By Dr. Kelly Walker, Medical Director at Posterity Health
When it comes to making a baby, you need both the sperm and an egg to conceive. Sperm is half the conception equation and plays a major role in both conceiving and maintaining pregnancy. Among couples having difficulty getting pregnant, males contribute equally to infertility:
- ⅓ of the time the cause of infertility is solely a male or sperm factor
- ⅓ of the time it is a female or egg factor
- ⅓ of the time both partners have issues contributing to infertility
The first step in assessing a male’s fertility is to complete a semen analysis. In the world of reproductive medicine, it offers a baseline of information on what’s going on with the male partner and can identify if there are any abnormalities that may make it difficult to get pregnant.
What is a semen analysis?
A semen analysis is the first laboratory test that is performed to assess male fertility. Semen, also known as ejaculate, includes sperm and other important fluids that help the sperm along within the female’s reproductive tract to reach the egg. A semen analysis test is an objective measure of fertility assessing the number of sperm and their function.
Who should get a semen analysis?
If you’re curious about your future fertility, a semen analysis is a good step towards knowing where you stand. If you are thinking about getting pregnant or planning to start a family, a semen analysis will let you know if you should be on a shorter conception timeline, or if there are sperm abnormalities that could cause difficulty.
It’s especially important to do a semen analysis if you’re having trouble getting pregnant or have been trying for longer than you would like. A semen analysis can determine if a sperm factor is responsible. Both the American College of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM) recommend early and concurrent evaluation of the male for any couple dealing with infertility. Infertility is clinically defined as the inability to conceive after one year of unprotected sex for couples when the female partner is less than 35 years old, or an inability to conceive after 6 months of unprotected sex for couples when the female partner is 35 years or older.
Why do a semen analysis?
Knowledge is power, and information about your or your partner’s semen means you can do something about it. With an abnormal semen analysis, a male fertility specialist (reproductive urologist) will do a more comprehensive evaluation detailing medical and sexual history, a physical examination, and other testing to completely assess for infertility. They’ll determine the underlying cause for an abnormal semen analysis and develop an individualized treatment plan to get those semen analysis numbers looking better. In addition to uncovering information about sperm health, a semen analysis can uncover other medical issues that need to be addressed.
In fact, abnormal semen analyses can represent an underlying health condition. For example, studies have found that males with fertility problems were more likely to develop testicular cancer than other males. Men in the lowest quartile of sperm motility, viability, morphology, or total motile count were found to have an even higher risk of testicular cancer. Overall, sperm health and fertility are important men’s health issues that need to be addressed.
Completing an at-home or in-clinic semen analysis collection
Preparing for a semen analysis
By the time the decision is made to complete a semen analysis or male fertility test, it’s important to take all the needed steps to prepare for the collections process. Most semen analysis instructions are simple and easy to follow. Make sure to read the instructions of the at-home or in-clinic collection kit. In general, the person doing the semen analysis will need to abstain from sexual activity, masturbation, or any form of ejaculation for a period of time prior to taking the test to get accurate results. According to the World Health Organization (WHO), a semen sample should be collected no less than 2 days after sexual intercourse, and no more than 7 days, although many labs recommend 2-5 days abstinence as ideal for accurate test results.
How to do it
To produce the sample, a male will be asked to masturbate into a sterile container. The act of producing a semen analysis may feel a little awkward, and that’s completely normal. Many opt to do an at-home collection kit to make the process more comfortable.
It’s important not to use any fluids (spit, lube, etc.) during the collection process to ensure the semen sample isn’t contaminated. Many lubricants aren’t sperm friendly and can interfere with the quality of the sperm concentration and sample collected. While you can’t count on lube to prevent pregnancy, research has shown that lubricants can hamper sperm movement, cause DNA damage, and even destroy sperm, affecting the accuracy of your results.
Choosing an at-home or in-clinic semen analysis
Deciding how and where to complete a semen analysis is a personal choice, and there is no right or wrong way as long as you use a reputable lab or at-home kit. If you have questions on what’s best for your situation, it’s best to talk to your fertility specialist. Options include:
- In office: The male will complete the sample in a dedicated collection room or a clinic bathroom, and the sample goes right to the lab for processing
- At home, then driven to the local lab: Some providers will give the male a sterile container to complete the sample at home and then quickly return it to the lab. The sample will have to be kept at body temperature (tucking it into the waistband is a common approach) and taken to the lab within 30-60 minutes
- At-home semen analysis kit, mailed to a lab: The male can simply follow the instructions and return in the mail. The results will be sent back to share with the doctor
Most samples are collected through masturbation. If this is not an option for you, talk to your fertility specialist about using a sterile condom for collection during sex.
Semen analysis results
When a semen sample is analyzed, the following parameters are evaluated to determine if the results are normal or abnormal. These standards are defined by the World Health Organization (WHO Manual for Human Semen Analysis).
The volume of semen is the amount of ejaculate that comes out when the male orgasms. The normal volume range for a semen sample is greater than 1.4 mL. If there’s trouble producing the normal semen volume, that may be indicative of an underlying issue that could affect one’s fertility.
