| Консультация специалиста | Врач | КМН | ДМН |
| Первичный прием | 1500 | 1800 | 2500 |
| Повторный прием | 1200 | 1500 | 2200 |
Спермограммой называется исследование семенной жидкости под микроскопом. Оно используется для определения численности подвижных и неподвижных половых клеток, их морфологических свойств, способности оплодотворения яйцеклетки. Чаще всего подобные анализы проводят с целью выявления факта бесплодия. Далее будет рассказано о том, как сдается спермограмма.
Подготовка к исследованию
Довольно важно понимать, что достоверные результаты будут получены исключительно при условии, что мужчина будет соблюдать определенные рекомендации:
— за несколько дней до сдачи анализа требуется полностью исключить воздействие любых токсичных факторов, к которым относят алкоголь и работу с химическими веществами. Если условия работы мужчины сопряжены с вдыханием токсинов, либо с их поступлением в организм сквозь кожу, то правильнее всего сделать спермограмму в понедельник, то есть после выходных дней;
— следует воздерживаться от половых актов примерно 2-7 дней до исследования. Это требуется для того, чтобы в семенной жидкости не присутствовало клеток из женской репродуктивной системы;
— следует не курить за 2-3 часа до процедуры забора спермы;
— за 6-7 месяцев до проведения исследования мужчина должен прекратить применение любых цитостатиков и гормонов;
— сбор материала не должен проводиться в процессе лечения любых урологических патологий, в особенности, имеющих воспалительный характер. Это может исказить результаты лабораторного теста;
— за сутки до сдачи анализа стоит исключить воздействие психических или физических факторов, способствующих перенапряжению организма. Кроме того следует на 10 дней прекратить посещение бани или сауны;
— при перенесенном простудном заболевании следует отложить сдачу анализа на 7 дней и более с момента выздоровления.
Как сдается спермограмма
Необходимо отметить, что одним из условий сдачи спермограммы является психологическая готовность мужчины. Это объяснимо тем, что сбор материала производится исключительно посредством мастурбации. Нельзя получать сперму посредством прерванного полового акта, так как в подобном материале могут присутствовать включения микрофлоры женских половых путей. Сбор эякулята производится в специальную лабораторную емкость, обязательно стерильную, которая чаще всего выдается медсестрами лечебного заведения.
Если решено производить забор материала дома, то его необходимо доставить в лабораторию не более чем за 30-40 минут после его получения. Большее время приведет к гибели клеток или изменению их морфологических характеристик. Так как объем эякулята – это один из важнейших показателей для диагностики, то вся полученная сперма обязательно должна отправиться на анализ. Перед сбором материала необходимо, чтобы пациент принял душ, а также опорожнил мочевой пузырь и кишечник. Во время мастурбации исключено применение смазок и кремов, нельзя использовать даже слюну. При отсутствии специальной лабораторной емкости для сбора материала можно воспользоваться чистой стеклянной баночкой с широким горлышком. Правильнее всего за несколько часов до сбора материала прокипятить ее и закрыть крышкой.
При самостоятельной доставке материала до лаборатории следует соблюдать температурную цепочку, то есть транспортировка спермы должна производиться в условиях температуры, приближенной УК человеческому телу. К емкости следует прикрепить листок с паспортными данными, следует указать период полового воздержания, и вся ли сперма собрана для исследования.
Результаты
Мужчин обычно консультируют урологи или андрологи, составляющие программу лабораторных обследований, а потом интерпретирующие полученные результаты. Если в результате обследования были обнаружены определенные отклонения, то важно помнить об определенных моментах. Мужская репродуктивная система характеризуется сильной чувствительностью к разнообразным внешним факторам и лекарственным препаратам. Это означает, что не стоит заниматься самолечением. Уролог должен сформулировать квалифицированную лекарственную терапию.
