The semen analysis is the most common test performed for male
infertility and should always be a part of the male infertility workup. A semen analysis assesses just how well sperm has been produced and matured as well as how it interacts with the seminal fluid. Your fertility specialist will report on the following criteria, using values that have been established by the World Health Organization.
Also referred to as the concentration, the sperm count is a measurement of how many million sperm a man has per milliliter of semen. On average, sperm count should be above 60 million/ml. Men who have less than 20 million/ml are thought to be infertile.
Sperm motility, or mobility, is an assessment of how well a man's sperm moves. Ideally, at least 50%, preferably more though, of a man's sperm should be active.
The shape of a sperm cell is also quite important when it comes to fertility. When examining your sperm's morphology, your sperm cells will be examined under a microscope for certain traits. At least 30% of your sperm should meet these criteria.
Just how much a man ejaculates is also assessed. 2ml or more is the normal volume for ejaculate. However, a variety of factors can affect just how much ejaculate is provided for a semen analysis. If not all of the ejaculate is collected in the provided container or if a man gets "performance anxiety", the amount of semen collected may be less than what the man actually produces.
Various factors regarding the seminal fluid will also be evaluated .This includes the fluid's color, viscosity and how long it takes for the semen to liquefy after ejaculation as all of these aspects can negatively impact on sperm.
Total Motile Count
This final assessment calculates the total number of motile sperm in a man's ejaculate. To figure this out, your fertility specialist will multiply the volume of your sample by the sperm count by the percentage of motile sperm. An acceptable ejaculate should have more than 40 million motile sperm.
A semen analysis is not the only type of test that your fertility specialist will likely want to perform. Other tests will examine these factors:
Some instances of male infertility can be attributed to anti-sperm antibodies. This is an immunological response whereby the male's body attacks the sperm, impeding fertility in a variety of ways. The antibodies may prevent the sperm from being able to properly travel through a woman's cervical mucus, impair the sperm from fusing to the egg, and/or inhibit the sperms ability to penetrate the egg. Some men are more at risk of developing antibodies than others.
If morphology of sperm is found to be a problem, a Kruger morphology test may be done. This infertility test allows fertility doctors to more closely examine a sperms shape. Stringent criteria must be met for sperm to pass as "normal". This evaluation involves examining a sperm's head, midpiece and tail. This test is beneficial in that it gives your specialist a better idea of which ART methods will be the most helpful for you.
White Blood Cells
If a semen sample contains a higher than usual number of white blood cells, it may indicate a past infection or possibly inflammation. While some white blood cells are expected to be found, a sample containing more than a million white blood cells per milliliter is considered to be problematic. If elevated levels of white blood cells are found, further samples will need to be provided as testing for white blood cells needs to be the first evaluation done on a sample.
This test is designed to evaluate how much progress motile sperm are able to make. Because motility does not guarantee forward progression, it is necessary to obtain a clear picture of just how active sperm are. By combining the percentage of motile sperm with the distance they are able to swim, your fertility specialist gains a better idea of how well your sperm perform.
When necessary, your fertility specialist may perform one, some or all of these specialized tests.
This staining technique allows fertility doctors to see which sperm are actually alive and kicking, literally. Men whose semen analysis revealed a motility of less than 30% will likely have this test performed on their semen sample.
Post-Ejaculatory Urinalysis (PEU)
This test is done to see whether or not some or all of the sperm is ejaculated backward into the bladder, a condition known as retrograde ejaculation. To perform this test, it is necessary for a man to provide a semen sample and, immediately afterwards, a urine sample. This post-ejaculatory urine is then examined for the presence of sperm.
Men whose sperm count is low or who have azoospermia will have this test done in order to determine whether sperm is being blocked or just not produced. This test is designed to differentiate between the two problems.
In some cases, a man may have such a low sperm count that no sperm are noticed on the initial test slide. However, sperm may still be present in the ejaculate. This test helps to determine if there is any sperm or not by spinning down the ejaculate sample, allowing all the sperm that may be present to separate and gather at the bottom of the tube. If sperm is identified, then a couple may still be able to use certain ART methods, such as ICSI with IVF.