Male Fertility Testing - Spermanalysis Semenanalysis and Sperm Count

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Finding out about his fertility is the second most important thing to know when trying to get pregnant (find the most important information HERE). A sperm analysis or sperm count is necessary to evaluate the man's male fertility.

A semen analysis, also known as a sperm count, measures the quality, the amount, number, and other paramentrs of semen a man produces. A man can only find out through a semen analysis if he is fertile or not.

A sperm count, also known as a semen analysis, is a test of a man's ejaculate to check for problems that may contribute to infertility. Normal findings vary from one laboratory to the other. Semen analysis measures the amount and quality of a man's semen and sperm. Semen is the thick, white fluid released during ejaculation that contains sperm. 

WHO (World Health Organization) 1992 criteria for a sperm count:

  1. Volume: 2.0 ml or more
  2. Sperm Concentration: Over40 million total
  3. Sperm Concentration: Over 20 million/ml
  4. Morphology: 30% or more normally formed
  5. Vitality: 75% or more alive
  6. PH : 7.2-8.0
  7. White blood cells: Less than 1,000,000/ml
  8. Immunobead test (%sperm with beads): Under 20
  9. MAR test (%sperm with RBCs) <10
  10. Coagulate, Liquify, and Agglutinate: Yes
  11. Motility: 50% or more with forward progression; more than 20 motile sperm/cc
  12. Color: Gray/Translucent No Clumping, Sperm-to-Sperm, and Sperm-to-Round Cell 

Normally, seminal fluid is clear to milky white in color, thick and sticky (viscous) in consistency, has a pH (acidity) level between 7.8 and 8.0, and contains few or no white blood cells (leukocytes).

World Health Organization (WHO) Reference Values (2009) for Fertile Men 

  5th %tile 10th%tile
Semen Volume (ml) 1.5 ml 2 ml
Concentration (Mill/cc) 15 Mill/cc 22 Mill/cc
Total Number (Mill/Ejac) 39 Mill/Ejac 69 Mill/Ejac
Motility (%) 40 % 45 %
Progressive Motility (%) 32 % 39 %
Normal Forms (%) 4 % 5.5 %
Vitality (%) 58 % 64

How the sperm count is performed

You will need to provide a semen sample, and methods for collecting a sperm sample include:

  1. Masturbating into a sterile jar or cup
  2. Using a special condom during intercourse given to you by your health care provider

You should get the sample to the lab within 30 minutes. If the sample is collected at home, keep it in the inside pocket of coat so that it will stay at body temperature while you are transporting it.

A laboratory specialist must look at the sample within 2 hours of the collection. The earlier the sample is analyzed, the more reliable the results.

The following things will be evaluated:

  • How the semen thickens into a solid and turns to liquid
  • Fluid thickness, acidity, and sugar content
  • Resistance to flow (viscosity)
  • Movement of the sperm (motility)
  • Number and structure of the sperm
  • Volume of semen

How to Prepare for a spermanalysis sperm count test

Do not have any sexual activity that causes ejaculation for 2 to 3 days before the test. However, this time should not be longer than 5 days, after which the quality can diminish.

Sperm count after a vasectomy

The test may also be used after a vasectomy to make sure there are no sperm in the semen. This can confirm the success of the vasectomy.

What abnormal sperm count results mean

Abnormal results may suggest a male infertility problem but one abnormal result does not always mean there is a problem with a man's ability to have children. Oftentimes the test needs to be repeated to esnure the initial abnormal result can be confirmed. For example, if the sperm count is very low or very high, a man may be less fertile. The acidity of the semen and the presence of white blood cells (suggesting infection) may affect fertility. Testing may reveal abnormal shapes or abnormal movements of the sperm. However, there are many unknowns in male infertility. Further testing may be needed if abnormalities are found.

FertilAid For MenMore than 40% of couples who are unable to have children are unable to do so because of problems with the man's sperm. The sperm count should be the #1 fertility test done when you evaluate your fertility. A sperm analysis is completed through masturbation; it is noninvasive and it guarantees the person getting tested an orgasm. What a great deal! 

According to World Health Organization (WHO) criteria these are the major parameters a sperm count checks for are:

  1. Volume
    (over 2 cc is normal)
  2. Sperm count (over 20 million per cc or 40 million total is normal).
  3. Sperm morphology (percentage of sperm that have a normal shape)
  4. Sperm motility (percentage of sperm that can move forward normally)

The sperm count checks to see if there are enough sperms. If the sample has less than 20 million sperm per ml, this is considered to be a low sperm count. Less than 10 million is very low. The technical term for a low sperm count is oligospermia (oligo means few).
Some men will have no sperms at all and are said to be azoospermic. This can come as a rude shock because the semen in these patients look absolutely normal - it is only on microscopic examination that the problem is detected.

