Analysis Overview
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Questions and Answers

Why is it essential to collect the entire ejaculate for sperm testing?

  • To reduce processing time in the lab
  • To minimize contamination risks
  • To obtain accurate analysis of sperm fertility (correct)
  • To ensure sample volume is adequate

    • What should be done if the sperm specimen does not liquefy after collection?

  • Discard the specimen
  • Treat with amylase or bromelain (correct)
  • Refrigerate the specimen immediately
  • Wait for natural liquefaction

    • At what temperature should the sperm specimen be kept while awaiting analysis?

  • 40C
  • On ice
  • Room temperature
  • 37C (correct)

    • What is the consequence of missing the first portion of the ejaculate during collection?

    <p>Decrease in motility</p> Signup and view all the answers

    What is the purpose of liquefaction analysis in sperm testing?

    <p>To observe the ejaculate viscosity</p> Signup and view all the answers

    If a patient is shy about collecting a sperm sample, what alternative is allowed?

    <p>Collecting the sample at home and returning it quickly</p> Signup and view all the answers

    What is a potential effect of collecting the last portion of the ejaculate?

    <p>Decreased semen volume</p> Signup and view all the answers

    What should be noted when labeling the sperm specimen?

    <p>Patient's name and collection details</p> Signup and view all the answers

    What viscosity grading indicates a gel-like consistency in semen?

    <p>4</p> Signup and view all the answers

    Which pH range indicates normal conditions for semen?

    <p>7.2-8.0</p> Signup and view all the answers

    According to the WHO criteria, what motility grading corresponds to rapid, straight line motility?

    <p>4.0</p> Signup and view all the answers

    What finding is indicative of necrospermia?

    <p>Presence of dead spermatozoa</p> Signup and view all the answers

    Which abnormalities of sperm heads and tails are most commonly observed?

    <p>Double head and pinhead</p> Signup and view all the answers

    What does the modified Bloom's test indicate in terms of sperm viability?

    <p>Living sperm are unstained and bluish white</p> Signup and view all the answers

    What is the criterion for normal forms under Kruger’s strict criteria?

    <blockquote> <p>14%</p> </blockquote> Signup and view all the answers

    Which test specifically examines for spermine using saturated picric acid and TCA?

    <p>Barbiero's test</p> Signup and view all the answers

    What is the significance of a viscosity grading of 0?

    <p>Watery consistency</p> Signup and view all the answers

    Which condition is characterized by an absence of spermatozoa?

    <p>Azoospermia</p> Signup and view all the answers

    What is the normal lymphocyte to monocyte ratio in adults?

    <p>70:30</p> Signup and view all the answers

    Which of the following methods is not included in specimen concentration?

    <p>Electrophoresis</p> Signup and view all the answers

    Which type of white blood cells is typically associated with bacterial meningitis?

    <p>Neutrophils</p> Signup and view all the answers

    What is the predominant protein found in cerebrospinal fluid (CSF)?

    <p>Albumin</p> Signup and view all the answers

    Which abnormal finding in cerebrospinal fluid is indicated by the presence of immature leukocytes?

    <p>Malignant cells</p> Signup and view all the answers

    Which cell represents the earliest stage of spermatogenesis?

    <p>Spermatogonium</p> Signup and view all the answers

    What is the effect of sperm-agglutinating antibodies on sperm?

    <p>Cause sperm to stick together</p> Signup and view all the answers

    Which test is used to measure the motility of sperm in a semen analysis?

    <p>Spinbarkeit test</p> Signup and view all the answers

    What condition does a positive Amine (Whiff) test indicate?

    <p>Bacterial vaginosis</p> Signup and view all the answers

    What is the main purpose of the Potassium Hydroxide (KOH) test in vaginal fluid analysis?

    <p>To dissolve blood cells and epithelial cells</p> Signup and view all the answers

    What role does fructose play in semen analysis?

    <p>Nutrient for sperm viability</p> Signup and view all the answers

    In which situation would the presence of antisperm antibodies be expected?

