Fertility Testing: Semen Analysis
Hey guys and welcome to another episode. I hope you're enjoying the content. We're now getting sort of into the meat and potatoes of everything and today I'm going to be talking about the guys. We don't want to leave them out and we're going to be talking all about the semen analysis.
So the first thing is why is this important? And we know that the male factor can be responsible for up to 30% of all cases of infertility. In an additional 20% of the time we see that there's an issue both on the male and female partner. So almost half of cases we're gonna see at least one parameter wrong with the semen analysis. And that's why we want to make sure we check it.
It is a little bit awkward. It is a little bit uncomfortable. The men typically are traumatized, but you have to understand if you're having it done at a fertility center or at Andrology center. So Andrology center is somewhere that is specific to sperm. They do all things sperm all day, every day. They're extremely accustomed to this. Most times they will have a collection room. If you live within approximately an hour of the center, they will allow you to collect it home and bring it in, but definitely make sure to ask ahead of time. You want to ask all your questions. What is their preparation? What paperwork needs to be done? Do you need to bring in a copy of your driver's license or your ID? Those are all things that you definitely want to check ahead of time before you actually show up with the sample.
Now those are by appointment only so you can't just kind of show up one day and drop off your sample. You want to make sure that things have been clarified with the clinic to make sure you make your appointments set it up properly all of the things.
So what happens when they receive the sperm sample?
The sperm sample is assessed in four ways. The first thing they're looking at is how much ejaculate did the mail provide? And we typically want to see by the new WHO recommendations at least 1.5 milliliters of sample of specimen. So if we have at least 1.5 milliliters then we know that we have enough sample to properly interpret the other parameters. So volume is number one.
The other thing you're going to see us focus on is concentration, which is basically the amount of sperm present. So again the the lower limit of normal is at least 15 million sperm per milliliter. Anything above that is considered within normal range. If there is a low concentration, that is a term known as oligospermia or low count of the sperm and can typically be divided into three groups, so you have mild oligospermia, which is just under the normal, so 10 to 15 million per milliliter. The other is moderate, so 5 to 10 million. And then typically severe oligospermia is less than 5 million sperm per milliliter present in the sample.
All of those are very different from Azoospermia. Azoospermia is the complete lack of any sperm present in the ejaculate.
And it's really important to make that distinction because when we're talking about treatment of oligospermia, typically whether that is with IUI or IVF with ICSI, we can have the man collect in a collection room or at home and bring in the specimen. But if we have azoospermia, we then have to go down a different path. We typically will work with a reproductive urologist and we'll talk to the male partner about what is the likelihood if we were to go into the testicle and search for sperm, so a testicular extraction procedure, what is the likelihood of us actually finding sperm?
The third parameter that we talk about is motility and specifically, you'll have us thinking about progressive motility or forward movement. Of the sperm present, how many of them are actually forward moving on the slide and based on the WHO newer criteria, we want to see at least 32% the sample forward moving. So overall motility you may see numbers of 40% or higher as normal and then progressive motility which is the forward movement of the sperm we want at least 32% or higher.
And then the 4th parameter is something called morphology which is the shape of the sperm. When we assess the sperm under the microscope, what is the shape of the head, neck and tail? Is it normal or is it abnormal? And there is what we call the strict Krueger criteria. That is what most IVF centers or most fertility centers and andrology centers will use, where you want to see greater than 4% of the sample with normal morphology. So if it's low morphology it'd be under 4%; if it's over 4% it's typically normal. Now most guys are going be 4%, 5%, 6%, 7%, 8% typically single digits. You don't typically see like 30% normal morphology, so as long as they’re 4% or higher that is deemed normal.
For a semen analysis there are some instructions. We typically recommend 2-5 days of abstinence. We typically recommend no anti-inflammatories. We typically recommend collection within an hour, so there's gonna be a few things and then the medical history right is going to be important. Does the male have any medical issues that are underlying? Is he taking any medications that could impact the sample? A classic one that may present problems with collection as diabetes, particularly if it's poorly controlled. These are all things that the center is going to want to know ahead of time.
And then the four parameters that they're looking at again just to summarize is going to be the volume, so the amount of ejaculate provided; the concentration or amount of sperm present; the motility and in addition to that the progressive motility; and then lastly, the morphology or normal shape of the sperm.
What happens if a semen analysis comes back abnormal? The first thing is you definitely want to talk to your physician about what this abnormality means. So which parameter came back abnormal and how abnormal is it? Is it mild? Is it severe? Is it one thing that's abnormal? Is it multiple things that came back abnormal? Those are all details you're going to want to know.
Now most providers will typically discuss repeating the semen analysis for confirmation. Specially if there is azoospermia, especially if there's no sperm present in the ejaculate, we definitely want to repeat and just have confirmation of that before we jump to any conclusions. And then the second thing is that there may be additional testing. There may be additional hormone testing that we look at in the male partner, a lot of the same hormones that we talk about with women, we talk about with men. And then we also may talk to them about genetic testing. Is there some sort of mutation? Something called a Y microdeletion? So these are all things that your physician may be talking to you about, depending on how severe the abnormality is on the semen sample. The third thing is we may talk to you about supplements. There are some supplements that are recommended just like we recommend them in women. Think of things like prenatal vitamins, COq10. Those are some things that we use in women. There may be a set of supplements that are indicated for men.
And then lastly most fertility physicians like myself will work with a reproductive urologist or a reproductive urology group to work up and treat that male partner. There are oral medications, there are injectable medications, and there are potentially surgical interventions that can be done to potentially treat that abnormal semen analysis. And there's multiple things that we're looking at. So we're not just looking at the male component, we also want to know how old is the female? What timeline are we talking about here? Usually with men any medical treatment is going to be a minimum of 3 months before we start to see changes, so do we have the luxury of that time on the female side? Is the semen analysis so severe that we need to start talking about sperm donation? There's a lot of different things that we're looking at when we're having that discussion, but those may be some of the additional tests that are explained to you or that are recommended to you in the setting of an abnormal semen analysis.
So again, just to summarize in conclusion:
The male factor accounts for at least 30% of all cases of infertility can be as high as 50.
You want to make sure that you're getting all your instructions in detail ahead of time, how to collect, when to collect, what things you need to avoid prior to collection, etc.
If it comes back abnormal, then what potential testing may follow? And that may be a repeat semen analysis. It may be additional hormone testing by blood, it may be additional genetic testing, it may include supplements, and it may also include referral to a reproductive urologist.
I hope this has been a nice little nutshell of the male part of all the testing and infertility workup, and while it appears simple and easy and quick, it is definitely just as important as all the other testing that we're doing in the setting of a heterosexual couple.
*This content is intended solely for educational purposes and is not to be construed as medical advice. For personalized recommendations concerning your specific healthcare needs, kindly consult with your healthcare provider.
