Male Fertility Testing: The Semen Analysis

A semen analysis is a male fertility test that tells your doctor (usually a fertility specialist or reproductive endocrinologist) the number of sperm in your semen, whether they are normal, and how well they move.

There are many reasons why couples have trouble achieving pregnancy. A semen analysis is one of the tests your doctor will use to evaluate the male partner during a consultation at a fertility clinic.

Although not a comprehensive measure of fertility, the semen analysis, if abnormal, may suggest that the probability of achieving fertility is statistically low. Among the numbers on the test, the sperm concentration and motility appear to correlate best with fertility. Two well-performed semen analyses can often suggest a diagnosis or direction.

The cause of low sperm count may be due to certain medications or a medical problem such as a blocked duct, low testosterone level, or a condition in which sperm back up into the bladder. Fever can also reduce sperm count.

Some men may have enough sperm, but their sperm may not swim well enough to reach the egg. Also, sperm that are not normal in shape may not be able to penetrate and fertilize the egg.

What is Male Factor Infertility? | Explained by Dr. Jacqueline Gutmann

Semen collection

Your doctor will want you to provide a semen sample. The semen sample is collected by masturbation at your doctor’s office in a private, comfortable room. You will be asked to collect your semen in a sterile specimen cup.

Key points for patients:

  • Recognize that not all semen analysis labs are equivalent. Some labs, especially those associated with fertility centers, may be more used to doing a semen analysis and have better quality assessments and reports.
  • Semen quality varies with collection technique, so follow the instructions as best as you can.
  • Abstain from ejaculation for 2-4 days prior to collection. Longer or shorter abstinence than this may result in artificially high or low concentration or motility.
  • Clean or sterile containers should be used for collection. The entire specimen must be collected. Regular condoms and lubricants should be avoided as they may kill sperm.
  • If collecting the sample at home, keep it at body temperature during transport (shirt pocket); it should be delivered within 1 hour of collection.
  • Speak with your doctor about instructions for transporting the sample to the office.
  • Test results often vary, so you may need to do this procedure more than once.

 

How to Analyze A Semen Analysis Report – Normal Levels

 

Areas of Review Normal Semen Analysis Ranges
Total sperm count 39 – 928 million
Ejaculate Volume 1.5 – 7.6 mL
Sperm Concentration 15 – 259 million per mL
Total Motility (progressive and non progressive) 40% – 81%
Progressive Motility 32% – 75%
Sperm Morphology 4% – 48%

 

 

Normal and Abnormal Sperm Morphology

Although males account for approximately one-third of infertility issues, there is little testing available to determine the cause. The main test for assessing male fertility is the basic semen analysis, which is mainly comprised of determining the sperm count, motility, and morphology. Some labs extend the analysis to include additional tests such as white blood cell counts and anti-sperm antibody assessment.

Sperm Morphology: How “normal” sperm looks

The evaluation of the various shapes of sperm is termed morphology. Several descriptive systems exist to evaluate morphology, and within each classification system, sperm are designated normal or abnormal based on a list of criteria. It is believed that sperm morphology may correlate with a man’s fertility potential, but in actuality, it has only been shown in studies to correlate with the ability of sperm to penetrate and fertilize eggs in the setting of in vitro fertilization (IVF).

sperm morphology graph

It is not been convincingly demonstrated that sperm morphology correlates with the ability of couples to conceive with either Morphsexual intercourse or intrauterine insemination (IUI). Sperm morphology may also be a sensitive indicator of testicular health because sperm morphology is largely determined during sperm production in the testis. The main role of morphology in the male evaluation is to complement the semen analysis data and better estimate the chances of fertility.

How sperm morphology is assessed

Sperm morphology is assessed by looking at individual sperm and giving them a characteristic based on their appearance. Most fertility laboratories follow Kruger’s Strict Morphology guidelines in which a normal value is a score of greater or equal to 4% normal.

Anything below 4% is considered abnormal and is given the diagnosis of teratozoospermia. Although it is not uncommon to have a score of less than 4% normal for morphology, the individual sperm characteristics are also very important when physicians are reviewing a patient’s morphology results.

semen analysis results chart

Sperm defects can be characterized as too large, too small, abnormal neck, and abnormal tails, in addition to many others. Some defects are very detrimental to sperm function, while others do not affect the function of sperm.

Sperm morphology is an additional tool used for determining the best course of treatment for a couple. Patients with very low morphology scores are usually recommended to pursue in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI), while slightly abnormal morphology scores may consider intrauterine insemination (IUI) treatment.

 

Additional Semen Testing Options

In some cases, additional semen analyses may be needed.

  • Semen Leukocyte Analysis: On a routine semen analysis, “round” cells are often found in addition to sperm with tails. These “round” cells are either immature sperm forms (spermatocytes) or white blood cells (leukocytes). It is important to distinguish between these two cell types because the treatments differ.
  • Karyotyping: Also infrequently indicated, chromosomal analysis is performed in men with low (less than 5 million) or no sperm in the ejaculate.

 

Common Questions & Answers

 

What does low sperm count mean?

A low sperm count is fewer than 20 million sperm per milliliter ejaculated. The normal range is between 40 million and 300 million sperm per milliliter ejaculated.

 

What does low motility mean?

Motility describes the movement of the sperm.  Low motility may reduce the chances of the sperm reaching and fertilizing the egg, especially if your sperm count is also low. In a normal semen sample, approximately half of the sperm have appropriate movement.

 

What does abnormal morphology mean?

A normal sperm has an oval head, slender midsection, and a tail that moves in a wave-like motion.  Sperm that do not have this normal share may not be able to swim effectively or penetrate the egg.

sperm abnormalities

 

How long must I abstain from sex before the analysis?

You should abstain from sex for at least 2 to 5 days before the analysis, but not longer than 1 week. Check with your doctor to see if there are any other recommendations specific to you.

 

How long does it take to get the results?

The test results are generally available within a few days.

 

Are boxers or briefs better for sperm count?

Dr. Jacqueline Gutmann answered this age-old debate in the video below. To cut to the chance, the answer is that neither is better than the other, but wait until you find out why!

 

Semen Analysis Conclusion

In conclusion, infertility in males is just as common as it is in females. The easiest way to diagnose male infertility is with a simple semen analysis test which can be performed at any of our RMA Network offices across the US. When you schedule a consultation with a fertility specialist they will most likely want to see both partners. The male partner’s semen will be tested with a semen analysis and the female partner will receive bloodwork and possibly an ultrasound test. Results for all tests typically will only take a few days and your physician will give you a call to follow up with all of your results.

The great news is that there are plenty of options when it comes to treating male and female infertiltiy. Make the first step and schedule an appointment today.

Jacqueline N. Gutmann
12/09/2020 8:10 AM - Written by: Jacqueline N. Gutmann

MD, FACOG

Dr. Jacqueline N. Gutmann received her medical degree from the Yale University School of Medicine, and completed her residency and fellowship in Reproductive Endocrinology and Infertility at the Yale-New Haven Hospital, where she received the Irving Friedman Award for Excellence in Patient Care and was also named a Robert Wood Johnson Clinical Scholar. She currently serves on the medical advisory board of the American Fertility Association (AFA). She has been featured on The Learning Channel and in Philadelphia Magazine. She is board certified in OB/GYN and sub-specialty board certified in Reproductive Endocrinology and Infertility.

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