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Understanding the Semen Analysis

male infertility Nov 10, 2023

The semen analysis is a crucial tool in assessing male fertility and can provide valuable insights for couples struggling to conceive. It is also one of the most commonly misunderstood tests in infertility. Many people assume that a semen analysis is assessing the quality of the sperm. In reality, the semen analysis can tell us about the quantity of sperm and the efficiency of the sperm, but does not have the capability to assess the quality of the DNA that the sperm is carrying. In this blog post, we will review the basics of a semen analysis, why it is important, and what to expect during the process.

Why Is a Semen Analysis Important?

Knowing the male partner’s semen analysis results is important for not only understanding his fertility status, but can be a window into a man’s overall health. Abnormal semen analysis results can indicate underlying medical conditions such as infections, certain medical conditions, hormonal imbalances, or genetic issues that may be affecting fertility. Additionally, a semen analysis is an important monitoring tool for couples who are undergoing fertility treatments as it used to monitor the effectiveness of male fertility treatments and to provide guidance for the couple on what assisted reproductive technology (ART) treatments will give them the best chance of success.

How to Prepare for a Semen Analysis

The semen analysis can be kind of an awkward test and many men are reluctant to complete it. However, it is an important step in the overall fertility workup for the couple. A semen analysis can be performed at a fertility center or lab. There are also a few reliable options to collect a semen analysis at home and mail the kit back to the lab, such as the Baseline Assessment at Posterity Health.

It is important that the male partner goes into this test with a game plan as they need to abstain from ejaculation for 2 – 5 days to allow for the most accurate results.

Recommended steps when you are ready to collect the semen analysis:

  1. Wash hands and unscrew the specimen lid. Try to minimize anything touching the inside of the lid or inside the cup

  2. Masturbate without lotion or saliva

  3. Ejaculate into the specimen container

  4. Complete the form! (including indicating the number of days of abstinence and if any of the sample did not make it into the cup).

  5. If you are collecting at home and dropping off at the fertility center, most require that the sample be dropped off at the lab within 30 minutes of collection. If you are collecting at home and mailing the analysis back to the lab, follow the important packaging instructions.

What Do the Semen Analysis Results Mean?

Interpreting semen analysis results should be done with your healthcare provider or fertility specialist. Below is an explanation of the most important semen parameters based on the current 2021 WHO references ranges:

  • Semen Volume: To put it frankly, semen volume assesses the total amount of stuff that made it into the cup. A normal ejaculate volume is 1.4 to 6 milliliters. A lower volume may affect the transport of sperm or indicate that there is some sort of blockage in the male reproductive tract. Research has shown that a higher ejaculate volume can actually reduce a man’s fertility potential.

  • Sperm Concentration: Sperm concentration (or count) assesses how many millions of sperm are present per milliliter of ejaculate. A normal sperm concentration is anything over 16 million sperm per milliliter. A lower concentration reduces a man’s fertility potential.

  • Sperm Motility: This refers to what percentage of the sperm that we see are moving. This is an important tool to assess the viability of the sperm, as we know that moving sperm are living sperm. A normal motility rate is 42% or higher. Low motility can decrease the ability of the sperm to reach the egg.

  • Progressive Motility: This refers to what percentage of the sperm that are moving in a forward direction. Meaning they are not just twitching their tails or swimming in circles, but actually trying to get somewhere with a purpose. A normal progressive motility is above 32%. Low motility can decrease the ability of the sperm to reach the egg.

  • Sperm Morphology: Morphology assess what percentage of the sperm have perfect sperm shape based on very strict (Kreuger) criteria. Ideally, at least 4% of sperm should have normal morphology. It is important to note that morphology assesses the function of sperm. Abnormally shaped sperm may be less efficient swimmers, but it does not mean they cannot cause a pregnancy. Many studies have shown that morphology does not correlate to the quality of the DNA that the sperm is carrying. Having an abnormal morphology does not increase your risk of birth defects or miscarriage.

  • Total Motile Count: The total motile count is calculated by multiplying the volume X motility X concentration. This gives us the total number of moving sperm present in the sample. This is an important tool used to provide guidance from the male side on what treatment options will allow for the best chance of pregnancy. The research indicates that to have the best chance of natural conception the male partner should have TMC of at least 20 million, but ideally greater than 40 million. To have the best chance of success with intrauterine insemination (IUI) it is recommended to have a TMC of at least 5 million, but ideally greater than 10 million. To have the best chance of success with In Vitro Fertilization (IVF) it is recommended to have a TMC greater than 1 million, however, realistically we only need as many motile sperm as we have eggs retrieved in the IVF cycle.

  • Signs of inflammation or infection: There are many other semen parameters that are assessed such as viscosity, liquefaction, aggregation, round cells and agglutination. Abnormalities in these other semen parameters can be a sign of inflammation or infection.

Approximately 1 in 6 people worldwide have difficulty conceiving and about half of the cases the male partner has an abnormal semen analysis. Despite the equal contribution of male factors to infertility, the semen analysis tends to be the final diagnostic step in the couple's fertility assessment. In many instances, by the time the male is evaluated the couple has been trying for well over a year. The semen analysis is a crucial diagnostic tool for assessing male fertility and reproductive health. The experts in infertility (ASRM, AUA, and ACOG) all agree that the semen analysis should be performed concurrently with the female fertility workup. By providing education and clarity around the semen analysis my hope is that more men will be comfortable completing the semen analysis, potentially expediting the chances of conception for the couple.

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