This reflects the number of sperm found in 1 mL of semen. Sperm makes up about 10% of the semen or ejaculate, and the remaining 90% is fluids or “liquefaction” that help the sperm. A normal concentration is ≥16 million sperm per mL of semen or ejaculate, but sperm count can range up to 200 million/mL.
For conception to occur, the sperm must swim up through the female’s reproductive tract to reach the egg; therefore, motility, or the ability of sperm to move, is very important. Of the sperm collected in the sample, a normal result will show that 42% or more are moving.
Sperm morphology refers to the shape of the sperm cells. Normal sperm shape is important for both the ability to swim and the efficiency of swimming. The lab looks at the head, midsection, and tail, as well as the measurements and proportions between each. While they may see many abnormal sperm, at least 4% should have a normal shape.
Total motile count (TMC)
This total number provides a summary about the moving sperm in the ejaculate. It is calculated by multiplying volume (in mL), concentration (million sperm/mL), and motility (% moving). A normal TMC is ≥20 million.
Abnormal semen results
If you or your partner received an abnormal semen analysis result, it can come as a shock, but it’s important to remember it’s common! While some males feel like they are the first to ever experience male factor infertility issues, they’re not alone. Remember, male infertility is a health issue—not a measure of masculinity or virility.
Sperm must go through a lot to fertilize an egg. That’s why you need so many! And they have to be great swimmers and have a normal shape. There are many factors that can contribute to an abnormal semen analysis result and difficulty getting pregnant. On the plus side, most abnormal semen analyses can be corrected with specialized treatments.
What could cause abnormal semen results?
It’s important to note that an abnormal semen analysis result does not mean you can’t get pregnant. There are many factors that can cause or impact an abnormal semen analysis, which is why it’s important to meet with a reproductive urologist to review abnormal results. The following factors can impact fertility:
- Taking or using testosterone
- Exposure to heat or toxins
- Alcohol abuse
- Undiagnosed hormone imbalances
- Past or present infections
- Having an undescended testicle or experienced trauma to the testicles
- Taking certain medications
- Undergoing medical treatments such as chemotherapy or radiation to treat cancer
- Having certain medical conditions, including chronic illnesses such as diabetes
Treatment for an abnormal semen analysis
In addition to talking to your healthcare provider and creating a personalized treatment plan, there are several lifestyle and behavioral changes that are important to incorporate into one’s day-to-day routine.
- Aim for and maintain a healthy weight through exercise and nutrition
- Limit alcohol intake
- Discontinue the use of illicit drugs
- Stop smoking
- Avoid things that lead to prolonged heat for the testicles
- Reduce stress
- Avoid exposure to pesticides, heavy metals, and other toxins
Hormone imbalances, once identified, can often be treated. Common hormone imbalances include:
- Low testosterone, which may be caused by everyday lifestyle choices, an unknown medical condition, or age. It’s important to talk with a reproductive urologist if you’re experiencing signs or symptoms of low testosterone to determine the cause and the appropriate way to treat it. Use of testosterone medications or supplements can have negative effects on fertility and can even stop sperm production altogether!
- Low follicle stimulating hormone (FSH) can impact sperm production and quality, as FSH plays a major role in spermatogenesis (sperm development). Low luteinizing hormone (LH) can also impact male fertility. LH is produced by the pituitary gland and is the signal to the testicles to make testosterone, which is important for sperm production
- Estradiol can affect FSH and LH levels and result in decreased testosterone. A portion of testosterone is converted into estrogen, and if too much testosterone is converted that can result in low testosterone (bad for sperm production). The elevated estradiol can suppress LH and FSH production by the pituitary gland (also bad for sperm production)
The great news is that these conditions can often be identified with the appropriate workup, and many are treatable with medication and hormonal management—meaning many more better—swimming, high-quality sperm!
Surgeries can be performed to repair conditions that are detrimental to sperm production. They can fix a blockage that is preventing sperm from being in the ejaculate, or even find sperm that is produced at such small numbers they don’t make it to the ejaculate. Sperm extraction procedures, retrieving sperm from the testicle, are performed if there is extremely low sperm production, no sperm in the ejaculate, or a blockage preventing sperm from making its way out. These sperm retrieval procedures are used in conjunction with in vitro fertilization (IVF), fertilization of the egg in a laboratory. Surgery can also be effective for repairing blockages in the tubes that transport sperm, such as a vasectomy reversal, or repairing a varicocele, which is an enlarged vein on the loose bag of skin that holds the testicles (scrotum) that affects sperm production.
A semen analysis is advised if you’re planning on having children
To expedite the conception timeline, it’s advisable to get a semen analysis as soon as possible to ensure you and your partner have all the information you need to successfully get pregnant. If there’s any hesitation, understand that you’re not alone, and that the benefits of knowing your sperm health are far greater than the unknown. In a standard conception timeline, the male is not evaluated until after 12-15 months of trying to conceive, if at all. Identifying and understanding male fertility early in the process can save months of heartache and stress, and instead allow you and your partner to take action and find the fastest path to pregnancy.