What is normal sperm motility?

Motility checks whether the sperms are moving well or not (sperm motility). The quality of the sperm (morphology) is often more significant than the count. Sperm motility is the ability to move. Sperm are of 2 types - those which swim, and those which don't. Remember that only those sperm which move forward fast are able to swim up to the egg and fertilise it - the others are of little use.

Motility is graded from a to d, according to the World Health Organisation (WHO) Manual criteria as follows.

  • Grade a (fast progressive) sperms are those which swim forward fast in a straight line - like guided missiles.
  • Grade b (slow progressive) sperms swim forward, but either in a curved or crooked line, or slowly (slow linear or non linear motility).
  • Grade c (nonprogressive) sperms move their tails, but do not move forward (local motility only).
  • Grade d (immotile ) sperms do not move at all.

Sperms of grade c and d are considered poor. If motility is poor (asthenospermia), this suggests that the testis is producing poor quality sperm and is not functioning properly - and this may mean that even the apparently motile sperm may not be able to fertilise the egg.

This is why we worry when the motility is only 20% (when it should be at least 50% ? ) Many men with a low sperm count ask is - " But doctor, I just need a single sperm to fertilise my wife's egg. If my count is 10 million and motility is 20%, this means I have 2 million motile sperm in my ejaculate - why can't I get her pregnant? " The problem is that the sperm in infertile men with a low sperm count are often not functionally competent - they cannot fertilise the egg. The fact that only 20% of the sperm are motile means that 80% are immotile - and if so many sperm ( Sperm Video ) cannot even swim, one worries about the functional ability of the remaining sperm. After all, if 80% of the television sets produced in a factory are defective, no one is going to buy one of the remaining 20% - even if they seem to look normal.

What is normal sperm morphology?

Whether the sperms are normally shaped or not - what is called their form or morphology. Ideally, a good sperm ( Sperm Video ) should have a regular oval head, with a connecting mid-piece and a long straight tail. If too many sperms are abnormally shaped (this is called teratozoospermia, when the majority of sperm have abnormalities such as round heads; pin heads; very large heads; double heads; absent tails) this may mean the sperm are functionally abnormal and will not be able to fertilise the egg.

Many labs use Kruger "strict " criteria (developed in South Africa ) for judging sperm normality. Only sperm which are "perfect" are considered to be normal. A normal sample should have at least 15% normal forms (which means even upto 85% abnormal forms is considered to be acceptable!)

Sperm Clumping or Agglutination

Under the microscope, this is seen as the sperms sticking together to one another in bunches. This impairs sperm motility and prevents the sperms from swimming upto through the cervix towards the egg.

Putting it all together, one looks for the total number of "good" sperms in the sample - the product of the total count, the progressively motile sperm and the normally shaped sperm. This gives the progressively motile normal sperm count which is a crude index of the fertility potential of the sperm. Thus, for example, if a man has a total count of 40 million sperm per ml; of which 40% are progressively motile; and 60% are normally shaped; then his progressively motile normal sperm count is : 40 X 0.40 X 0.60 = 9.6 million sperm per ml. If the volume of the ejaculate is 3 ml, then the total motile sperm count in the entire sample is 9.6 X 3 = 28.8 million sperm.

What does the presence of pus cells in the semen signify?

Whether pus cells are present or not. While a few white blood cells in the semen is normal, many pus cells suggests the presence of seminal infection. Unfortunately, many labs cannot differentiate between sperm precursor cells ( which are normally found in the semen) and pus cells. This often means that men are overtreated with antibiotics for a "sperm infection" which does not really exist !

Some labs use a computer to do the semen analysis. This is called CASA, or computer assisted semen analysis. While it may appear to be more reliable (because the test has been done "objectively" by a computer), there are still many controversies about its real value, since many of the technical details have not been standardised, and vary from lab to lab.

What does a normal semen analysis report mean?

A normal sperm report is reassuring, and usually does not need to be repeated. If the semen analysis is normal, most doctors will not even need to examine the man, since this is then superfluous. However, remember that just because the sperm count and motility are in the normal range, this does not necessarily mean that the man is "fertile". Even if the sperm display normal motility, this does not always mean that they are capable of "working" and fertilising the egg. The only foolproof way of proving whether the sperm work is by doing IVF (in vitro fertilisation)!

