Semen Analysis (SA), also called a sperm count, is the most important male fertility test. It tests many important factors regarding sperm quality and quantity. It is usually performed in a laboratory or physicians office. The male is asked to masturbate and collect the ejaculate in a cup for examination.
- We schedule all tests because we need to have the processing materials prepared.
- We do not want men to be waiting on each other in order to reduce stress.
- We require a specified abstinence from the previous ejaculation, usually two days. Semen values change with longer abstinence times. A standard abstinence allows us to compare results to a normal population.
- The basic semen analysis results are available in a short time.
- The results for the acrosome reaction test take longer because of additional sperm processing.
SA tests for sperm count, mobility and velocity, size and volume, among other factors. The results show how many sperm are present, how many are normal and how many active.Often times, sperm infertility problems are not isolated. A male with a low sperm count may have sperm that are also low in motility and velocity.
Nearly 20 percent of male infertility cases have azoospermia. This diagnosis means the male shows no signs of sperm in the ejaculate.
This can be defined in two ways:
- Obstructive azoospermia means there is a blockage preventing the sperm from being ejaculated. A vasectomy, scarring of the epididymis or absence of the vas deferens may be the cause.
- Non-obstructive azoospermia means there is a non-existent or severely impaired production of sperm. This can be caused by Klinefelter’s Syndrome, paraplegia, multiple sclerosis, diabetes or a lack of sperm producing hormones.
Information collected from SA allows the couple to know how fertile the male is based on sperm and helps evaluate successful pregnancy chances or if the couple should consider a sperm donor.The use of lubricants and the timing or frequency of sex can help to improve male sperm fertility when azoospermia has not been diagnosed.
Additionally, use of medications and drugs, chemical or radiation exposure, smoking and steroid use can affect male fertility. It is recommended that the male does not have sex for two or three days prior to SA for the best sample.
The sperm analysis fundamentally seeks to explain two important facts:
- Does the male have any sperm that are alive?
- Do the sperm have normal function?
Here are the latest criteria for the semen analysis measurements from the World Health Organization.
Notice in the following graph that low sperm counts/concentrations are more common in infertile men. Fertile men can also have low sperm counts.
If the sperm count is low then the man is more likely to have male infertility. Some fertile men have low counts too.
At Poma Fertility, we see infertility treatments can often be considered a team sport. This means that even if a man is somewhat infertile, having a highly fertile female partner can make up for their partner’s sub-fertility. Imagine if we could measure a person’s fertility on a scale of 1-10. Each partner would get a score. Our approach to treatment suggest that a certain combined score is necessary to achieve a pregnancy.
Notice in this example that the man in each pair has a score of three. If his partner is also a 3 then they have infertility. If the partner’s score is 5 then they have normal fertility (combined score = 8).
This old study demonstrates that women whose husbands have low sperm counts do not get pregnant as often as women whose husband’s have NO sperm. Consider the previous concept that some men with low counts have highly fertile partners. Those couples make babies without our help. Only the couples where the man and the woman are both subfertile would come for donor sperm insemination.
The idea of infertility treatment being a team sport is a useful concept to understanding that fertility disorders must always consider both parties.
Strict sperm morphology affects fertilization at IVF. The role of strict sperm morphology became evident in the 1980s as illustrated in the following graphic:
None of these measurements are perfect. Remember that we deal with two partners and there are many variable surrounding egg fertilization. Still, these data show us that there is a relationship between semen quality and egg fertilization. All of these tests are not intended to be perfect but to provide us a guide to what will probably happen.