Mobility is divided into 3 categories:

• progressive movement – movement in direction
• non-progressive movement – local movement, usually in circles
• immobility – no movement

The most important factor is progressive motility – the movement in the direction. Motility is considered normal, if more than 32 % of the sperm move progressively or in the direction.

Sperm concentration

In the assessment of fertility, the concentration and number of spermatozoa have an important prognostic and diagnostic value. They tell how many sperm are released during intercourse. The number indicates the ability to form sperm, the supply of sperm as well as the patency of the tubular system.

Morphology (shape)

The shape of the spermatozoa is extremely important for determining fertility. Under the microscope, different criteria and a classification system to consider the morphology of human spermatozoa are used for damage to the head, midsection and tail.

The morphology is defined as norma,l if the average number of spermatozoa with a normal shape is more than 4%.

Vitality

The percentage of live sperm in the ejaculate is analyzed to assess viability.

To assess the quality of the semen, an analysis is performed, called a spermiogram. The assessment is carried out in accordance with the guidelines of the World Health Organization (WHO) from 2010. Limit values ​​are:

• Total sperm count: over 39 million
• Sperm concentration: more than 15 million per ml
• Mobility: more than 40 % or more
• Progressive motility: more than 32 %
• Vitality: more than 58 %
• Sperm morphology: more than 4 % normal
• Semen volume: more than 1.5 ml
• Liquefaction time: less than 60 minutes
• Semen color: pale yellow
• Semen pH: > 7.1
• Leukocyte count: < 1 million
• MAR test (presence of antibodies): < 50 %

The limit values ​​represent the lowest still acceptable values, so that the semen sample is considered normal or of sufficient quality. 

Possible results of a spermiogram:

• normozoospermia (normal sperm parameters or good quality semen)
• hypospermia (low semen volume)
• oligozoospermia (low sperm count)
• asthenozoospermia (poor sperm motility)
• teratozoospermia (poor sperm morphology)
• OAT or oligo-astheno-terato-zoospermia (combination of poor motility, low count and bad morphology)
• necrozoospermia (all sperm are dead)
• azoospermia (absence of sperm)
• aspermia (no ejaculate and therefore no sperm)
• leukocytospermia (presence of leucocytes in the semen)

Normozoospermia

All measured parameters are within normal limits.

Hypospermia

The amount of ejaculate or seminal fluid is less than 1.5 ml. The most common cause is  retrograde ejaculation – when the semen goes back into the bladder instead of traveling out through the urethra. It can be e.g. a consequence of taking drugs for benign prostate enlargement.

Oligozoospermia

A condition where the  sperm count is lower than normal. Oligozoospermia can be mild, moderate, severe or extreme. Extreme oligozoospermia is also called  chriptozoospermia. A low sperm count often coincides with other sperm health problems, including poor motility and morphology. Possible causes are:

• varicocele
• stress
• infections or inflammation
• hormonal imbalance
• untreated diabetes 
• cancer treatment
• undescended testes and other abnormalities of the reproductive tract
• genetic and environmental factors, such as testicular overheating and toxins
• abuse of alcohol or drugs, including recreational drugs
• some medication

Sometimes the cause cannot be discovered. In this case, we are talking about  idiopathic oligozoospermia.

Oligozoospermia is the most common cause of subfertility in men. A man with mild or moderate oligozoospermia may still be able to conceive a child of his own, however with a reduced sperm count, the likelihood of a couple successfully conceiving is reduced and the time it takes to get pregnant extended.

Asthenozoospermia

A condition involving  abnormal sperm motility. 

Usually, poor motility occurs along with a low sperm count. Causes of low sperm count can also lead to poor motility – exposure to harmful, hazardous substances, poor diet, disease, recreational drug use, excessive alcohol consumption or smoking, as well as certain medications.

Progressive motility is the most important factor or the best measure of natural fertility. Sperm must reach the last third of the fallopian tube where, under the right conditions, fertilization occurs. Thus, men with less than 5 million progressively motile sperm are considered to have a severe form of infertility, those with 5-20 million a moderate form, and those with more than 20 million normal sperm quality. The first measurement of the quantity of progressively motile spermatozoa can also be carried out at home with semen quality tests, which are capable of distinguishing motile sperm from other spermatozoa. Semen quality tests using the swim-up technique, which is also used in laboratories to prepare semen for fertilization with biomedical assistance, are most suitable, in case one would like to make preliminary home test.

