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INTRODUCTION TO SEMEN ANALYSIS
If you're having trouble conceiving, the first step in your evaluation will be a comprehensive semen analysis. In 60% of all couples experiencing infertility, a male factor is involved (40% primarily male and 20% combined male/female.) The comprehensive semen analysis is a noninvasive check.
A fact worth knowing is that the testes take three months to produce and mature sperm. That means there is often a four to six month delay between treatment of the man and any changes that we see in the semen analysis. Since the evaluation of the woman may take several months, it is recommended that a comprehensive and accurate semen analysis be performed at the outset. Treatment of the man can then occur at the same time as treatment of the woman, and there will be no unnecessary delay once the woman's treatment is completed.
What happens in the semen analysis or, if appropriate, a consultation, is we identify any problems and then address them in order to maximize the quality of the man's semen. This may reduce the need for more complicated interventions for the female partner. It is also important to rule out significant medical problems that may contribute to a poor semen analysis. Therefore, the most important first step in any man's evaluation is the semen analysis.
Semen is the fluid that a man ejaculates. This fluid is produced at several different sites. The sperm within the semen are the cells that actually fertilize the egg and are therefore the most important to assess. However, the sperm account for only 1% to 2% of the semen volume. Problems with the surrounding fluid may also interfere with the movement and function of the sperm so both the sperm and the fluid must be tested.
The key thing to know is that we're not looking for a specific, magic number in the semen analysis of men whose partners will get pregnant and those who won't. The partners of some men with a very poor semen analysis may conceive easily. The partners of some men with an excellent semen analysis may experience difficulty. However, men with good semen analysis results will, as a group, conceive at significantly higher rates than those with poor semen analysis results.
The semen analysis will help determine whether there is a male factor involved in the couple's sub-fertility. If that's the case, we'll recommend an evaluation. Some findings of the semen analysis suggest certain specific potential problems. For example, an increased white blood cell count may indicate infection or inflammation. However, other abnormalities in many of the main parameters are non-specific. For example, there are a number of different causes for a decreased sperm count or diminished sperm movement. A few of these causes have other serious medical implications. A thorough evaluation helps determine the cause of an abnormal semen analysis and rules out medical problems.
Basic Semen Analysis
Almost all laboratories will conduct tests and report on the following information, using values established by the World Health Organization:
- Concentration (sometimes referred to as the count):
This is a measurement of how many million sperm there are in each milliliter of fluid. There are various techniques for obtaining this number. Some prove to be more accurate than others. Average sperm concentration is more than 60 million per milliliter (>60 million/cc). Counts of less than 20 million per milliliter (<20 million/cc) are considered sub-fertile.
- Motility (sometimes referred to as mobility):
This describes the percentage of sperm that are moving. Fifty percent or more of the sperm should be moving.
This describes the shape of the sperm. The sperm are examined under a microscope and must meet specific sets of criteria for several sperm characteristics in order to be considered normal. Most commercial laboratories will report WHO morphology (use World Health Organization criterion). Thirty percent of the sperm should be normal by these criteria.
This is a measurement of the volume of the ejaculate. Normal is two milliliters (two ccs) or greater. The volume may be low if a man is anxious when producing a specimen, if the entire specimen is not caught in the collection container, or if there are hormonal abnormalities or ductal blockages.
- Total Motile Count:
This is the number of moving sperm in the entire ejaculate. It is calculated by multiplying the volume (cc) by the concentration (million sperm/cc) by the motility (percent moving). There should be more than 40 million motile sperm in the ejaculate.
- Standard Semen Fluid Tests:
Color, viscosity (how thick the semen is), and the time until the specimen liquefies should be measured. Abnormalities in the seminal fluid may adversely affect the sperm. For example, if the semen is very thick, it may be difficult for the sperm to move through it and into the woman's reproductive tract.
Other Semen Tests
- Forward Progression:
This describes how well the sperm that are moving are making progress. Only when the motility (percent moving) is combined with the forward progression is an accurate picture of sperm movement obtained. Unfortunately, this is often not tested by commercial laboratories. A man's motility may be normal and the fact that the sperm are moving sluggishly or almost not at all will be overlooked if the forward progression is not recorded separately.
- Kruger Morphology:
This is a more detailed evaluation of the morphology. Slides are specially stained and the sperm examined microscopically under high-power magnification. The sperm must meet a stringent set of criteria that evaluate the shape and size of the head, midpiece, and tail in order to be considered normal. A Kruger test helps determine which of the available advanced reproductive techniques may be most appropriate and successful.