    <p>When sperm are exposed to the male's immune system</p> Signup and view all the answers

    Which of the following tests specifically evaluates sperm's ability to penetrate cervical mucosa?

    <p>Sims Huhner test</p> Signup and view all the answers

    What is a common application of vaginal swabbing in clinical practice?

    <p>Identifying pathologic conditions affecting female reproductive capability</p> Signup and view all the answers

    What does a mixed agglutination reaction detect in semen analysis?

    <p>Presence of IgG antibodies</p> Signup and view all the answers

    What is the normal opening pressure of cerebrospinal fluid (CSF) in mmHg?

    <p>50 to 180 mmHg</p> Signup and view all the answers

    Which type of CSF appearance is characterized by a yellow color due to oxyhemoglobin?

    <p>Xanthochromic</p> Signup and view all the answers

    What is the primary cause of xanthochromia in CSF?

    <p>RBC degradation products</p> Signup and view all the answers

    When collecting CSF, how much total volume is typically removed into the tubes?

    <p>10 to 20 mL</p> Signup and view all the answers

    What does the term xanthochromia refer to in CSF analysis?

    <p>CSF supernatant that is pink, orange, or yellow</p> Signup and view all the answers

    What is the least likely factor to affect cell count in CSF?

    <p>Refrigeration of samples</p> Signup and view all the answers

    Which of the following is NOT a reason for elevated xanthochromia in CSF?

    <p>Normal serum bilirubin levels</p> Signup and view all the answers

    What is the typical CSF appearance associated with heavy hemolysis?

    <p>Orange</p> Signup and view all the answers

    What is the closing pressure range for cerebrospinal fluid (CSF) in mmHg?

    <p>10 to 30 mmHg</p> Signup and view all the answers

    Which type of meningitis can result in xanthochromic CSF?

    <p>Tubercular meningitis</p> Signup and view all the answers

    Study Notes

    Semen Analysis

    • Complete collection of ejaculate is essential for accurate testing. Most sperm are in the first portion.
    • Condom method is not recommended because lubricants contain antisperm agents.
    • Specimen should be delivered to the laboratory within 1 hour of collection at room temperature.
    • Analysis should be done after liquefaction (usually 30-60 minutes).
    • Specimen awaiting analysis should be kept at 37°C.
    • If it does not liquefy, treat with amylase or bromelain.

    Missing portions of the ejaculate during collection can affect results:

    • Missing the first portion can lead to decreased sperm count, falsely increased pH, and the sample will not liquefy.
    • Missing the last portion can lead to decreased semen volume, falsely increased sperm count, falsely decreased pH, and the sample will not coagulate.

    Viscosity

    • Normal: pours in droplets
      • Immediately after ejaculation: 95%
      • Within 1 hour: 50% - Normal
      • After 3-6 hours: 25-40%
      • After 12 hours: 0%
    • Increased viscosity = decreased sperm motility.

    pH

    • Normal: 7.2-8.0
    • Increased pH: infection
    • Decreased pH: more prostatic fluid is present

    Morphology

    • Papanicolau stain/Wright-Giemsa stain differentiates morphology of semen.
    • Routine criteria: >30% Normal forms
    • Kruger’s Strict Criteria: >14% Normal forms
    • Measure the head, neck, and the tail:
      • Head: normal shape is oval
      • Midpiece: contains the mitochondria
      • Tail: for motility

    Sperm Abnormalities

    • Double head and pinhead: most common
    • Tapered head: varicocele

    Motility Grading (WHO Criteria)

    • Grade 4.0 (a): Rapid, straight-line motility
    • Grade 3.0 (b): Slower speed, some lateral movement
    • Grade 2.0 (b): Slow forward progression, noticeable lateral movement
    • Grade 1.0 (c): No forward progression
    • Grade 0 (d): No movement

    Viability

    • Modified Bloom’s Test:
      • Reagent: Eosin and Nigrosin Stain
      • Living sperm: Unstained, Bluish white (75%)
      • Dead sperm: Red colored

    Viability Test Conditions

    • Necrospermia: Presence of dead spermatozoa
    • Oligospermia: Decreased number of spermatozoa
    • Azoospermia: Absence of spermatozoa

    Chemical Analysis

    • Norma L Value: Indicates lack of seminal fluid volume.