Итак, теперь вам известно, как сдается спермограмма, теперь можно сказать о том, как улучшить результаты такого исследования, а также повысить эффективность лечения:
— прекращение курения часто способствует увеличению степени подвижности сперматозоидов;
— полное исключения алкоголя, в особенности пива, оказывает положительное воздействие;
— улучшение условий быта и работы, исключения факторов стресса, физических перегрузок и подобных явлений, позволяет улучшить картину;
— эффективное лечение инфекционных и воспалительных заболеваний дает положительный результат;
— если речь идет о спортсменах, то следует снизить интенсивность их тренировок.
Получение недостоверного результата грозит постановкой неправильного диагноза и подбором неподходящих методов лечения. Конечная точность лабораторной диагностики на 70 % зависит от самого пациента: от его подготовки и правильности сбора биоматериала.
Поэтому важно понимать то, как правильно подготовиться мужчине к спермограмме и чего делать категорически нельзя.[contents]
Подробнее про сдачу анализа
На территории России на федеральном уровне официально не утверждены правила подготовки к сбору биоматериала для спермограммы и стандартные референсные (нормальные) значения. Исходя из этого, частные лабораторные отделения предъявляют собственные правила к преаналитической подготовке пациента и процедуре сбора эякулята. Значения нормальных показателей также варьируют в зависимости от лаборатории.
Ориентиром для составления правил служат рекомендации ВОЗ. Нормальные величины спермограммы ежегодно пересматриваются сотрудниками организации здравоохранения на основании данных клинических исследований.
В статье собранны и обобщены рекомендации, которые применяются крупнейшими диагностическими центрами России.
Подготовка к сдаче
От того насколько внимательно мужчина подойдёт к изучению вопроса подготовки анализа зависит точность полученных результатов. Неправильная подготовка – причина получения ложных данных, что обуславливает необходимость повторного проведения исследования.
Что можно делать
Многих мужчин волнует вопрос – можно ли заниматься спортом перед спермограммой? Да, физические тренировки могут проводиться согласно стандартному расписанию. Накануне вечером перед визитом в лабораторию следует снизить интенсивность физических нагрузок и не заниматься на пределе возможностей. Более того, гиподинамия отрицательно сказывается на достоверности результатов, так как на её фоне снижается активность половых клеток.
Важно: необходимо избегать травмирования области паха, поскольку это может привести к уменьшению подвижности сперматозоидов. От велоспорта следует отказаться.
Что нельзя
За трое суток до исследования мужчине категорически запрещается:
- посещать бани и сауны, а также принимать горячие ванны;
- проходить диагностику при помощи рентгенологического метода;
- проходить физиотерапевтическое лечение.
Ограничить следует и длительную работу с ноутбуком на коленях, нижняя поверхность которого нагревается. Предпочтение стоит отдавать свободному белью и брюкам.
Влияние внешних факторов на мошонку нарушают процесс нормального образования спермы, что приводит к получению недостоверных результатов.
Подогрев сидения автомобиля по пути в лабораторное отделение включать нельзя.
Ограничения в питании
За 72 часа мужчине следует скорректировать режим питания. Из рациона исключаются экзотические продукты, а также копчёности, острые и сильносолёные блюда. Необходимость данного правила обусловлена тем, что продукты оказывают влияние на биохимический состав эякулята. В результате могут искажаться исследуемые параметры, например вязкость, запах или однородность.
Следует избегать длительного голодания, которое приводит к недостатку витаминов групп В, С и Е. Гипофункция витаминов – причина изменения качественного и количественного состава спермы.
Медикаменты и влияние болезней
За 1 сутки мужчине противопоказано употреблять любые лекарственные средства. Перед их отменой следует проконсультироваться с лечащим врачом. Если отменить жизненно важные препараты не представляется возможным, то об их приёме сообщается лаборанту. Особое влияние на результаты спермограммы оказывают гормональные препараты и анаболические средства.
