A semen analysis should be a part of every couple’s infertility work-up. It is the single most important test of male fertility. Sometimes medical practitioners refer to a semen analysis as sperm count testing, however a thorough semen analysis looks at so much more than just a count of the sperm…
SEMEN ANALYSIS
A complete semen analysis looks at the shape and size of the sperm, how well the sperm swim and in which direction, along with the total number of sperm. The laboratory analysis also looks at the color of the semen, how it clumps and liquefies, how much semen volume there is, as well as a number of other factors. A sperm culture may also be done to look for signs of infection.
According to the World Health Organization (WHO), a sperm concentration of 20 million per milliliter, with a total of at least 40 million per ejaculate, is needed for ideal fertility. Sometimes, results of a thorough semen analysis show the number of sperm may be fine, however other less-than-ideal factors are found in the semen. In that situation, the other factors may prevent pregnancy achievement.
Approximately one-third of infertility cases are related to an issue with just the man and another third involves a problem with just the female. The remaining cases are related to problems on both sides or to unexplained infertility. It is entirely possible, based on these numbers, that there is at least a 33%+ chance that a couple’s infertility could be related to the male partner. Therefore, it is imperative that every infertile couple makes the effort to ensure the male partner is tested.
Unfortunately, a semen analysis is often overlooked, especially if a reproductive specialist is not evaluating the couple’s infertility. Since gynecologists usually concentrate on woman’s health issues, when a woman sees her gynecologist for an infertility evaluation, basic male fertility testing is often not on the radar. In addition, fertility testing for the male partner may be overlooked or disregarded if a fertility issue has already diagnosed for the woman.
It is important to talk with your reproductive specialist during the initial infertility work-up phase to make sure that a semen analysis is completed upfront. There is no reason to put a woman through medical procedures and tests without knowing the status of her partner’s semen. In fact, it is possible that this testing will help you avoid additional distress or sadness, not to mention the potentially unnecessary dollars spent later in the treatment process. Reproductive specialists know that if you treat just the woman, even though there are male factors involved, most fertility treatments will typically fail.
In order to complete a semen analysis, the male partner is typically asked to abstain from any ejaculations for two to three days prior to the test. For most men, making specimens at home is preferred, however the sample should be brought to the lab within about an hour. When completing the specimen at home, be sure to use a cup provided by the lab, as some materials are toxic to sperm.
When completing the actual semen analysis, laboratory technicians look at the following:
SPERM COUNT
40 million to 300 million is the normal range for the number of sperm per milliliter. Counts below 10 million are considered poor; counts of 20 million or more may be fine if motility and morphology are normal. Most low counts go unexplained, but occasionally this can be hormonally related.
TOTAL VOLUME
A normal volume is considered to be 2-5 milliliters. While volume does not play an important role in fertility, a low volume suggests an incomplete collection; the seminal vesicles may not be making enough fluid or the ducts may be blocked. In addition, a very low volume may indicate a problem with the prostate gland. On the other hand, very large volumes may lead to the dilution of sperm, causing substantial leakage after intercourse.
MORPHOLOGY
The Kruger (strict) morphology test inspects the size and shape of the sperm head. Results are considered to be normal when 14% or more of the sperm have normal shaped heads. Men with less than 4% of normal shaped sperm may have a significant infertility problem.
MOTILITY AND VELOCITY
There are two different aspects of motility that are evaluated. The percentage active cells is compared to the total number of cells; at least 60% should be active. The quality sperm’s movement is rated on a scale of 0-4. A score of 2 or more is considered to be acceptable.
LIQUEFACTION
Typical semen, which is liquid at ejaculation, immediately coagulates into a pearly gel. Within twenty minutes, the semen gel becomes a liquid again. Failure to coagulate and then liquefy may indicate a problem with the seminal vesicles. Other factors that could indicate issues with the seminal vesicles include increased thickness or the presence of white blood cells in the semen.
SEMINAL FRUCTOSE
If no sperm are present, the semen will be tested for seminal fructose, which is naturally produced by the seminal vesicles. If no fructose is present, congenital absence of the vas deferens or seminal vesicles or obstruction of the ejaculatory duct may be an issue.
CULTURING
The physician may test the semen and/or the urethra for the presence of any STDs or other bacteria. The presence of common pathogenic microorganisms in the male genitourinary tract can be responsible painful ejaculation and/or urination, haemospermia (presence of blood in the semen), urinary frequency or urgency, and other symptoms associated with infection. In some cases, the physician may combine a semen culture with a urine culture to check for certain pathogenic bacterium that may be detected only in the urine.
The idea of a semen analysis makes many guys anxious. In today’s world of free information and internet advertising, many men go online in hopes of finding and taking a more anonymous test. Some men choose to use mail-based semen analysis tests that are available. Keep in mind that these anonymous tests are not as accurate as the testing done in a lab with fresh semen. In fact, to get the best test results, the sample should get to the testing lab within an hour of collection.
The at-home sperm tests are limited in what they can evaluate. Most of them measure sperm count and semen volume, but they can’t evaluate sperm movement and they rarely look at sperm shape. You can have great sperm counts, but if the sperm are not moving properly, or they’re all poorly shaped, you may still be infertile. If you are concerned about your fertility, see your doctor and get a comprehensive and accurate test done.
Take control of your fertility and make an appointment with one of our compassionate and highly trained reproductive specialists at the Center of Reproductive Medicine. CORM serves the greater southeast Texas area with three state-of-the-art fertility clinics located in Houston, Webster, and Beaumont with doctors who will work diligently to give life to your dreams. The professional staff at the Center of Reproductive Medicine will listen closely and help you choose the most appropriate fertility program for your individual reproductive medical needs.