The semen volume can reflect the testosterone secretion of the testis and the functional status of the accessory gonads. The congenital dysplasia or dysfunction of the seminal vesicle and prostate will lead to the decrease of semen volume. In our study, it was found that endocrine hormone levels were mostly characterized by high levels of prolactin (PRL), follicle stimulating hormone (FSH), and luteinizing hormone (LH) when semen volume was below normal. During color Doppler examination, abnormalities such as absence of seminal vesicles, small seminal vesicles, testicular sheath effusion, varicose veins, and epididymal cysts were mostly found. We believe that semen volume can also to some extent indicate hyperprolactinemia and hypogonadism caused by excessive secretion of gonadotropins.
In addition, congenital absence of seminal vesicles, epididymitis, and obstruction of the vas deferens can lead to a decrease in semen pH value; In acute epididymitis, prostatitis, and seminal vesiculitis, pH>8.0. In our study, we found that the semen and seminal plasma Elastase content of PH>810 indicated infection; At the same time, the patients with azoospermia whose semen PH<710 have no seminal vesicles by Doppler examination! Abnormalities such as epididymal cysts or varicose veins. Therefore, the volume and pH value of semen in patients with azoospermia can reflect the development and function of male gonads and accessory gonads, which is of great significance for analyzing its etiology and should be highly valued.
The biochemical examination of semen is an analysis of the secretion function of the prostate, seminal vesicles, and epididymis. The semen fructose is mainly secreted by the seminal vesicle glands. In the case of congenital azoospermia, azoospermia caused by the dysplasia of vas deferens or seminal vesicles, the fructose is zero or minimal, and the semen volume is also low. The fructose content was normal in simple vas deferens obstructive azoospermia. In our study, we found that among the patients with azoospermia whose fructose was lower than the normal value, most of them had abnormal seminal vesicles or no seminal vesicles in the routine color Doppler examination. At the same time, we also found that the fructose content of azoospermia patients with high serum levels was significantly higher than the reference value. Bucket et al. believed that this might be related to the reduction of fructose metabolism in azoospermia patients, and more likely to be the increase of fructose products in seminal vesicles in azoospermia patients.
Obstructive azoospermia is mainly caused by the absence or abnormality of accessory gonads, infection and other causes of obstruction of the vas deferens. When male reproductive tract infections occur, the lobulated neutrophils participate in anti-inflammatory reactions such as phagocytosis of pathogens and secrete elastase in the extracellular seminal plasma. Its reliability as a diagnostic and prognostic indicator for stationary reproductive tract infections has been recognized. Our experiment found that the content of elastase is reflected in cases of infection, and color Doppler detection mostly indicates orchitis, testicular sheath effusion, and epididymal cysts.
Semen analysis is an important analysis for evaluating infertility, but basic semen analysis cannot directly detect sperm fertilization ability and many biochemical events before and after fertilization. In the past 20 years, many biochemical analyses including semen have been developed! The methods related to analyzing semen function, such as ultrastructure, zona pellucida attachment, and egg penetration test, among which semen biochemistry has become a routine examination item in some laboratories due to its relatively simple and easy operation. Our experiment found that seminal plasma biochemistry is an important means of detecting azoospermia, especially obstructive azoospermia. As Mazzilli et al. believed that semen biochemical analysis was a diagnostic test for obstructive azoospermia, but it could not provide a particularly useful explanation for secretory azoospermia with hypogonadism.