Большое значение оказывают болезни мужчины. Например, заболевания, передающиеся половым путём, воспаление предстательной железы, аутоиммунные патологии, а также врождённые генетические мутации и аномалии.
Сексуальная активность перед спермограммой
Минимальный срок воздержания от сексуальной жизни составляет 2 суток, однако оптимальным сроком считается 5 суток. Следует подчеркнуть, что высокая сексуальная активность или длительное воздержание отрицательно сказываются на достоверности исследования.
Как может повлиять
Высокая половая активность и способность к деторождению не являются связанными факторами. Первая зависит от уровня тестостерона в крови у мужчины, а также влияния внешних факторов (физические и эмоциональные стрессы). Вероятность к зачатию напрямую зависит от качества и количества спермы.
Многие мужчины полагают, что длительный отказ от секса повысит активность сперматозоидов. Это ошибочное мнение, поскольку на фоне длительного бездействия половые клетки утрачивают свою подвижность, а также накапливается большее число их аномальных форм. Это приводит к получению ложноотрицательных результатов спермограммы по вине самого мужчины.
Как происходит сдача исследования
Перед проведением сбора биоматериала для спермограммы пациенту следует провести гигиенические процедуры. Особое внимание уделяется отверстию мочеиспускательного канала, это позволит избежать загрязнения исследуемого биоматериала.
Почему нельзя использовать биоматериал из презерватива? Известно, что компоненты состава презерватива отрицательно влияют на эякулят. Значительно повышается риск получения недостоверных результатов, в которых подвижность половых клеток будет снижена. Это правило действительно и для сбора эякулята в ходе прерванного полового акта. Недопустимо попадание сторонней микрофлоры партнёрши.
Важно: собирается абсолютно весь выделившийся эякулят, поскольку его количество – один из лабораторных критериев спермограммы. Следует отметить, что если процесс мастурбации был успешен, при этом сперма не выделилась, то нужно сразу собрать мочу и доставить её на анализ.
Сдача биоматериала возможна двумя путями: собрать самостоятельно дома и доставить в лабораторное отделение или провести сбор в клинике в специальной оборудованной комнате.
Несмотря на то, что первый вариант более комфортен для пациента, некоторые лаборатории отказываюсь принимать такой биоматериал. Аргументируется это тем, что доставку необходимо провести в ближайший час, при этом соблюдя правила хранения и транспортировки. А в случае недостоверных результатов вина возлагается на лабораторию.
Поэтому предпочтение стоит отдать второму способу. Частные клиники создают максимально комфортные условия психологического и физического аспекта для мужчины. Как правило – это отдельная комната с видеостимуляцией соответствующего характера.
Где можно пройти исследование
Мужчине следует максимально внимательно подойти к вопросу выбора места сдачи анализа. Поскольку от точности полученных результатов будут зависеть последующие действия врача по подбору лечения.
При необходимости повторных анализов следует обратиться в тоже лабораторное отделение, поскольку реагенты, приборы и стандарты проведения исследования должны быть одинаковыми. Это позволит отследить изменение всех параметров в динамике.
Можно сдать анализ в государственной или частной клинике широкого профиля. Однако предпочтение следует отдавать клиникам, специализирующимся на репродуктивной системе человека и реализации искусственного оплодотворения. Как правило, при таких центрах работают их собственные лаборатории. Преимущества выбора узкоспециализированной клиники – профессионалы именно в области репродуктивного здоровья, возможность получения консультации специалиста в той же клинике.
Лаборатории существует также при научно исследовательских и медицинских институтах. Преимущества обращения в том, что сотрудниками являются врачи, получившие степень кандидата или доктора наук, а также профессора. Недостаток таких лабораторий – отсутствие специально оборудованной комнаты, обеспечивающей психологический комфорт мужчине.