    Barbiero’s Test

    • Very specific for Spermine.
    • Reagents: Saturated Picric Acid + TCA
    • (+) Dark Brown Rhombic Crystals

    Antisperm Antibodies

    • Detected in semen, cervical mucosa, or serum.
    • Causes: Ruptured blood, testes barrier.
    • Sperm cells exposed to male’s immune system.
    • Sperm-agglutinating antibodies cause sperm to stick to each other.

    Mixed Agglutination Reaction

    • Detects the presence of IgG antibodies.
    • Semen sample + AHG reagent + Latex particles or treated RBCs coated with IgG.
    • Normal: 30 organisms or cells/HPF

    Vaginal Fluid

    • To identify: Pathologic conditions that may affect a female’s reproductive capability.
    • To identify: Compelling signs of sexual assault and abuse.

    Vaginal Swabbing

    • Cotton: Toxic to Neisseria gonorrhoeae
    • Wood: Toxic to Chlamydia trachomatis
    • Calcium alginate: inactive herpes simplex virus (HSV)
    • Room temperature: Ideal for Trichomonas vaginalis, Neisseria gonorrhoeae

    Cerebrospinal Fluid (CSF)

    • Normal pressure:
      • Opening pressure: 50 to 180 mmHg
      • Closing pressure: 10 to 30 mmHg
    • Typically, 10 to 20 mL of CSF is slowly removed into three or four tubes that are numbered sequentially.

    CSF Tests

    • Chemical & Serologic tests: Least affected by blood and bacteria introduced during the tap procedure.
    • Microbiology Laboratory tests: Remain at room temperature.
    • Cell count tests: Least likely to contain cells introduced by the spinal tap.

    CSF Appearance

    • Clear CSF: Normal
    • Turbid CSF: Microorganisms, Protein
    • Bloody CSF: RBCs
    • Xanthochromic CSF:
    • Pink: Slightly amount of oxyhemoglobin
    • Yellow: Oxyhemoglobin
    • Orange: Heavy hemolysis

    Xanthochromia

    • Term used to describe CSF supernatant that is pink, orange, or yellow.
    • Due to degradation products of RBCs.
    • Other causes: Elevated serum bilirubin, presence of the pigment carotene, markedly increased protein concentrations, and melanoma pigment.

    Cell Count

    • Lymphocyte:monocyte ratio: 70:30
    • Children’s ratio is reversed.
    • Occasional neutrophils are normal.
    • Pleocytosis: Increased amount of normal cells.
    • Abnormal: If immature leukocytes, eosinophils, plasma cells, macrophages, increased tissue cells, and malignant cells are present.
    • Neutrophils: Bacterial meningitis
    • Lymphocytes and Monocytes: Viral, tubercular, fungal, parasite origin

    Protein

    • Albumin is predominant, prealbumin is second predominant.
    • Alpha globulins: Haptoglobin and ceruloplasmin
    • Transferrin: Major Beta Globulin
    • TAU Transferrin Fraction: Carbohydrate-deficient transferrin seen in CSF but not in blood.

    Types of CSF

    • Clotted CSF: Clotting factors, Tubercular meningitis
    • FROZEN CSF: Contains protein introduced as a result of the tap procedure.
    • REFRIGERATED CSF: Contains protein introduced by the spinal tap.
    • Oily CSF: Radiographic contrast media
    • Clotted CSF: Clotting factors.
    • Protein levels: may be influenced by factors like a traumatic tap or disorders affecting the blood-brain barrier.

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    Description

    This quiz covers essential aspects of semen analysis, including the importance of specimen collection, viscosity, and the effects of missing portions of the ejaculate. Understand the protocols for ensuring accurate testing and the procedures for specimen handling and analysis.

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