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Is my semen analysis report normal?

Q: I am a 34 years old man who had a semen analysis done. The reports showed - volume: 4 ml, pH – 8, appearance – normal, liquefaction time - 30 min, consistency – normal, sperm concentration – 90 m/ml, total sperm count – 360 m per ejaculation, rapid progressive - 45%, slow progressive - 25%, non progressive - 15%, non motile - 15%, normal morphology - 75%, abnormal morphology - 25%, mononuclear cells - 10-12/HPF. The doctor said that there is infection because of the presence of mononuclear cells and he has asked to me undergo semen culture and ultrasonography (USG) of scrotum. We are trying for a baby for the last 4 months and have had no success. Am I infertile? Please advise.

A:The semen parameters provided by you seems to be within the described normal range. For your reference, the World Health Organization defines the following reference values as normal (WHO, 1999):
Volume: 2.0 mL or more
pH: 7.2 or more
Sperm concentration: 20 × 106 or more spermatozoa/mL
Total sperm number: 40 × 106 or more spermatozoa per ejaculate
Motility: 50% or more with grade “a + b” motility or 25% or more with grade “a” motility.
Morphology: 15% or more by strict criteria
Viability: 75% or more of sperm viable
WBCs: Less than 1 million/mL.

Regarding the presence of mononuclear cell; in most of the situations mononuclear cells are just the immature germ cell (or immature sperms). It is very easy to confuse them as white cells (which are sign of infection). Thus with out special stains to differentiate immature germ cells from white cells it is not right to blame infection as a cause of infertility.

Specific to your situation I think it's too early to label the diagnosis of infertility. According to details in your query it has been only 4 months since you are trying for baby. Its good you have undergone semen examination, which seems to be normal.

I hope you are aware of the fact that the most fertile days for a female are the days immediately around ovulation. Thus intercourse in the fertile period is most effective. Even with everything alright, the chances of a normal couple conceiving is estimated to be 20-25% per month, 75% by 6 months, and 90% by 1 year. Thus infertility is often not considered to exist until after 12 months of attempted conception. But it’s good to have baseline investigations done.

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