Третий вариант – это обращение в крупные диагностические лабораторные отделения. Например, Хеликс, Инвитро, Наука или Гемотест. Преимущества – оборудованная комната, большое число офисов, осуществляющих приём пациентов в удобное для них время, а также возможность получения результатов анализов любым удобным способом.
Сколько стоит сдать спермограмму
Средняя цена анализа – 1000 рублей. Расширенная лабораторная диагностика с определением антител на поверхности сперматозоида или в семенной жидкости предполагают дополнительную оплату в 500 – 700 рублей.
Заключение специалиста по результатам анализов обойдётся пациенту в 1500 – 2000 рублей. Некоторые лаборатории (Хеликс) выписывают заключение бесплатно, однако они носят исключительно рекомендательный характер и не могут использоваться для постановки на их основе диагноза.
Консультация доктора наук или профессора начинается от 3000 – 5000 рублей.
Если мужчине необходимы результаты в срочном порядке, то стоимость увеличиться на 50 – 100 %, при этом время получения результатов сокращается до 2 – 3 часов.
Как сдать спермограмму бесплатно
Для того чтобы пройти исследование бесплатно необходимо чтобы в клинике, к которой прикреплен мужчина, была специальная лаборатория. Следует отметить, что крайне малое количество государственных поликлиник проводят такое исследование.
Первоначально необходимо получить направление от врача-уролога, затем обратиться в лабораторию поликлиники.
Для получения максимально быстрых и безошибочных данных исследования, следует отдавать предпочтение научно исследовательским институтам или частным лабораторным отделениям.
Расшифровка и нормы
Набор определяемых лабораторных параметров для стандартной спермограммы состоит из 40 пунктов. Учитываются:
- физические показатели эякулята – объём, уровень рН, цвет и запах;
- количественные характеристики – абсолютное число половых клеток и их подвижность;
- наличие аномалий в морфологии сперматозоидов;
- степень агглютинации половых клеток;
- присутствие в биоматериале клеток крови;
- наличие представителей болезнетворных микроорганизмов.
Следует подчеркнуть, что расшифровка полученных данных – это задача врача. Не следует самому интерпретировать результаты и пытаться подбирать лечение.
Резюмируя, необходимо выделить важные моменты:
- от того как правильно мужчина подготовится и сдаст биоматериал зависит 70 % точности результатов;
- пренебрежение правилами подготовки приводят к получению ложных результатов. Это может привести к отсрочке назначения правильного лечения и ухудшения состояния мужской половой функции;
- следует внимательно подходить к месту выбора учреждения для анализа. Предпочтение лучше отдавать частным клиникам узкого профиля или научно исследовательским институтам.
Диагностика мужского бесплодия проводится на основании обследования и сбора информации. Главный анализ на бесплодие у мужчин – спермограмма (исследование эякулята на предмет фертильности). Правильная подготовка к спермограмме позволяет получить достоверные данные и избежать искажения показателей, отклонений от нормы.
Анализ проводится не только для подтверждения и определения способности к зачатию. В некоторых случаях исследование назначают для определения необходимости операции, например по поводу, варикоцеле или предстоящего лечения онкологических заболеваний (с целью криоконсервации спермы).
Как известно, признаком бесплодия считается неспособность пары, которая живет половой жизнью без использования какой-либо контрацепции в течение года, зачать ребенка. Во всем мире до 15% пар являются бесплодными. Из них бесплодны 50% по причине мужского фактора (аномальные параметры эякулята). В 50% случаев проблема может быть решена с положительным исходом.
Содержание
- Как мужчине провериться на бесплодие?
- Причины изменения фертильности мужчин
- Когда не стоит затягивать и сдать спермограмму?
- Подготовка к спермограмме
- Тест на бесплодие у мужчин. Что нужно знать?
- Показатели спермограммы
- Мужской фактор бесплодия
- Как сдавать спермограмму?
Как провериться на бесплодие мужчине?
