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The anatomy of a sperm
If there are enough sperms. If the sample has less than 20 million
sperm per ml, this is considered to be a low sperm count. Less than 10
million is very low. The technical term for this is oligospermia
(oligo means few). Some men will have no sperms at all and are said to
be azoospermic. This can come as a rude shock because the semen in
these patients look absolutely normal - it is only on microscopic
examination that the problem is detected.
Whether the sperms are moving well or not (sperm motility). The
quality of the sperm is often more significant than the count. Sperm
motility is the ability to move. Sperm are of 2 types – those which
swim, and those which don’t. Remember that only those sperm which move
forward fast are able to swim up to the egg and fertilise it – the
others are of little use. Motility is graded from a to d, according to
the World Health Organisation ( WHO) Manual criteria , as follows.
Grade a ( fast progressive) sperms are those which swim forward fast
in a straight line - like guided missiles. Grade b ( slow progressive)
sperms swim forward, but either in a curved or crooked line, or slowly
(slow linear or non linear motility) . Grade c ( nonprogressive)
sperms move their tails, but do not move forward ( local motility
only). Grade d ( immotile ) sperms do not move at all . Sperms of
grade c and d are considered poor. Why do we worry about poor motility
? If motility is poor, this suggests that the testis is producing poor
quality sperm and is not functioning properly – and this may mean that
even the apparently motile sperm may not be able to fertilise the egg.
Whether the sperms are normally shaped or not - what is called their
form or morphology. Ideally, a good sperm should have a regular oval
head, with a connecting mid-piece and a long straight tail. If too
many sperms are abnormally shaped (round heads; pin heads; very large
heads; double heads; absent tails) this may mean the sperm are
abnormal and will not be able to fertilise the egg. Many labs use
Kruger "strict " criteria ( developed in South Africa ) for judging
sperm normality. Only sperm which are "perfect" are considered to be
normal. A normal sample should have at least 15% normal forms ( which
means even upto 85% abnormal forms is considered to be acceptable !)
Sperm clumping or agglutination. Under the microscope, this is seen as
the sperms sticking together to one another in bunches. This impairs
sperm motility and prevents the sperms from swimming upto through the
cervix towards the egg.
Putting it all together, one looks for the total number of "good"
sperms in the sample - the product of the total count, the
progressively motile sperm and the normally shaped sperm. This gives
the progressively motile normal sperm count which is a crude index of
the fertility potential of the sperm. Thus, for example, if a man has
a total count of 40 million sperm per ml; of which 40% are
progressively motile; and 60% are normally shaped; then his
progressively motile normal sperm count is : 40 X 0.40 X 0.60 = 9.6
million sperm per ml. If the volume of the ejaculate is 3 ml, then the
total motile sperm count in the entire sample is 9.6 X 3 = 28.8
million sperm.