A semen analysis is a standard test to evaluate the quality and quantity of sperm. It’s often the first recommended test for male infertility and can provide valuable information for couples who are struggling to conceive.
Although this test may not offer a comprehensive view of a male’s overall fertility, it’s a good starting point as an abnormal result can provide clues and narrow the scope of further testing.
This article explores what a semen analysis entails, how it’s performed, and what the results may indicate.
Semen analysis is a diagnostic tool used to evaluate male fertility. It’s a simple and non-invasive procedure that involves sperm collection followed by laboratory testing. This section provides an overview of the test and its significance in assessing male infertility.
Semen is the substance released from the penis during ejaculation (orgasm).
It contains sperm and several other components, including:
Semen can also contain white blood cells, fructose, vitamin C, and zinc.
Infertility is a common problem that affects both men and women. Male infertility, in particular, affects one in every six couples trying to conceive. Moreover, nearly half of all infertility cases are due to male factor infertility.
What is Male Factor Infertility? | Explained by Dr. Jacqueline Gutmann
Male infertility is the inability to achieve pregnancy after a year or more of regular, unprotected sex.
Possible causes of male infertility include, but are not limited to:
It’s important to note that this isn’t an extensive list of causes for male infertility. Male infertility is a complex condition that can have multiple underlying causes.
A semen analysis is a laboratory test that evaluates the quality and quantity of an individual’s semen. It’s a non-invasive and straightforward procedure that involves collecting a semen sample and examining it under a microscope. This test can provide valuable information about a man’s fertility status, including his sperm count, motility, and morphology.
Semen analysis is typically recommended for couples trying to conceive for at least one year without success (or six months if the female partner is 35 years old or older). If male infertility is suspected, and the female partner has already undergone fertility testing, a semen analysis is usually the next step in diagnosing the cause of infertility.
A semen analysis may be recommended for men with certain medical conditions or lifestyle factors that can affect their fertility, such as a history of testicular cancer, previous chemotherapy or radiation treatment, or exposure to toxins in the workplace. In some cases, a semen analysis may be part of routine testing for men who are considering donating sperm or for those who are undergoing fertility treatments such as in vitro fertilization (IVF).
This section covers the procedure, including the steps before, during, and after the test.
During a semen analysis, the patient must provide a semen sample either by ejaculating into a sterile container in a private room at a fertility clinic or by using a special condom during intercourse.
Once collected, the sample is sent off to the laboratory for analysis, where technicians will examine it under a microscope to evaluate the sperm count, motility, and morphology of the sperm. The analysis will also assess the semen pH, the viscosity of the semen, and the time to liquefaction (how quickly the semen changes from a sticky substance to a liquid).
After the test, a healthcare professional will explain the results to the patient and discuss the next steps.
Masturbation is the most common method for collecting a semen or sperm sample. However, some clinics may offer a special condom or, for individuals with severe male infertility, offer assistance with microsurgical epididymal sperm aspiration (MESA) or testicular sperm aspiration (TESA).
For accurate results, it’s important to abstain from ejaculation for two to seven days before the semen analysis. Additionally, specialists recommend patients avoid lubricants or saliva during collection as they can affect the quality of the sperm.
Preparing for a semen analysis is relatively simple. Patients should abstain from sexual activity that results in ejaculation for two to seven days before sperm collection. This includes intercourse and masturbation. Patients should also ensure that their hands are clean and that they’ve wiped their genital area thoroughly (or showered) before collection.
At-home semen analysis kits are available online or at some drugstores, which offers a convenient and cost-effective alternative to traditional laboratory testing. However, convenient as they are, these kits may not provide a different level of accuracy than a professionally administered test.
Furthermore, at-home tests may not detect underlying male fertility conditions, such as infections, hormonal imbalances, or genetic abnormalities.
For these reasons, healthcare professionals generally recommend a clinical semen analysis to diagnose male infertility accurately.
During a semen analysis, three primary factors are examined: the quantity of sperm (volume), the movement of the sperm (motility), and the shape of the sperm (morphology). These factors help to determine whether the semen parameters are within the reference range for male fertility.
This section aims to help patients decipher their semen analysis results.
Sperm count measures the total number of sperm cells in a semen sample (one ejaculate). The average sperm count is between 40 million and 300 million sperm per milliliter.
According to the World Health Organization (WHO), a “normal” sperm concentration is 15 million or more sperm per milliliter of semen.
