A Complete Guide to the Semen Analysis Process
The semen analysis is a test used to assess the health and quality of sperm. During a fertility consult, a Fertility Specialist might recommend this test to determine if there are any possible underlying causes affecting the sperm’s ability to travel to the egg and successfully fertilize it.
Today, we are going to cover 5 key factors that are accounted for during a semen analysis. These include:
- Sperm concentration
- Sperm motility
- Sperm morphology
- Other parameters
Here is an explanation of what the results mean for your fertility.
With so much emphasis on female fertility, it’s easy to forget about the other key ingredient to achieving a pregnancy: healthy sperm. In fact, male factor infertility is the main issue in about 20% of couples with infertility and a contributing factor in 30-40% of cases.
The semen analysis is the main test used to analyze sperm. It gives you 3 key pieces of information about the sperm:
- How many sperm are present
- How well the sperm are moving
- Whether the sperm is a normal shape
Fertility Specialists use this information to determine whether problems with the sperm are affecting your ability to get pregnant. The results of the semen analysis may also prompt additional evaluation, such as a hormone or genetic testing, imaging, or even referral to a Urologist.
It’s important to understand that the normal reference ranges of a semen analysis do not represent the absolute minimum values needed for pregnancy to happen. In other words, some men with an abnormal semen analysis may still be fertile and be able to achieve a pregnancy.
In this RISE Fertility Blog, we break down the semen analysis and discuss the most important parameters to help you understand what they mean and how they affect your fertility.
The first number to look at is the volume, which tells you how much ejaculate there is. The volume should be at least 1.5 milliliters.
If the volume is low, first make sure the collection was done properly. Did any of the samples spill or not make it into the collection cup? How long was the abstinence period prior to collection?
We recommend 2-5 days of abstinence before doing a semen analysis. Shorter abstinence periods typically lead to lower ejaculate volumes.
If your partner had a few issues with the collection process, reassure him that it’s ok, but talk to your Fertility Specialist to see if it’s worth repeating the test at another time. Assuming there were no issues with the collection of the sample, a low volume can signal a few different problems including hormonal or anatomic abnormalities.
2. Sperm Concentration
The next parameter to focus on is the sperm concentration, which tells you how many sperm are in the sample. A normal sperm concentration is 15 million sperm per milliliter (mL) of ejaculate.
Concentration is important because it can be directly tied to your chances of getting pregnant. Azoospermia, which is a condition where no sperm are found in the sample, is seen in about 1% of all men and 10-15% of men with infertility.
Low or absent sperm concentrations can be linked to hormonal, genetic, or anatomic problems. A Fertility Specialist can help suggest additional testing that can be done in this case.
3. Sperm Motility
Having a lot of good swimmers improves your chances of getting pregnant. You want to see at least 40% of the sperm moving and at least 32% of them progressively motile, which means moving in a forward direction.
Low motility, which is also called asthenospermia, can be due to lifestyle factors, anatomic problems, or even genetic issues. Bottom line: if there are problems with sperm motility, it’s important to talk to see a Fertility Specialist.
Sperm motility is especially important if you’re trying to get pregnant the old-fashioned way or with intrauterine insemination (IUI). Studies have shown that a total motile sperm count (TMSC) less than 10 million is associated with a very low likelihood for success with IUI and more advanced fertility treatments like in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) will give you a much better chance to get pregnant.
4. Sperm Morphology
Sperm is composed of 3 main parts: a head, midpiece or neck, and a tail. The head contains the DNA or genetic materials and is the part of the sperm that is responsible for fertilizing the egg. The tail is important for sperm motility.
Sperm morphology or shape is the best predictor of sperm function and it tells us a lot about the health of the sperm. Studies have shown that fertilization rates and the probability of achieving a pregnancy are highest when normal morphology is 14% or higher and very poor when it’s less than 4%. Abnormal morphology may be linked to hormonal, genetic, or anatomic problems and usually warrants more testing to determine the underlying causes.
5. Other Parameters
There are a few other values on a semen analysis that deserve an honorable mention. These can include:
The term “immature sperm” refers to sperm that are not fully developed. They lack the attributes of fully developed sperm and may have difficulty successfully reaching and fertilizing the egg.
Immature sperm can appear as “round cells”. A normal round cell count should be less than 5 million per milliliter. If a high round cell count is detected, this may require additional testing to analyze the cell types.
What causes immature sperm? There are a few possible reasons why you might experience this condition. These include:
- Genetic factors
- An infection
- Testicular injuries
- Prolonged exposure to extreme hot or cold temperatures
- Hormonal imbalance or irregularity
- Exposure to toxins affecting sperm health
Once a cause is determined, the person with immature sperm might be advised to seek treatment for the underlying cause before attempting to impregnate their partner.
High White Blood Cell Count
A high white blood cell count could indicate the presence of infectious bacteria in the semen. This can affect the sperm count, motility, and other attributes of quality as well as physical symptoms like pain or infertility.
If there is a high white blood cell count from an infection, antibiotics are the most suitable treatment option. After completing a course of medication, your fertility specialist will likely re-analyze the semen to see if the blood cell count has returned to normal levels.
Viscosity can create difficulties for sperm when attempting to travel to the egg. Oftentimes, this can be treated through a variety of methods, such as antibiotics, anti-inflammatory products, or mucolytic enzymes.
Agglutination is a condition where multiple sperms cells stick together. This affects their ability to reach the egg. Like some of the other infertility factors listed above, this can often be treated through antibiotics or vitamin supplements.
Get a Semen Analysis from Orange County CA’s Top Fertility Specialists
The semen analysis is an important test used by Fertility Specialists to assess the health of the sperm and is one of the first steps in evaluating a couple struggling to get pregnant. There are several key parameters that can affect your chances of pregnancy and abnormalities detected on a semen analysis may prompt additional testing. A Fertility Specialist can review your semen analysis results with you to help you understand the findings and also help figure out the next steps in your journey.
If you would like to schedule a semen analysis for you or your partner, contact our team of Orange County Fertility Specialists anytime. Fertility consults can be scheduled online anytime.
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Dr. Ghazal is a double board certified Fertility Specialist, a Southern California native, and an award-winning Top Doctor and Rising Star in the field. She specializes in all aspects of female and male infertility, IVF, egg freezing, LGBTQ+ family building, miscarriage & pregnancy loss, PCOS, ovulatory disorders, intrauterine insemination, fertility preservation for cancer patients, endometriosis, and preimplantation genetic testing. Her research has covered a wide variety of topics in the field of reproductive medicine including assisted reproductive techniques, embryo culture, fertility preservation, endometriosis, implantation, and IVF outcomes. She has authored numerous book chapters and articles that have been published in top journals and she has been invited to present her research at national meetings.