Page 618 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

602 PART 8 ■ Fundamentals of Hematological Analysis
Te analysis o sperm is associated with ertility studies.
In an evaluation o a man’s ertility, each aspect o the semen
analysis is considered. Abnormal results are considered to
decrease the chances o ertilization. Various actors can
a ect a sperm count or other semen analysis values, includ-
ing li estyle behaviors such as the use o alcohol, tobacco,
ca eine, some prescription drugs and herbal medicines such
as St. John’s wort. Anabolic steroids, cocaine, and marijuana
can impact sperm production. Emotional stress, obesity, and
occupation are inf uencing actors. Certain occupations can
increase the risk o in ertility, including those associated
with extended use o computers or video display monitors,
shi work, and work-related stress. Sports activities such as
prolonged bicycling can increase heating o the testicles and
bicycle seat pressure on the perineum can cause numbness in
the penis and erectile dys unction.
Health issues and medical actors can also impact male
ertility. Anatomical problems such as undescended testicles
or medical conditions such as celiac disease can decrease er-
tility. Other actors include the ollowing:
■ Varicocele. A varicocele is a swelling o the veins that drain
the testicle. T is is the most common reversible cause o
male in ertility. A varicocele may prevent normal cooling
o the testicle, leading to reduced sperm count and ewer
moving sperm.
■ In ection. Some in ections can inter ere with sperm pro-
duction or can cause blockage o the passage o sperm.
In ections include some sexually transmitted in ections
such as Chlamydia and gonorrhea.
■ Ejaculation issues. Retrograde ejaculation occurs when
semen enters the bladder during orgasm instead o emerg-
ing out the tip o the penis.
■ Antisperm antibodies. Antisperm antibodies mistakenly
identi y sperm as nonsel .
■ umors. Malignant and nonmalignant tumors can a ect
the male reproductive organs directly or can a ect the
glands that release hormones related to reproduction.
■ Hormone imbalances. In ertility can result rom hormonal
systems including the hypothalamus, pituitary, thyroid,
and adrenal glands.
■ Sperm duct de ects. Some men experience blockage in the
epididymis or a blockage o one or both o the tubes that
carry sperm out o the testicles. Men with cystic brosis and
other inherited conditions may be born without sperm ducts.
■ Genetic de ects. Inherited disorders such as Kline elter’s
syndrome (XXY)—in which a male is born with two X
chromosomes—cause abnormal development o the male
reproductive organs.
■ Di culties with sexual intercourse. T ese can include erec-
tile dys unction, premature ejaculation, pain ul intercourse,
anatomical abnormalities, or psychological problems.
■ Medications. estosterone replacement therapy, long-term
anabolic steroid use, chemotherapy, certain anti ungal
medications, some ulcer drugs, and other medications can
impair sperm production.
■ Surgical history. Certain surgeries including vasectomy,
inguinal hernia repairs, scrotal or testicular surgeries,
prostate surgeries, and large abdominal surgeries per-
ormed or testicular and rectal cancers can impact ertility.
Environmental actors can also contribute to in ertility.
Overexposure to environmental conditions such as toxins,
chemicals, or heat can reduce sperm production or sperm
unction. Speci c causes include
■ Industrial chemicals
■ Heavy metal exposure
■ Radiation
Anatomy and Physiology
Each o the male reproductive structures (Fig. 29.8) con-
tributes speci c components to seminal f uid. In addition
to spermatozoa, this f uid has a highly varied composition
( able 29.12).
On ejaculation, sperm, which constitute only a small part
o the total volume o seminal f uid, are released rom the
epididymal stores and combine with f uids rom accessory
glands to orm seminal f uid. Initially, secretions are added
rom the prostate gland and then rom the seminal vesicles.
Prostatic f uid has an acidic pH and provides components
(e.g., brinolysin or lique action o the clot that orms at
ejaculation) to the semen. T e seminal vesicle, which has an
alkaline pH, contributes 70% o the seminal f uid volume and
other components (e.g., enzymes or coagulum ormation).
T e rst part o the ejaculated seminal f uid contains
sperm and prostatic secretions. T e second part o the semi-
nal f uid is composed primarily o seminal vesicle secretions.
Analysis of Sem inal Fluid
Principle
Seminal f uid (semen) is examined macroscopically and
microscopically. T ese procedures are per ormed to deter-
mine the physical and chemical properties o the f uids such
as lique action, to quantitate the number o sperm cells, and
to examine cellular motility and morphology.
Semen analysis is the primary test or the evaluation o male
in ertility. Although no speci c measures are diagnostic o
in ertility, sperm concentration, motility, and morphology can
be used to classi y men as sub ertile, o indeterminate ertility,
or ertile ( able 29.13). Semen also can be analyzed or a variety
o reasons, including arti cial insemination protocols, postva-
sectomy assessment, and evaluation o probable sexual assault.
Specim en Collection
A resh specimen is needed. T e specimen may be collected
in a clean, sterile, glass or plastic container. Ideally, seminal
fuid should be analyzed within 30 minutes o collection. It is
mandatory that the specimen be kept at 37°C and examined
within 1 hour o collection. A er 60 minutes o storage in
a plastic container, sperm motility is signi cantly reduced.
Most laboratories examine two specimens collected a ew
days apart. Collection, proper transport, and prompt exami-
nation are critical actors in the analysis o seminal f uid.
Standard precautions should be adhered to when handling
semen, blood, and other body f uids.