Semen Analysis. Get Tested

In one-third of infertile couples in the USA, a male factor is the only infertility problem. This generally means abnormal sperm count and quality.

Other male factors may include:

• Difficulty in maintaining erection or in ejaculation
• Disorders within the testicles
• Blockage of sperm passages

Causes for sperm disorders may include:

• Previous surgery, chemotherapy or radiation
• Chronic medical problems
• Specific medications
• Genetic causes
• Environmental and lifestyle factors

If your semen analysis indicates a problem, Our Doctors will refer you back to your urologist, if you already have one, or to a male fertility urologist in order to determine your underlying problem and manage it appropriately.

Most times, the couple can continue to pursue their fertility efforts while this is being done because there are techniques for assisted reproduction that can overcome a sperm problem for purposes of conceiving.

In general, sperm quality is constantly changing in the same person, because the sperm population changes every 90 days (the time it takes for sperm cells to develop and mature). Even if someone already has children, there is no guarantee that he continues to be fertile or that his sperm is adequate. In cases when one has high fever, undergoes medical treatment, or starts to take new medications, the analysis should be repeated 3 weeks later to see if there is a change in sperm quality.

What is semen?

Semen is the fluid that a man ejaculates.

• It carries the sperm cells produced in the testicles.
• In men with normal sperm count, the sperm cells make up only 1-2% of the volume ejaculated.
• Semen, to which various testicular sites contribute, can contain substances that may interfere with sperm movement and function (ability to fertilize the egg).

What is the role of sperm in fertility?

• Only 1 sperm cell is needed to fertilize an oocyte (egg cell).
• Spontaneous pregnancies can occur even when the total motile sperm count is less than 1 million per milliliter of semen.
• At intercourse, sperm must pass from the vagina into the cervix (the lower opening of the uterus), into the uterus and to the fallopian tubes.
• Generally, only about 200 sperm cells reach the woman’s fallopian tubes, where fertilization occurs, after intercourse or insemination.
• The more sperm cells are present in the ejaculate, the more chances there are for 200 of the best-moving sperm to reach the tubes.

Prolonged infertility is also common even when a semen analysis is repeatedly normal and no female problem is identified. This condition is usually referred to as unexplained infertility, and this may imply inherent functional defects in the sperm cells or the egg cells or both.

What characteristics are evaluated in a semen analysis?

Volume (of the ejaculate):

• At least 2 milliliters (ml) – about half a teaspoonful – is considered normal.
• Too little semen may not allow the sperm to reach the entrance to the uterus which they must enter in order to get to the fallopian tubes.
• The volume may be low if:
  • A man is anxious when producing the specimen.
  • All of the sample is not caught in the collection container.
  • There is blockage of the channels that lead from the testicle to the tip of the penis.
  • The man is dehydrated at the time of semen collection.

Concentration (sperm count):

• Average sperm concentration is at least 60 million cells per milliliter of semen (60M/ml) in men who are younger than 40.
• Counts of less than 20M/ml are considered sub-fertile.

Motility (percentage of moving sperm and quality of motion):

• 50% or more of the sperm cells should be moving rapidly in a forward straight-line pattern.
• If the sperm cells move slowly or are simply shaking in place, this may indicate:
  • Abnormalities in the sperm tails
  • Factors in seminal fluid that interfere with sperm movement

Morphology (shape of the sperm cells):

• Morphology refers to the shape of sperm cells when seen through a powerful microscope.
• Strict criteria developed by Kruger in the 1970s is used to carefully evaluate the sperm head, midpiece and tail.
• Multiple studies have shown that sperm morphology determined by strict Kruger criteria is a useful and reliable way to distinguish between fertile and sub-fertile men.
• Sperm cells with normal head shapes and rapid tail motion are best able to penetrate the egg cell so fertilization can occur.
• The sample is considered sufficiently ‘fertile’ if at least 14% of the sperm have normal shapes by strict criteria.

Most men, even those who have had several children, rarely have normal morphology that is >30%. In fertility care, >4% normal morphology (5-13%) is considered sufficient to have a fair chance for producing a pregnancy if the other sperm parameters are normal, and if the female partner has no fertility issues herself.

Secondary characteristics evaluated in a comprehensive semen analysis:

• Semen color and odor
• Viscosity (how thick the semen is)
• Sperm agglutination (whether the sperm cells are separate or clumped together)
• The time it takes for the semen to change in consistency from the gel-like ejaculate to a more liquid form
• The presence of many round cells without tails may represent immature sperm or white blood cells; WBC in a concentration of more than 1M/ml usually indicates an infection in the genito-urinary tract
• Presence of other bacteria seen as colonies of round cells (cocci) or rod-shaped cells (bacilli)

How is a semen analysis performed?

Semen Volume:

• The volume is determined by transferring the sample into a test tube with volume markings. The other secondary characteristics listed above are also noted at this time. 

Sperm Count:

• A tiny drop of semen is placed on a counting device under a microscope.
• The device contains a grid of 100 squares.
• The total number of sperm cells – both moving and non-moving – counted in 10 squares of the grid is equivalent to the number of sperm in millions (M) per milliliter (ml) of semen.
• Because the number of sperm in each field varies, the technician usually counts the number of sperm in 10 squares on 3 different parts of the grid, and the average of these three counts is taken. For example, if the average number of three counts for 10 squares is 98 cells, the count is recorded as 98 M/ml.

Sperm Motility:

• While doing the sperm count, the technician also classifies the moving sperm according to speed and forward movement.
• Motility is recorded as the percentage of total moving sperm, and the overall quality of movement moving in place (slow, moderate, rapid).

Sperm Morphology:

• A small drop of semen is spread on a glass slide in a thin layer, which dries immediately.
• The slide is then stained with a special preparation to more clearly outline the head, midpiece and tail for microscopic evaluation.
• The technician classifies the visible characteristics of at least 200 individual sperm cells on a tally sheet (listing normal head shapes, head defects, midpiece defects and tail defects).
• These are reported as a percentage of the total cells counted.

Will a semen analysis tell me if I am fertile?

Yes, in the sense that the doctor and you will have an idea of your sperm and semen quality. But since it requires only one sperm cell to fertilize an egg, you would theoretically be able to impregnate your partner by natural or assisted means even if your sperm count was very low. On the other hand, some men are unable to impregnate their partner even with more than 10 million sperm per milliliter of semen. But chances of successful impregnation through intercourse or insemination are, of course, better with normal semen and sperm values.

Can any laboratory do semen analysis testing?

We recommend that fertility patients go to a fertility laboratory rather than a general laboratory for semen analysis. A fertility laboratory has specially trained technicians who routinely perform comprehensive and detailed semen analyses on a daily basis.

Even the best reference laboratories (e.g. Quest Diagnostics, LabCorp, etc.) only provide limited information on their semen analysis reports. A poorly done or incomplete semen analysis will not give your doctor enough information to indicate your next step. You may have to repeat it at a fertility laboratory.

What must I do to get a semen analysis?

 

You must call us @ (646) 448-3564 to schedule a semen analysis. Our referral laboratories accept insurance.

We generally get the semen analysis reports within 2-3 days of your testing. We will call you when our doctors get the report, so they can discuss the findings with you.