Teratozoospermia

A condition where a  large percentage of sperm have an abnormal morphology or shape. Normal, healthy sperm should have an oval head with a long tail. Abnormal sperm may have an unusually shaped head, more than one head, an unusually shaped tail, or more than one tail. If the sperm are not of normal shape, it is more difficult to fertilize or they cannot fertilize the ovum, as it is more difficult for them to move or swim. Therefore, poor motility is associated with poor morphology.

Poor morphology can be caused by a variety of genetic causes. In rare cases, a genetic mutation is the cause of formation of round instead of oval sperm head. This is called globozoospermia. 

Oligoasthenoteratozoospermia or OAT syndrome

A condition where  all sperm parameters are abnormal  – poor motility, poor morphology and low sperm count. It is the most common cause of male infertility. It is divided into mild, moderate and severe. Causes of OAT syndrome:

• abnormal placement or position of testicles
• varicocoele
• chromosomal abnormalities
• hormonal disorders
• infection
• alcohol consumption / drug consumption

Necrozoospermia

It is a very rare condition where  all the sperm are dead. If the spermatozoa are immobile but alive, they can be used in MAR procedures and injected into individual oocytes using the IVF-ICSI method. In some cases, it is possible to perform a biopsy of the testicles and in this way obtain otherwise immature spermatozoa, which, after maturation in the laboratory, can be used in the IVF-ICSI procedure. 

Azoospermia

A condition where no (or only a few) sperm are present in the ejaculate. This is a severe form of male infertility. 

The most common causes of azoospermia are: 

• genetic disorders (e.g. Klinefelter syndrome)
• congenital abnormalities of the reproductive tract
• obstruction of the seminal ducts; some untreated sexually transmitted diseases can cause tissue damage and, as a result, obstructions, blockages
• as a result of treatment for testicular cancer
• hormonal imbalance
• severe sexual dysfunction
• mumps infection (and subsequent inflammation of the testicles), but these cases are rare.

Aspermia

A condition where  there is no ejaculate and therefore no sperm. A man can experience orgasms normally, but there is no ejaculate. This is sometimes called a “dry orgasm.”

Aspermia can occur due to: 

• retrograde ejaculation
• genetic disorders (e.g. Klinefelter syndrome or cystic fibrosis)
• congenital abnormalities of the reproductive tract
• hormonal imbalance
• severe diabetes
• after treatment for testicular cancer or
• due to severe sexual dysfunction.

Aspermia greatly affects a man’s fertility, but it is still possible for such a man to have a biological child. In some cases, the causes of aspermia can be treated. When this is not possible, a testicular biopsy can be used to obtain sperm. These immature spermatozoa can then be matured in the laboratory and used in the MAR procedure by performing the ICSI method.

If the sperm cannot be obtained from the testicles or if they are useless for fertilization of the egg cells, it makes sense to consider a donated sperm.

Leukocytospermia

A condition with a large number of white blood cells or leukocytes present in the seminal fluid. This is also known as  pyospermia.

In leukocytospermia, the sperm are not necessarily abnormal, but a high concentration of leukocytes can cause damage to the sperm and thus reduce a man’s fertility.

A high leukocyte count often indicates an infection, and in some cases, an autoimmune disease. 

DNA FRAGMENTATION

In about 10% of normal spermiograms, the cause of inability to conceive or recurrent miscarriage is so called DNA FRAGMENTATION or damage to male genetic material. It is known that male infertility is also associated with damage to the genetic material. The higher the number of sperm with damaged DNA, the lower the probability of conception. The job of the sperm is to safely carry the genetic information, DNA, to the egg. The more broken the DNA strand is, the harder it is for the sperm to do its job. DNA fragmentation increases dramatically with a man’s age. Spontaneous abortion in women is increased in couples with older male partner and does not depend exclusively on the age of the woman.

Various methods are available to assess DNA damage (fragmentation index), called functional sperm tests.

When poor semen quality is most likely the result of increased oxidative stress in the seminal fluid, the use of antioxidants with a proven effect on sperm quality is recommended. It can be beneficial in cases of:

• unexplained infertility
• varicocele
• DNA fragmentation or in elderly patients
• infections or their treatment
• leukocytospermia, when leukocytes release huge amounts of reactive oxygen compounds
• increased stress
• environmental factors, such as testicular overheating and toxins (occupational history)
• abuse of alcohol or drugs, including recreational drugs
• use of certain medicines
• unhealthy diet
• smoking
• fertilization procedures with biomedical assistance