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Initial Microscopic Examination of Semen

Preparation of sample for initial microscopic examination
Thoroughly mix the semen specimen in order to ensure as much as possible that the sample you are examining is representative of the whole specimen. One recommended mixing method is to aspirate the sample 10 times into a wide-bore disposable plastic pipette, gently so as not to create air bubbles. Obtain the sample to be examined immediately after mixing the contents in the original container. If additional aliquots are taken, mix the specimen in the original container again before taking those samples.
Initial microscopic examination of semen is first done using 100X magnification. Observe mucous strand formation, sperm aggregation, and/or sperm agglutination.
Sperm aggregation
Non-specific aggregation of spermatozoa should be recorded but is usually not clinically significant. Aggregations include immotile sperm adhering to each other in random fashion and motile sperm adhering to mucous strands, epithelial cells, or other debris in the specimen.
Sperm agglutination Agglutination should be noted in the report. The WHO 5th edition recommends grading agglutination as:
  • Grade 1 - isolated: <10 spermatozoa per agglutinate, many free spermatozoa
  • Grade 2- moderate: 10-50 sperm per agglutinate, free spermatozoa
  • Grade 3- large: >50 sperm per agglutinate, some spermatozoa still free
  • Grade 4-gross: All spermatozoa agglutinated and agglutinates interconnected