Conducting and deciphering a spermogram according to Kruger

According to the definition, a couple is considered infertile if for more than a year the spouses have had regular sex life (two to three sexual contacts per week), do not use contraceptive methods, but pregnancy does not occur. Previously, it was believed that this situation is a consequence of disorders of the reproductive system of women. Today, practitioners agree that the partner is no less likely to be the culprit of infertility.

For the implementation of fertilization, it is necessary not only to release during ejaculation a normal volume of sperm containing a sufficient number of male gametes, but also the viability and activity of the germ cells themselves. Indeed, out of the millions of spermatozoa that have entered the female vagina, only a few will be able to overcome the difficult path to the cherished egg, dissolve its outer shell and give rise to a new life. In order for a tiny sperm to have such remarkable endurance and dexterity, it needs to be of the correct shape, not to have violations of morphology, that is, appearance. Fertilization requires only one healthy sperm, but the chances of conception increase when there are many such cells in the ejaculate.

For a long time, experts argued about the criteria by which to evaluate the normality of spermatozoa. Thirty years ago, Professor Krueger clarified this issue by determining that normal gametes are those that pass through the cervical canal for a maximum of eight hours. It was these spermatozoa that differed in almost ideal morphology and did not have any structural disturbances. To date, the Kruger spermogram is the most informative method for studying ejaculate indicators.

Normal structure of sperm

Sperm morphology is assessed by comparing test cells with reference samples. Moreover, in the course of a laboratory analysis, a specialist evaluates at least two hundred sperm in this way. A mature male gamete consists of three parts:

• The head is oval in shape, most of the upper part is occupied by an acrosome containing enzymes necessary for splitting the outer membrane of the egg.
• The neck is a thin part, about one and a half times longer than the head, attached at a certain angle.
• The tail (flagellum) is even, without twisting and loops, approximately the same thickness, which may be slightly less in the middle part. Nine to ten times longer than the head.

The study of sperm according to Kruger differs from the usual laboratory analysis of ejaculate by a detailed study of the morphology of spermatozoa. If in the first case only defects of the sperm head are determined, then the Kruger technique involves the diagnosis of structural disorders not only of this part, but also of the neck and tail. Therefore, this analysis is considered the most informative way to assess the quality of sperm and the degree of male fertility.

Which indicators are evaluated?

The morphology of the spermogram and the following properties of sperm are being studied:

• Total volume of ejaculate.
• The number of germ cells in one milliliter.
• Sperm motility
• Acidity.
• Viscosity.
• Color
• Presence and number of leukocytes and erythrocytes.

A characteristic feature of the Kruger technique is the classification of pathological spermatozoa with borderline deviations, and normal - cells with an ideal structure. The following grading system has been adopted:

• Normal spermatozoa of 14% or more is the norm, there are high chances of getting pregnant naturally.
• From 4 to 14% - deviation from the norm, fertilization is possible, but unlikely.
• From 0 to 3% - teratozoospermia, natural conception is impossible.

What are structural violations?

Anomalous spermatozoa are distinguished by defects in the structure of any one or several parts at once.

Head morphology disorders:

• Differences in size (too small or large).
• Irregular shape - the head may not be oval, but elongated, pear-shaped, resembling a ball or cone.
• Presence of vacuoles in the chromatin zone.
• Small or no acrosome occupying less than 40% of the head.
• Split.
• Irregularly shaped non-specific chromatin.

Incorrect neck structure:

• Twist.
• "Inclined" neck - attaching to the ponytail at an angle of more than 90.
• Thickened middle part of the sperm due to asymmetrical attachment of the neck to the head.
• Mitochondrial envelope missing.

Ponytail defects:

• Too long or too short.
• Slopes and breaks.
• Twist.
• Alternating sections of different thicknesses.

How the decryption is done

A decrease in male fertility is evidenced by deviations from the normal values of the following indicators:

• The volume of ejaculate - the norm is from three to five milliliters, less than two milliliters is a sign of microspermia, and exceeding the upper threshold indicates the course of inflammation.
• Thinning time - normally, the viscosity of the semen decreases in forty minutes, deviations indicate an inflammatory process.
• Color - in a healthy man, the ejaculate is white-gray. With pathologies of the liver, the sperm acquires a yellow color, and in case of inflammation or injury, it may contain blotches of blood, due to which it becomes pinkish.
• Acidity - in infectious and inflammatory pathology, the acidity of sperm, which is normally 7.2-8.0, increases.
• The total number of spermatozoa is from twenty to one hundred and twenty million per milliliter of ejaculate. Decrease (oligozoospermia) or increase (polyzoospermia) value is reflected in fertility.
• Sperm viability and activity - the probability of fertilization is low when more than 20% of immotile gametes are found in the ejaculate.
• Sperm morphology - a high degree of fertility is indicated by an indicator of the number of normal spermatozoa, at least 14%, if the value is less than 4%, natural conception is impossible.

For a successful spermogram, you should prepare for the analysis, following all the rules. In the case of obtaining material at home, it is necessary to adhere to the established requirements for transporting sperm to the laboratory.

If the results of the spermogram are disappointing

It is recommended that patients with unsatisfactory spermogram results be reanalyzed twice, since a deviation from the norm does not necessarily mean the presence of a pathology. The quality of sperm depends on many different reasons, and very often a man has a temporary deterioration in performance in response to negative external factors, a recent illness, fatigue, nervous tension.

If the diagnosis of infertility is nevertheless confirmed, this is also no reason to panic and give up. In the arsenal of modern medicine there are drugs aimed at improving the quality of sperm and fertility, physiotherapy. And even in the case of incurable infertility, not everything is lost - IVF and ICSI methods will help to conceive a healthy baby.