- Anti-Sperm Antibodies:
Some men may produce antibodies to their own sperm. These antibodies may decrease fertility rates in a number of ways. They may impede the movement of sperm through a woman's cervical mucous, inhibit the binding of a sperm to the egg, and/or inhibit its penetration into the egg. Men who are most at risk for developing antibodies are those with previous testicular and epididymal infection, trauma, surgery, or large varicoceles. The presence of these antibodies is often not predictable from other semen parameters or from the man's history.
- White Blood Cells:
White blood cells cannot be differentiated from other round cells normally found in the semen (debris and immature sperm) without special staining. If more than one million round cells are found in the ejaculate, a portion of the ejaculate should be specially stained to look for an increased number of white blood cells.
If the white blood cell count is elevated, semen cultures should be performed on a subsequent specimen. Unfortunately, the semen culture cannot be performed on the original specimen as it must be the first step performed on the specimen in order to keep it sterile.
Specialized Semen Tests
In certain situations, specialized tests are needed. These depend on the findings at the time of the analysis and can often be performed on that specimen.
- Spun Specimen:
Even if no sperm are seen on the test slide, the sperm count may still not be zero (there may be very low numbers of sperm in the ejaculate). This has very important implications as it may determine if the couple can conceive using advanced reproductive techniques. This must be assessed by spinning down the specimen so all of the sperm are concentrated in a pellet on the bottom of the tube and then examining the pellet beneath the microscope.
Sperm may be alive, but not moving. A specialized staining technique is used to determine what percentage of the sperm are alive and is indicated when the motility (percent moving) is less that thirty percent.
In men with no sperm or very low numbers of sperm in the ejaculate, it is important to determine whether the sperm are not being produced at all, or whether they are being produced but are blocked from "getting into" the semen. A fructose test can help differentiate between these two problems.
- Post-Ejaculatory Urinalysis (PEU):
Some men ejaculate all or part of the sperm backward into the bladder. This can be detected by having a man ejaculate and immediately afterward urinate into a separate cup. The post-ejaculatory urine is then centrifuged to see if any sperm are present.
RESULTS & TREATMENT
The purpose of this testing is to move ahead with a treatment that can improve your fertility or to discuss other ways to achieve results. More than 50% of men will have a treatable cause of male factor infertility. These factors include varicoceles (dilated veins in the scrotum), infections, hormonal abnormalities, abnormalities in the seminal fluid, ductal blockages, and difficulties with erections and ejaculation. When these conditions are treated, either through medication (hormones or antibiotics) or surgery (varicocelectomy, vasal reconstruction, repair of a blocked ejaculatory duct), a man will often see a significant improvement in his semen analysis.
Those men with poor semen analyses whose conditions are not treatable may still have the option of using advanced reproductive techniques to achieve a pregnancy. Even those men with no sperm in the ejaculate may be able to have some living sperm procured from them through other methods and achieve a pregnancy using advanced reproductive techniques. Those few men who produce absolutely no sperm at all will have this information in order that they can explore other options.
FINDING A LABORATORY FOR SEMEN ANALYSIS
- Expertise: Semen testing is a sophisticated and technical field. An improperly or incompletely performed semen analysis may miss significant problems. Unrecognized problems may unnecessarily delay a man's treatment. Unlike many other lab tests, a semen analysis relies completely on the expertise of those performing it. Make sure the lab has sophisticated protocols and well-trained, specialized technicians.
- Timing: In order to get accurate results, the specimen must be processed within one hour of collection. If not, the measurement of the movement of the sperm may be extremely inaccurate. With any lab you use, make sure that the analysis is performed on site and not shipped elsewhere for evaluation.
- Thoroughness: As a semen analysis is being performed, certain findings may indicate the need for additional tests. Ideally, you should use a laboratory that has the capability to do complete initial testing as well as the flexibility to do the appropriate follow-up testing on the same specimen.
- Comfort and Convenience: In order to maximize your results, it is important that you are as relaxed as possible. It is preferable that the specimen be collected at the laboratory itself in a comfortable room that is meant specifically for that purpose.
If your physician has recommended that you have a semen analysis at our laboratory, these are most likely some of the reasons:
At M.A.Z.E. Laboratories, we:
- Are committed to state-of-the-art medical and scientific expertise.
- Perform all semen analyses within one hour of production.
- Perform the necessary secondary or additional testing on the same specimen. This maximizes the information obtained from the semen analysis and will limit the number of semen analyses you will need.
- Offer weekend and evening appointments.
- Give you the option of producing a specimen at home or in the office. Our private collection rooms are comfortable and equipped with appropriate materials.
- Communicate your results promptly and thoroughly to your doctor, helping you and your physician create an appropriate plan in a timely manner.
Contact us for information about semen analysis in New York and New Jersey.