Спермаграмма

Semen analysis (spermogram, seminal fluid analysis) assesses male fertility by quantifying sperm concentration, motility, and morphology and by evaluating seminal fluid characteristics. The test helps define male-factor contributions to infertility, clarifies obstacles to conception, and informs selection of assisted reproductive technologies such as intrauterine insemination. It also aids in the differential diagnosis of urologic conditions (for example, prostatitis), supports treatment monitoring, and serves as the standard laboratory method to verify the effectiveness of vasectomy.

Roughly 1 in 15 reproductive-age couples experience difficulty conceiving, with a male factor present in approximately 20–25% of cases. Semen analysis is the foundational laboratory assessment of male fertility. Testes, seminal vesicles, and the prostate coordinate sperm and seminal fluid production; seminal vesicles contribute the majority of volume (about 45–80%), providing an alkaline milieu that buffers vaginal acidity and supplying fructose as an energy source. Only about 1% of the ejaculate consists of spermatozoa and testicular fluid. Multiple conditions can impair production of functionally competent sperm. Varicocele accounts for roughly 40% of male infertility and is treated surgically. Inflammation of the testes represents about 10% of cases and can reflect malignancy, infection (including mumps), genetic disorders such as Klinefelter syndrome, trauma, or prior radiation and chemotherapy. Hydrocele contributes approximately 10%, while endocrine disorders that disrupt spermatogenesis constitute about 9% and are often associated with hypoplasia of the pituitary or adrenal glands or with hyperestrogenism. Obstruction of the ejaculatory duct explains around 5% of cases. Autoantibodies to sperm occur in about 1–2% of men with infertility. Infectious prostatitis and other urogenital infections can directly reduce motility; Mycoplasma genitalium and Ureaplasma urealyticum may adhere to the sperm head and midpiece, diminishing motility and fertilizing capacity. Microbial toxins and inflammatory mediators further impair spermatogenesis, and pathogen binding to sperm can trigger autoimmune responses that worsen both qualitative and quantitative semen parameters. The specimen is obtained by masturbation into a sterile medical container; coitus interruptus and condoms must not be used. The full ejaculate should be submitted, as loss of any portion can alter results. A standard semen analysis incorporates macroscopic measures (volume, color, pH, viscosity, and liquefaction time), quantitative parameters (sperm concentration and motility), detailed morphology, assessment for agglutination and germ cells, and evaluation for leukocytes, erythrocytes, epithelial cells, mucus, bacteria, and fungi. Findings inform the likelihood of a male contribution to infertility, guide diagnosis of urologic disease, and help evaluate postoperative outcomes such as vasectomy. Results can fluctuate; repeat testing at clinician-directed intervals is often required, and nonpharmacologic measures (smoking and alcohol cessation, weight normalization, adequate rest) may improve semen quality. Because semen parameters vary among individuals and fertilization depends on additional factors, the test does not provide definitive assurance of conception potential; however, normal results support male fertility. For vasectomy follow-up, the analysis focuses on presence or absence of sperm and is performed 6 weeks after the procedure or after 20 ejaculations; if sperm are detected, repeat testing is recommended in 2–4 weeks and again several months later to exclude recanalization.