If a patient’s sperm count is low, it may indicate infertility or reduced fertility. Individuals with no sperm in their semen may have a condition known as azoospermia.
A low sperm count (oligospermia) doesn’t mean conception is impossible. It just makes it more challenging and may require more advanced fertility treatments. In contrast, an abnormally high sperm count doesn’t guarantee fertility.
Sperm count is just one of the many factors contributing to male infertility and should be interpreted in conjunction with other semen analysis parameters and lifestyle factors that may affect fertility.
Sperm motility refers to the percentage of sperm that are actively moving. Being able to “swim” is a crucial aspect of sperm function, as that’s how they make their way to the egg for fertilization. When talking about motility, specialists evaluate sperm motility in two types of movement: total motility and progressive motility.
Total motility refers to the percentage of sperm that are moving, regardless of whether their movement is progressive or non-progressive. Progressive motility, on the other hand, refers to the percentage of sperm that are moving forward in a straight line or a circle.
For sperm to reach the egg successfully, they must have progressive motility of at least 25 micrometers a second. When less than 32% of the sperm cannot move efficiently, it may indicate low motility or asthenozoospermia.
Sperm morphology refers to the shape and size of sperm cells. These cells are deemed “normal” or “abnormal” based on specific criteria. Many fertility clinics follow Kruger’s Strict Morphology guidelines to determine sperm morphology.
According to the Kruger criteria, “normal” sperm has an oval-shaped head, a straight tail, and no visible abnormalities. Sperm that deviate from these criteria are classified as abnormal. If the percentage of normal sperm is below 4%, the individual may have poor sperm morphology or teratozoospermia.
Sperm defects can vary in size, shape, and structure, including abnormal neck, tails, and size. While some defects can harm sperm function, others do not. Couples with low sperm morphology may require IVF with intracytoplasmic sperm injection (ICSI), while couples with slightly abnormal scores may consider intrauterine insemination (IUI) treatment.
Although sperm morphology has been suggested as a marker for male fertility, not all experts agree on its significance in predicting fertility. Some studies have found that morphology is less accurate in predicting fertility than other semen parameters like motility and count.
Reading the results of a semen analysis report can be overwhelming for many individuals, but understanding what each parameter means can help.
Here’s a guide to analyzing a semen analysis report:
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% |
In short, healthy semen analysis reports include:
It’s important to note that a semen analysis report is just one tool used to evaluate male fertility, and a single abnormal result doesn’t necessarily mean that an individual is infertile.
Many factors can affect semen quality, and it’s not uncommon for semen analysis results to vary from one test to another. If the semen analysis report shows abnormal results, scheduling a follow-up appointment with a healthcare professional to discuss the results is important.
Additional testing may be necessary to rule out underlying medical conditions, infection, or hormone abnormalities. This section outlines other sperm testing options.
This test measures the number of white blood cells in a semen sample. High levels of white blood cells, also known as leukocytes, in semen may indicate an infection or inflammation in the reproductive tract.
Karyotyping is a genetic test that looks for chromosomal abnormalities in men with abnormal semen analyses. This test is usually recommended for individuals with a low or absent sperm count, as chromosomal abnormalities can cause this condition. Karyotyping can identify genetic disorders that the parents can pass on to their offspring.
The sperm penetration assay, also known as the hamster egg test, is a test that measures the ability of sperm to penetrate and fertilize an egg in a laboratory setting. Doctors often recommend this test for couples undergoing assisted reproductive techniques such as IVF to assess the fertilizing potential of sperm.
The anti-sperm antibody test checks for antibodies that damage sperm. High levels of these antibodies can affect sperm movement and reduce fertility. The test can identify the cause of infertility and guide treatment.
A semen analysis can help piece together the puzzle of male fertility, but it’s important to remember that it’s just one part of the evaluation process. If you or your partner receive abnormal results, don’t panic! Take a deep breath and schedule a follow-up appointment with your healthcare professional to discuss the results and create a plan.
Remember, infertility is an emotional and difficult journey, but many treatment options are available.
If you have concerns about your fertility, the experienced team at RMA Network can help. Our fertility specialists are dedicated to providing personalized care and creating treatment plans tailored to each patient’s unique needs. Make the first step and schedule an appointment today.
At RMA: Reproductive Medicine Associates, we understand how overwhelming infertility can be. Our team is here to guide you through the diagnostic process and help you achieve your dreams of parenthood. Contact us today to schedule a consultation.
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