How to Make Sense of a Semen Analysis

The semen analysis is a test used to assess the health and quality of sperm. Here is an explanation of what the results mean for your fertility.

Introduction

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 are 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 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.

1. Volume

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 sample 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. The concentration is important because it can be directly tied to your chances of getting pregnant. Azospermia, 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 an 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 are 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. Immature sperm, or sperm that are not fully developed, can appear as “round cells” and a normal round cell count should be less than 5 million per milliliter. If the round cell count is high, additional testing is needed to analyze the cell types.

A high white blood cell count is also important to note because it can be a sign of inflammation or a genital tract infection. Abnormalities in other parameters like color, viscosity, and agglutination can also be signs of underlying issues and should be discussed with a Fertility Specialist.

Summary

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 as well help figure out the next steps in your journey.

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