If you’re having difficulty achieving pregnancy, the first step is to evaluate the fertility of both partners. For men, this includes a detailed semen analysis. Up to 40% of couples with fertility problems have sperm issues, so a careful evaluation of male fertility is important.
In order to evaluate sperm, a semen specimen must be collected. Understandably, this can make many men uncomfortable and for that reason specimen samples can be collected at home or in a private collection room. If collected at home, the specimen should be brought in within an hour of collection and kept near body temperature during transport. It’s normal to feel a little uncomfortable about producing a specimen in a public place, which is why some men prefer to collect it at home
Believe it or not, sperm production in the male body is a delicate and complicated process which requires collaboration of several organs (not just one) to work together. The testicles, seminal vesicles, and prostate are the main organs that are very important to ensure sperm production. The seminal vesicles produce most of the fluid in the semen, which is a critical component. The fluid has a high pH to counteract the acidity in the vagina and help the sperm survive, and it also produces a sugar (fructose), which provides the sperm with energy for their long journey.
Results from a semen analysis typically come back within a week or less, depending on the laboratory and the andrologist (sperm scientist) who is reviewing the specimen.
How the results are interpreted can vary from lab to lab, as there are many models and methods for evaluating sperm. But don’t worry — the basics of semen analysis in all systems are the same and your doctor will guide you through interpreting the results.
So, what do fertility doctors look for in a sperm specimen?
There are 6 main parts to semen analysis:
How many milliliters were produced? Normal is between 1.5 – 5 mL, or between ¼ – 1 teaspoon. Low volumes can indicate a blockage or dysfunction in the seminal vesicles or prostate.
How many million sperm per milliliter were produced? The normal is approximately 15-20 million or higher. Lower numbers may indicate that sperm is being blocked from coming out, or that the testicles are not producing sperm they way they should.
How many moving sperm are present? This should be somewhere above 40 – 50% depending on the system used for analysis. A lower number may indicate that there is toxin exposure such as smoking, alcohol, chemicals from a job or hobby and caffeine. Low motility can also indicate hormonal problems or a varicocele (varicose veins in the scrotum).
4. Total Motile Count
How many moving sperm are in the entire sample? Normal sperm samples have at least 20 million moving sperm. A quick reference — if the sperm count is between 10-20 million, intrauterine inseminations may be helpful. If there are less than 10 million moving sperm, in vitro fertilization is recommended.
What percentage of sperm are normally shaped? I am asked frequently if abnormal sperm will increase the chances of a birth defect. They do not because only normally shaped sperm can fertilize the egg. But with a low number of normally shaped sperm, the chances of pregnancy decrease.
6. Other Factors
There are a few other items we look at such as the number of days of abstinence (how many days since last ejaculation). This should be between 2-5 days. Longer days of abstinence may have higher counts but less motility or lower morphology. Shorter days may have less numbers. We also look at other cells such as white blood cells, which could indicate a potential infection.
Because sperm abnormalities are very common, don’t be surprised when it is one of the first items the doctor orders. The results will serve as a treatment guide with you and your partner. Be sure to review the results with your doctor to determine if there is a problem and what can be done to treat it. Don’t be afraid to ask questions. Understanding a diagnosis is important to success. Happy trying!
Dr. Allison K. Rodgers is board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility, and has been practicing medicine since 2004. She completed her residency at Case Western Reserve-Metrohealth Medical Center/Cleveland Clinic, followed by fellowship at University of Texas Health Science Center in San Antonio. Dr. Rodgers’ personal experiences with both secondary infertility and pregnancy loss have given her a unique insight into reproductive medicine, and she is well known for her compassionate and individualized patient care. She has published many original research articles in top medical journals on topics such as endometriosis, tubal factor infertility, in vitro fertilization, and donor sperm. Her special interests include in vitro fertilization, male infertility, endometriosis, polycystic ovarian syndrome, unexplained infertility, recurrent pregnancy loss, and premature ovarian insufficiency.