• Everything You Need to Know About an Infertility Semen Analysis

      Approximately 30% of couples' infertility issues can be attributable to male factors such as semen quality. To identify (or rule out) semen quality as the cause of infertility, one of the first and most routine diagnostic tests performed is a semen analysis. The semen analysis looks at several characteristics of both the semen and the sperm to evaluate overall semen health and identify any issues that may affect infertility.

      Preparing for a Semen Analysis
      Prior to a semen analysis, your doctor or nurse will take a thorough medical history. Questions will include overall health, diet (including any vitamins or herbal supplements), past diseases, diagnoses and surgical procedures, sexual history (including any history of STDs), and a list of current medications (prescription and over-the-counter).

      You will be asked to refrain from ejaculating for 2 to 5 days before providing a semen sample for analysis. It is important not to go longer than 5 to 7 days before the test without ejaculating, as this can cause the analysis to show fewer active sperm.

      Semen samples can vary from day to day; your doctor may ask you to provide two or three samples spread out over a few months for comparison.

      Procuring a Semen Sample
      Different doctors and labs have different preferred semen collection methods; your doctor will give you their recommendation before your sample is needed. The four most typical methods of collection are:
      • masturbation
      • sex with a condom
      • sex with withdrawal before ejaculation
      • electrical stimulation

      The preferred method of collection is masturbation, although men who cannot masturbate (for religious or other reasons) can opt to use one of the other methods.

      Prior to producing your sample (either at home or in a private room at the doctor's office) you will be given a sterile collection cup. It is important that the semen be deposited directly into this cup and kept at body temperature from time of ejaculation until the analysis is performed. If the sample is procured at home, it must be delivered to the clinic or lab within an hour.

      Semen Analysis Definitions
      Sperm Count Sperm count is the the concentration of sperm (how many sperm are present) per milliliter (mL) of ejaculate.
      Normal: At least 15 - 20+ million sperm per mL.
      Abnormal: Fewer than 15 million sperm per mL.
      Sperm Morphology Sperm morphology refers to the physical shape of the sperm.
      Normal: At least 30% of the sperm have a normal shape: an oval head with a long tail.
      Abnormal: Less than 30% normal shape. Examples of abnormal shapes include: wrong size or shaped head, more than one head, a short or crooked tail, more than one tail, etc.
      Sperm Motility Sperm motility describes the proportion of the sperm have good, forward movement.
      Normal: At least 50% of sperm have good, forward movement. Some labs include a note of how the motility changes over time.
      Abnormal: Less than 50% with good, forward movement (leaving more than 50% to move via zig-zag fashion or vibration, or not at all). When less than 10% are motile, the likelihood of non-assisted fertilization is low.
      Semen Volume Semen volume describes the amount of semen in a single ejaculate, measured in mL.
      Normal: A normal ejaculate contains between 2 and 6 mL.
      Abnormal: Less than 2mL of semen may indicate a blockage of the seminal vesicles.
      Semen pH The pH reflects how acidic or basic the semen is. A semen pH that is either too high or too low can damage or kill sperm.
      Normal: 7.2 - 7.8
      Abnormal: A pH outside of the range 7.2 - 7.8 is abnormal and harmful to the sperm. A pH below 7.2 may indicate a blockage of the seminal vesicles; a pH above 7.8 can signal an infection.
      Fructose Level The fructose level describes the amount of fructose present per mL of semen. The fructose found in semen is the primary energy source for the sperm.
      Normal: Fructose should be present; a positive test indicates the presence of the sugar.
      Abnormal: The absence of any fructose in the semen may indicate a blockage or malformation of the seminal vesicles.
      Liquefaction Liquefaction is a measure of the time it takes for semen to change from gel to liquid. Immediately after ejaculation, semen is a gel-like consistency; this helps it adhere to the cervix. After liquefaction it is easier for the sperm to swim to the egg.
      Normal: Liquefaction should take place within 20 to 60 minutes after ejaculation.
      Abnormal: Liquefaction after more than 60 minutes; however if all other aspects of the semen analysis are normal, this is not typically considered an issue.
      White Blood Cells (WBCs) White blood cells (WBCs) are found just about everywhere in the human body. They are the cells that fight foreign pathogens and protect the body from disease. A simple semen analysis may state merely the presence or absence of WBCs, while a more in-depth analysis may yield a WBC count.
      Normal: Typically men have very few WBCs in their semen; a finding of between 5 and 10 WBCs found under a high powered field is normal.
      Abnormal: More than 10 WBCs under high power may indicate an infection.
      Vitality Vitality refers to the percentage of live sperm per ejaculate.
      Normal: At least 60-75% of the sperm should be alive.
      Abnormal: Fewer than 60% live sperm per sample may indicate an infection or other issue.
      Additional (Optional) Tests Your doctor may order additional (less common) semen analysis measures, including:
      • MOT (the percentage of sperm that are highly motile)
      • Total motile sperm count (the total amount of motile sperm)
      • Sperm auto-immunity (men may develop antibodies to their own sperm)
      • Raman spectroscopy (identifies, quantifies and pinpoints location of sperm nuclear DNA damage)
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