Mr. Chen, 28 years old, married for 3 years. After both spouses underwent examinations, it was found that Mr. Chen's semen analysis was abnormal. The liquefaction time of the semen exceeded 60 minutes, with a sperm count of 30 million per milliliter and a motility rate of 37%. The doctor recommended artificial insemination. What constitutes normal semen?

 

In fact, this is becoming an increasingly common issue. Among couples undergoing infertility examinations, male factor infertility accounts for about one-third of the cases. However, it seems that there is a growing misconception due to the increased willingness of men to undergo testing and the advancement of diagnostic techniques, reflecting the enlightenment of public awareness.

 

According to the World Health Organization's definition, normal semen parameters are as follows: ejaculate volume of 2 cc per ejaculation, sperm concentration of 20 million sperm per milliliter (20 million/cc), sperm motility of 50%, normal morphology rate of 30%, white blood cells less than 1 x 10^6 cells per milliliter (1 x 10^6/cc), and antibody reaction (MAR test) less than 10%. Any abnormality in any of these parameters serves as a warning sign that may lead to infertility.

 

Abnormal semen liquefaction refers to the failure of normal semen to transform from a gel-like state to a watery consistency within approximately 10 to 20 minutes after ejaculation. If the ejaculated semen remains thick and gelatinous for more than 30 minutes, it indicates abnormal semen liquefaction. This condition is often caused by an increase in clotting proteins produced by the seminal vesicles or a decrease in proteinase and fibrinolytic enzymes secreted by the prostate. Clinically, patients with this condition often have a history of prostatitis, but with appropriate treatment, improvement is generally achievable.

 

Next is sperm count. The normal concentration of sperm is generally 20 million sperm per milliliter (20 million/cc). A condition called oligozoospermia occurs when the concentration is less than 20 million sperm/cc. If the concentration is less than 5 million sperm/cc, it is considered severe oligozoospermia, and assisted reproductive techniques such as in vitro fertilization (IVF) combined with intracytoplasmic sperm injection (ICSI) are typically required. In cases where there is no sperm present, it is referred to as azoospermia, and further examinations such as chromosome analysis or testicular biopsy are necessary. Chromosome analysis is recommended for patients with azoospermia, oligozoospermia, testicular volume less than 12 milligrams, poorly developed secondary sexual characteristics, a history of habitual miscarriages in the wife, a history of teratoma in the wife, or more than 50% abnormal sperm morphology. The aforementioned conditions all warrant chromosome analysis.

 

As for sperm motility, it is generally classified into four grades. The combined percentage of "good" and "very good" motility should be greater than 50%. Poor motility can prevent sperm from traveling upward to reach the fallopian tubes and fertilize the egg, thereby leading to infertility. If the MAR test shows a result of more than 20%, it indicates the presence of anti-sperm antibodies. Anti-sperm antibodies are produced within the male body, leading to sperm agglutination or immobilization, resulting in a loss of sperm motility.

 

Based on a simple semen analysis, the physician can determine whether the male patient requires artificial insemination or if they should undergo procedures such as in vitro fertilization (IVF) with testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). In the case of azoospermia, where no sperm are found even in testicular biopsy, the option of using donor sperm needs to be considered to fulfill the desire for parenthood.