Обследование мужчинами и женщинам при бесплодии назначают одновременно. Но диагностика мужского бесплодия выполняется раньше, чем у женщины, потому что это проще.
Как проверить мужчину на бесплодие? Для начала достаточно подготовиться и сдать спермограмму. Исследование эякулята – это несложно и сразу становиться понятно – нужно ли дальше обследовать супруга или искать причину у женщины.
Причины мужского бесплодия
Причины бесплодия у мужчины зачастую – это факторы, которые в 50% случаев поддаются коррекции. Среди них:
- состояние здоровья в целом;
- негативные факторы окружающей среды;
- образ жизни;
- урологические заболевания;
- генетические причины;
- некорректная работа иммунной системы.
Когда не стоит затягивать и сдать спермограмму?
Рекомендовано сдать спермограмму не дожидаясь истечения года (для постановки диагноза) в следующих случаях:
- При наличии ванамнезе операций на органах мошонки и в области паха (варикоцеле, крипторхизм, паховые грыжи, водянки, кисты придатков).
- При воспалительных заболеваниях половых органов: эпидидимит орхит, паротит (свинка) Особенно нужно быть настороженным, если заболевания хламидийной этиологии).
- Если возраст женщины более 35 лет.
В перечисленных случаях нужна регулярная половая жизнь в течение 3-6 месяцев, если беременность не наступает – следует начинать обследования.
Подготовка к спермограмме
Подготовка к сдаче спермограммы предусматривает:
- Половое воздержание перед сдачей анализа 3-5 дней. Причем исключаются все формы половой жизни.
- Обязательно исключить перегревание. И это нужно сделать на несколько дней раньше: не за 3-5 дней, а за 7-10 суток до того, как провериться на бесплодие мужчине (бани, сауны и горячие ванны)
- Подготовка перед сдачей спермограммы – это обязательное ограничение жирных, острых, жареных блюд и исключение приема алкоголя.
Тест на бесплодие у мужчин. Что нужно знать?
При подготовке перед спермограммой нужно учесть, что цикл развития сперматогенеза – от рождения сперматозоида в яичке до попадания его в сперму в среднем длиться 72 дня (65-75 суток).
За это время на качество эякулята могут оказывать влияние неблагоприятные факторы. Например, тяжелое воспаление легких с высокой температурой до 40 C°. Поэтому в течение двух месяцев при сдаче анализа могут быть выявлены признаки мужского бесплодия (хотя на самом деле это будет не достоверно). Поэтому, если вы знаете, что последние 3 месяца с мужчиной происходило что-то серьезное, дождитесь истечение 3 месяцев и сдайте спермограмму повторно.
Показатели спермограммы
Эякулят – многокомпонентная смесь, каждый из компонентов которой важен и оценивается в комплексе с другими показателями спермограммы.
В анализе эякулята оцениваются, прежде всего, такие показатели:
- количество сперматозоидов, так называемая концентрация в 1 мл и общая (на весь объем спермы);
- способность к движению – подвижность;
- морфология – это как выглядят сперматозоиды – правильность их строения.
Мужской фактор бесплодия
- Олигозооспермия – снижение количества сперматозоидов. Например, 15 млн. в 1 мл сперматозоидов и ниже считается олигозооспермией. Есть такой термин как полиспермия, когда количество спермиев увеличено. Такая сперма – вариант нормы и плохой не считается.
- Астенозооспермия – снижение подвижности.
- Таратозооспермия – снижение количества половых клеток с идеальным анатомическим строением.
- Олигоспермия – малое количество самого семени (менее 1,5 мл).
- Аспермия – полное отсутствие эякулята – сперма не выделяется.
- Азооспермия – сперма есть, но в ней отсутствуют сперматозоиды.
- Сочетанные формы , например, олигоастенотератоспермия.
