How is a spermogram performed?

The spermiogram is often one of the first examinations prescribed when a baby project takes too long to materialise. However, it remains poorly understood, sometimes a source of apprehension, when it is a sperm analysis used to explore male fertility. This examination provides concrete information on sperm quantity, their ability to move, their shape, and the overall quality of the ejaculate. It does not, on its own, provide a definitive diagnosis, but it is very useful for guiding the rest of the fertility assessment.

The spermiogram is an essential medical examination for assessing male fertility. It analyses several sperm parameters to identify any anomalies.

A spermiogram is a biological examination that studies several sperm parameters after collection in a laboratory. In practice, this sperm analysis assesses, in particular, sperm concentration, motility, morphology, sperm volume, and, depending on the case, vitality. It forms the basis of the exploration of the male aspect in a conception project.

A spermiogram is usually requested in cases of difficulty conceiving, but also after certain genital infections, testicular surgery, varicocele, or treatment potentially toxic to the reproductive organs. Its purpose is to objectively assess ejaculate quality beyond subjective impressions.

During the conception project, a spermiogram is often suggested after 12 months of regular (2 to 3 times a week) and unprotected attempts without pregnancy before age 35, or earlier in the presence of known risk factors or if the partner is 35 or older. It can also be requested earlier when male medical history suggests a sperm disorder.

Before performing a spermiogram, certain conditions must be met to guarantee the reliability of the results. These recommendations ensure a precise analysis of sperm quality.

Before a spermiogram, the laboratory generally recommends a period of sexual abstinence of a few days, usually between 2 and 7 days depending on the protocols. This step is important because it directly influences several parameters of the spermiogram results, particularly volume and concentration. It is also advisable to report any recent fever, as it can temporarily alter sperm quality for several weeks.

Collection is usually done by masturbation into a sterile container, most often at the laboratory. The goal is to collect the entire ejaculate, as the first fraction is particularly rich in sperm. In other words, the technical quality of the collection is very important for the interpretation of the spermiogram.

After collection, the sample is left to liquefy and then analysed using a standardised methodology. The laboratory measures macroscopic and microscopic parameters, then establishes the spermiogram results. Depending on the situation, this sperm analysis may be supplemented (sperm culture), a test (sperm DNA fragmentation) or other specialised examinations, especially if a spermiogram abnormality is detected.

A spermiogram relies on the analysis of several key parameters to assess sperm quality. Each of them provides valuable information on male fertility.

Sperm concentration corresponds to the number of spermatozoa per millilitre of semen. This is a key parameter of the spermiogram, but it must be interpreted with the total volume of the ejaculate. A reduced number may suggest oligospermia, a term used when the sperm count is below 15 million spermatozoa/mL.

Sperm motility provides information on their ability to progress through the female genital tract to the oocyte. Insufficient motility may suggest asthenospermia (progressive motility < 32%).

Sperm morphology studies the proportion of forms considered normal according to standardised criteria. A too low proportion may correspond to teratozoospermia (< 4% normal forms). This parameter is sensitive, as its evaluation requires good standardisation and can vary between laboratories.

Sperm volume and vitality complete the analysis. A too low volume may indicate an emission disorder or accessory glands issue, while low vitality indicates. These data enrich the overall interpretation of a normal or pathological spermiogram (see WHO reference values).

Interpreting a spermiogram relies on comparing the results with established reference values. These benchmarks help assess male fertility and identify potential anomalies.

The WHO reference values help to position a patient's result in relation to a population of men who have successfully conceived within a defined period (< 1 year). These are very useful, but a normal spermiogram is not a guarantee of absolute fertility, just as a reduced result does not mean impossibility of conceiving. Interpretation must take into account the couple's context.

These benchmarks are reference thresholds derived from WHO data and serve as support for interpretation, without replacing a complete clinical analysis.

Common abnormalities include oligospermia for a decrease in concentration, asthenozoospermia for a decrease in motility, teratozoospermia for morphological alteration, or azoospermia when no spermatozoa are found. A spermiogram abnormality can be isolated or associated with several others. This is why the report must be read holistically.

No, an abnormal spermiogram does not automatically mean male infertility. Firstly, because spermatogenesis spans several weeks, and an infectious episode, significant stress, or thermal exposure can temporarily alter parameters. Secondly, because fertility also depends on female elements and the timing of intercourse. This is why a second spermiogram is often requested at a later date to confirm the observed profile.

It is possible to act on certain factors to improve sperm quality. Environment and lifestyle play a key role in male fertility.