As much as men may not want to believe it, infertility is due to male factor issues almost half of the time. When a couple begins an infertility work-up, the male partner is often asked to provide a semen sample for a semen analysis, sometimes called a sperm count. For a couple hundred bucks, it's non-invasive, relatively inexpensive, and only slightly embarrassing.
Why Do a Semen Analysis?
During a semen analysis, the semen sample is analyzed for volume, viscosity (thickness), pH and color of the ejaculate, sperm concentration, motility, morphology, and forward progression of the sperm. The sample is also examined for the presence of white or red blood cells which may indicate infection or inflammation. As Dr. Werthman of the Center for Male Reproductive Medicine explains, "from this simple test, we can tell how many sperm are present, how many appear normal and how many are moving. A semen analysis does not assess sperm function. It does not determine if the sperm are good enough to conceive."
What about home tests?
Your local pharmacy may offer home semen analysis kits, which are convenient, cheaper, and less embarrassing than carrying a semen sample around a soctor's office. However, so far no one test can replace all the indicators checked in a lab semen analysis. For example, one popular measures whether a semen sample has a sperm concentration above the minimum fertility standard of 20 million per milliliter based on the density of the sample. Great. But it doesn't look at the spermatazoan's shape or their ability to move, which are just as important.
The Nuts and Bolts of Semen Analysis Testing
This isn't brain surgery. You've got two options for a semen analysis.
First, you can provide a sample by masturbating (either at home or in the doctor's office). If you provide a sample from home, it will need to be tested within an hour of ejaculation. If you give a sample at the office, you will generally be provided with a private room, a tattered selection of adult magazines, and a cup. Not surprisingly, most men prefer to provide a sample from the privacy of home if they can.
If you're collecting semen through intercourse, don't use collected sperm from a regular condom. There are special condoms that may be used, known as "semen collection devices" (SCDs). Your doctor can tell you where to purchase them. Also, if you are engaging in sexual activity, remember that vaginal lubrication and saliva can affect the tests, so keep the special condom on. If you are masturbating, avoid using creams or lubricants because they can poison the sperm. When you are transporting the semen to the office, keep it at body temperature–your shirt pocket should be fine.
You will usually be asked to refrain from releasing semen from 2-5 days before doing a semen analysis. The American Society for Reproductive Medicine (ASRM) recommends testing twice with each test being at least two weeks apart because samples from the same man can be different at different times.
Semen extraction from the testicles is an option if necessary.
Survival of The Fittest:
The following are the usual parameters for a normal semen analysis:
- More than 20 million sperm/ml
- More than 50% motile
- More than 50% normal morphology
- Semen Volume
- 2-5 ml
- White Blood Cells
- Less than 1 million/ml (a high white blood cell count in a sperm sample usually indicates infection, and is often treatable.)
Source: Adapted from the Consumer Journal of Infertility Awareness Association of Canada
According to the Mayo Clinic, normal sperm have an oval head with a long tail. Abnormal sperm may have head or tail defects such as a large or misshapen head or a crooked or double tail. These defects may impair the ability of the sperm to reach and fertilize an egg.
Sperm motility refers to the ability of sperm to move forward by swimming inside the vagina, through the cervix, and into the fallopian tubes, where it could fertilize an egg. In other words, if it can't get there, it can't do its job.
As M. Sara Rosenthal discusses in the "Fertility Sourcebook," there is debate among the medical community about what constitutes a "healthy" number of sperm. "The World Health Organization (WHO) considers 20 million sperm per milliliter to be fertile; the International Society of Andrology (ISA) consider 40 million sperm per milliliter to be fertile. Generally, anything below 20 million is considered a low sperm count. Anything between 20 and 100 million sperm is considered normal. Keep in mind, however, that sperm numbers can change daily, weekly, and monthly. Colds, flus, STDs, infections, antibiotics, temperature, and ejaculation frequencies all will affect the number. Also keep in mind that men with sperm counts of well below 20 million have often been able to father children."
Abnormal results during a semen analysis may suggest a male infertility problem. For example, if the sperm count is very low or very high there is a likelihood of being less fertile. More sophisticated tests of sperm quality such as the Sperm Chromatin Structure Assay (SCSA) can better help asses the "health" of the sperm. If the results are abnormal, a referral to a urologist may be the next best step.