- Некросперимя – отсутствие подвижных форм. В современном мире неподвижный сперматозоид – не значит мертвый. А слово «некро» – в переводе мертвый. Ныне среди неподвижных сперматозоидов с помощью теста – гипоосмолярного набухания можно выделить живые формы и использовать в программе ЭКО ИКСИ.
- Криптоспермия – очень часто встречаемое заключение при обращении в репродуктивные клиники с целью проведения ЭКО при мужском факторе бесплодия Это обнаружение единичных сперматозоидов в осадке после центрифугирования. То есть в нативной сперме при обычном анализе сперматозоиды не обнаруживаются, а при проведении центрифугирования выявляют подвижные или неподвижные единичные мужские половые клетки. Которые врачи научились использовать для оплодотворения методом ЭКО ИКСИ.
- Аутоимунный конфликт – это увеличения показателя МАР-теста более 50 % сперматозоидов покрыты иммунными антителами.
- Лейкоцитоспермия (пиоспермия) – увеличение количества лейкоцитов. Лейкоциты – не всегда являются признаком воспаления. Застойные явления – венозное напряжение вен малого таза, вен мошонки при варикоцеле могут провялятся повышенным содержанием лейкоцитов. После этого заключения нужно, прежде всего, понять – откуда эти лейкоциты, выяснить их происхождение, исключить воспаления, сделать бактериальный посев. Только потом, доказав диагноз лечить воспалительный процесс.
- Гематосперимия – кровь в сперме. Самая частая причина – это везикулит – воспаление семенных пузырьков или слабость сосудистой стенки везикул при венозном застое. В семенных пузырьках образуется до 65% объема всего эякулята.
Необходимо помнить, что во многих случаях мужской фактор бесплодия непостоянный и поддается коррекции.
Как сдавать спермограмму?
Лучший метод сдать спермограмму согласно рекомендациям ВОЗ – мастурбация. Другие способы имеют недостатки. Прерванный половой акт – нежелателен, потому что может быть: потеряна часть спермы, добавление примесей, лейкоцитов, флоры. Использование презерватива – не допускается. В производстве презервативов используется бактерицидная смазка, которая искажает результаты анализа. Презервативы без смазки встречаются, но действие латекса на сперматозоиды не изучено.
Перед тем как сдавать спермограмму, нужно приобрести стерильный пластиковый, биологически инертный контейнер. Эта посуда удобна для транспортировки и работы в лаборатории.
В платных клиниках существуют специально обустроенные комнаты для сдачи спермограммы (спермосдаточные или мастурбационные кабинеты), с диваном и располагающей обстановкой, с устройством для воспроизведения видео.
Для того чтобы сдать спермограмму можно пригласить супругу. Комната запирается. Мужчина должен овладеть собой, достичь оргазма и собрать эякулят в специальную посуду. Образец сразу же передают в лабораторию. Собрать семя для анализа дома и привести в клинику можно в исключительных случаях. Неправильная транспортировка, нарушение температурного режима, колебания при передвижении повреждают мужские половые клетки. Как следствие – некачественная диагностика и недостоверные результаты.
В рядовых клиниках пока не готовы оборудовать такие комнаты, поэтому мужчины сдают спермограмму в пустом закрытом кабинете, недалеко от лаборатории.
Правильная последовательность действий:
- помочиться;
- вымыть руки с мылом;
- открыть стерильный контейнер, не касаясь внутренней поверхности;
- собрать эякулят в контейнер;
- закрыть его;
- оставить на полочке или столе.
Сдать эякулят на анализ просто, главное – настроиться психологически и подготовится к сдаче спермограммы правильно. И помните, что качество семени у мужчины меняется во времени и при исключении неблагоприятных условий, стрессов, заболеваний показатели возвращаются в норму. Старайтесь не интерпретировать полученные результаты самостоятельно, так как мужская фертильность оценивается в комплексе сразу по всем показателям.
Статьи по теме:
Смотрите дополнительно — в этом видео рекомендации доктора: как готовиться и сдавать спермограмму.
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