What are the reasons for a poor semen analysis report?

Poor sperm tests can result from:

  • incorrect semen collection technique, if the sample is not collected properly, or if the container is dirty
  • too long a time delay between providing the sample and its testing in the laboratory
  • too short an interval since the previous ejaculation
  • recent systemic illness in the last 3 months (even a flu or a fever can temporarily depress sperm counts)

If the sperm test is abnormal, this will need to be repeated several times over a period of 3-6 months to confirm whether the abnormality is persistent or not. Don't jump to a conclusion based on just one report - remember that sperm counts do tend to vary on their own! It takes six weeks for the testes to produce new sperm - which is why you need to wait before repeating the test. It also makes sense to repeat it from another laboratory, to ensure that the report is valid.

A semen analysis is used to determine whether a man might be infertile - unable to get a woman pregnant. The semen analysis has many parts and tests a lot of aspects of the semen and sperm. A semen analysis to determine fertility should be performed on a minimum of two samples at least seven days apart over a period of two to three months because some conditions can affect sperm levels.

SpermanalysisThe semen analysis also can be used to count sperm after a man has a vasectomy. If there are still a lot of sperm present in the semen, the man and his partner will have to take precautions so that his partner will not become pregnant. He will have to return for one or more sperm counts until the sperm are cleared from his sample(s).

When is it ordered?

semen analysis is recommended if a woman cannot get pregnant and when a physician thinks that the patient might have a fertility problem. At least 10%-20% of married couples experience problems conceiving. Male factors are implicated about 50% of the time. Male infertility has many causes and some of these, such as varicocele (enlargement of the veins draining the testes), can be treated successfully. If male factors are involved, analysis of the semen is necessary to determine the feasibility of using assisted reproductive technology to facilitate pregnancy.

 

What does the test result mean?

The typical volume of semen collected is around one-half to one teaspoonful (2-6 milliliters) of fluid. Less semen would indicate fewer sperm, which would affect fertility. More semen indicates too much fluid, which would dilute the sperm, also impeding fertility.

Sperm concentration (also called sperm density) is measured in millions of sperm per milliliter of semen. Normal is greater than or equal to 20 million per milliliter (and more than 80 million sperm in one ejaculation). The fewer sperm a sample has, the less chance a man has of getting a woman pregnant. A man who has just had a vasectomy would want to have no sperm in his sample.

Motility is the percentage of moving sperm in a sample. The more slowly moving or immobile sperm in a sample, the less likely it is that a man could get a woman pregnant. The progression of the sperm is rated on a basis from zero (no motion) to 3 or higher for sperm that move in a straight line with good speed. If less than half of the sperm are motile, a stain is used to identify the percentage of dead sperm. This is called a sperm viability test.

Morphology analysis is the study of the size, shape, and appearance of the sperm cells. The analysis evaluates the structure of 200 sperm, and any defects are noted. The more abnormal sperm that are present, the lower the likelihood of fertility.

Is there anything else I should know?

Several factors can affect the sperm count and other semen analysis values. A man may have a lower sperm count if he has physical damage to the testicles, has gone through radiation treatment of his testicles, or has had exposure to certain drugs (such as azathioprine or cimetidine). A man with a higher level of estrogens may have lower sperm counts.

Some of the common causes of male infertility are extremely high fever, failure of the testicles, obstruction of the tubes that carry semen to the penis, and a less than normal amount of sperm in the sample (oligospermia).

Study about improving sperm count

A new study published in the March 2002 issue of "Fertility and Sterility" found that a combination of folic acid and zinc supplements increased sperm count by 74% in men with fertility problems. Researchers say the findings may open up new avenues for male fertility research and treatments. The Dutch study looked at the effects of the supplements in men with low sperm counts and men with normal counts. Folic acid and zinc supplements were studied because both elements are essential to the formation of DNA and creation of sperm. Researchers found that men with fertility problems who took 5 mg of folic acid a day and 66 mg of zinc sulfate a day for 26 weeks had a 74% increase in total normal sperm count and a minor (4%) increase in abnormal sperm count. No significant increases were found among the healthy men's sperm counts. When either zinc or folic acid was taken alone, there was no significant effect on sperm production. Researchers say more study is needed to understand how these two micronutrients work together to affect male fertility before widespread use of the supplements can be recommended as a fertility treatment.