Semen analysis

Semen analysis is possibly the most common among the tests for infertility. It is the basic test for men that will be ordered by your doctor at the first hint of infertility. So, let’s get straight to finding out all about semen analysis and what should you expect to see in your report.

Semen analysis will give you information on the sperm’s morphology (shape and size), motility (its ability to move) and concentration (sperm count). If the results on any of these accounts are abnormal, the doctor may recommend further testing or review your healthy history to figure out the cause of the problem and recommend a treatment plan.

Semen analysis

How commonly is it done?

Semen analysis is done routinely in almost all infertility cases and male factor infertility is found to be responsible in over 30% of them. It is small, simple, relatively inexpensive test, so it is normal for the doctor to order it first, so they rule out or establish the presence of male infertility before ordering any other tests.

If you have been trying to conceive for a while and have finally decided to see the doctor, you will likely be asked to undergo semen analysis.

Here’s what to expect of the process of semen analysis and how to comprehend the report:

Understanding the semen analysis report

The three main things that your doctor will check in the semen analysis report are:

1.     Sperm concentration or volume

A normal semen sample contains over 15 million sperm per milliliter. That might seem a lot since only one sperm is required to fertilize the female egg but a sperm needs to be really good quality to be able to reach and then fertilize the egg.

If you have oligospermia (low sperm count), you may have a few million sperm per milliliter of semen and still have trouble conceiving.

This is because a large number of sperm will not even make it through the vagina, cervix, uterus, to the fallopian tubes, where the fertilization happens.

So, you need an adequate number (15 million – over 200 million per ml) of really good quality sperm for optimum fertility.

Normal sperm concentration

2.     Motility of the sperm

The sperm have to travel long distances and make their past the vagina, which has an acidic attack on the sperm, the cervix, where they can be trapped by the cervical mucus, the uterus, where they may be attacked by the female’s immune cells, before they finally meet the female egg in the fallopian tubes.

Besides being fast, the sperm also has to be able to thrust itself forward in the right direction.

A fraction of your sperm will swim in small, tight circles and not have much forward growth; we call it the non-progressive sperm and they will not participate in fertilization.

Progressive sperm—the ones swimming in straight lines or large circles—need to have motility of at least 25 micrometers a second to make it through the cervical environment to the female egg.

If no more than 32 percent of your sperm are able to move efficiently, your diagnosis will read poor sperm motility or asthenozoospermia, which could be the probable cause of your infertility.

3.     Morphology or shape of the sperm

The normal shape of sperm is an oval head and a long, pointed tail. Sperm with abnormally shaped heads or short, coiled, crooked, or double tails are considered poor for fertility as they may have trouble first reaching and then penetrating the egg.

It is normal to have some part of abnormally shaped sperm in any given sample and even if 4-10% of your sperm has normal morphology, you’re good.

Normal sperm morphology

Published in 2010, the 5th edition of the WHO’s Laboratory Manual for the Examination and Processing of Human is considered one of the most credible reports for male infertility. According to it, a normal semen analysis should have values in the following ranges:

WHO reference range
Total sperm count in ejaculate39–928 million
Volume of the ejaculate1.5–7.6 ml
Sperm concentration15–259 million per ml
Motility of the sperm (progressive and non-progressive)40–81 percent
Progressive sperm motility32–75 percent
Normal sperm morphology4–48 percent

In June 2021, the WHO released the sixth edition of their Manual for the Laboratory Examination and Processing of Human Semen.

In the new report, the motility grading of sperm has been classified into 4 categories: rapidly progressive, slow progressive, non-progressive, and immotile.

The sperm morphology analysis has also been updated to reference ranges that represent the number of normal-shaped sperm in the ejaculate.

It is classified as:

Normal: Normal sperm ≥ 14%

Borderline: Normal sperm is 4% – 13%

Pathological: Normal sperm < 4%

Other than these three parameters, your semen analysis will also be assessed for:

  1. Semen volume: A sample of ejaculate is expected to contain least half a teaspoon of seminal fluid. Less than that may indicate a blockage in the vessels.
  2. Vitality: What percentage of the sperm are alive? In a healthy sample, at least 58% or more of your sperm will be viable.
  3. Semen PH: Your semen should not be too alkaline or acidic as that affects the sperm’s ability to move and penetrate the egg. The PH should be balanced in the middle at 7.1-8.
  4. Liquefaction time: Fresh semen ejaculate is usually thick like a gel and then softens. Normal ejaculate takes around 30 minutes to go from ‘gel’ to ‘liquid’. A semen sample that doesn’t liquefy or takes a long time to do that may indicate poor fertility. 

Why does abnormal semen analysis indicate?

A normal semen analysis is often important to be able to conceive and any variations from the normal values are important to understand the problem and device the treatment plan accordingly.

However, even if you’re not trying to get pregnant, your semen analysis may give an insight into your overall health.

A study presented at ENDO 2018, the Endocrine Society’s 100th annual meeting in Chicago, Illinois, found that sub-fertile men were more likely to have more body fat, higher BMI, and more blood pressure as compared to those with normal semen analysis. Consequently, they are also found to experience higher frequency of metabolic diseases and chances of having stroke, heart disease, or diabetes.  

For these reasons, if you’re found to have low sperm count, your physician may ask to check your testosterone and overall health.

What if my results are abnormal?

Poor sperm quality may be an indication of poor heath, but the good news is that by making some lifestyle changes and adopting healthier practices you can improve your sperm quality.

In case you have any infections, blockages, your doctor will advise on the required medication or surgical procedures for correction.

Abnormal semen analysis is not a big cause of concern as new sperm is regularly formed in the human body. The human sperm cycle is only around 3 months; adopting the right practices with your doctor’s guidance, it is possible to have better quality sperm in a few weeks.

Find a reliable partner for semen analysis and get in touch via the form on this page to consult with one of our experienced specialists.

Resources:

Kumar N, Singh AK. Trends of male factor infertility, an important cause of infertility: A review of literature. J Hum Reprod Sci [serial online] 2015 [cited 2021 Aug 20];8:191-6:  https://www.jhrsonline.org/text.asp?2015/8/4/191/170370

Kevin Ka-Wai Lam, BSc, PhD; Raymond Hang-Wun Li, MBBS,FRCOG, FHKAM (O&G); Ernest Hung-Yu Ng, MBBS, MD, FRCOG; Pak-Chung Ho, MBBS, MD, FRCOG; William Shu-Biu Yeung, BSc, PhD. Semen Analysis – What a Clinician Should Know http://www.mims-cpd.co.id/Portals/0/Semen%20Analysis-What%20a%20Clinican%20Should%20know.pdf

Alberto Ferlin, M.D., Ph.D, Carlo Foresta, M.D, Low sperm count not just a problem for fertility, The Endocrine Society: https://www.eurekalert.org/news-releases/634621

WHO’s sixth edition of the Manual for Laboratory Examination and Processing of Human Semen: https://www.who.int/publications/i/item/9789240030787

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