Checking Your Swimmers
Is going to the doctor ever fun? Let’s be honest, going to the doctor’s office for ANY reason can be an anxiety-inducing experience, but even more so when dealing with something as personal as trying to get pregnant. I’ve met so many men that have put off getting their fertility checked simply because they’re nervous about what’s going to happen at that first visit. But if you’re thinking about getting your fertility checked as man, the good news is that you can relax because, for most men, getting your fertility checked is a completely non-invasive process. Your doctor will draw some blood for some hormonal tests, perform a physical exam that includes an examination of the testicles, and yes, check your swimmers. But what’s involved with a semen analysis and what do the individual values mean?
What is a Semen Analysis?
Checking a man’s fertility should begin with a comprehensive clinical and laboratory evaluation by a reproductive urologist with specialty training in male infertility. Although there are many specialized lab tests for male fertility and testicular function, the semen analysis is considered to be the single most important test in the evaluation of male fertility and the foundation upon which all other tests are based.
Some Basics
When a man ejaculates, the resulting fluid is called semen. This fluid contains sperm from the testicles, but also specialized enzymes and chemicals secreted by organs known as the prostate and seminal vesicles that protect sperm and facilitate their function. A semen analysis is a comprehensive evaluation of both the sperm themselves and their surrounding fluid. There are several key components to this including: 1) volume, 2) sperm concentration, 3) motility, and 4) morphology.
Volume
After allowing to incubate and liquify for approximately 20 minutes, the semen is placed into a measuring cylinder and is evaluated for its total volume in milliliters (mL). In 2010 the World Health Organization (WHO) released their 5th edition guidelines for semen analysis reference ranges stating that anything greater than 1.5 mL is considered normal.
Common causes for low ejaculate volume include incomplete collection (if some of the ejaculate fails to be collected) or a blockage somewhere along the ejaculatory tract.
Sperm Concentration
Once the semen volume has been measured, a predetermined amount is placed on a specialized platform known as a standardized count chamber and examined under a microscope by a trained technician. All moving (motile) and non-moving (non-motile) sperm are counted. The number of sperm observed in this fixed amount of fluid allows determination of man’s sperm concentration. The WHO 5th edition minimum value for sperm concentration is > 15 million sperm per mL of fluid.
Low sperm concentration (also known as oligospermia) can be the result of many different factors including toxin exposure, testicular failure, and prior injury.
Motility
Another critical aspect of sperm function is sperm motility. While being examined under the microscope, at least 100 (or as many as possible) sperm are assessed to see if they’re they are swimming and, if so, how well. This results in a percent motility and a percent progressive motility. The WHO 5th edition criteria for these values are >40% and >32% respectively.
Causes of poor sperm motility (also known as asthenospermia) include vitamin deficiency, varicocele, or intrinsic problems with sperm anatomy.
Morphology
Sperm morphology is a quantitative evaluation of the number of ‘ideal’ looking sperm in the semen specimen as defined by a set of very strict criteria. The vast majority of sperm rarely look perfect however, and as a result the normal range for sperm morphology is only >4%. That means that only 4 out of every 100 sperm can look ‘normal’ and that’s still completely normal.
Studies have shown that even men with ‘abnormally’ shaped sperm (called teratospermia) can still achieve fatherhood at rates similar to that of men with ‘normal’ sperm. As a result, sperm morphology is one of the more challenging aspects of the semen analysis and its significance should be discussed with a reproductive urologist with expertise.
Other Factors
There are many other values that are frequently tested during semen analysis. These include viscosity (semen thickness), pH (relative acidity), and the presence or absence of fructose. These values can offer varying insight into a man’s fertility and should be interpreted in the context of the above values.
Getting Tested
It’s important to know that semen analysis results can be highly variable, even when collected from the same patient on different days. That’s why it’s important for men to submit at least two different samples when undergoing a fertility evaluation. These samples should be given with ideally 2-7 days of abstinence prior to each evaluation. This is a critical point that men should be aware of when planning to see their physician or submit a specimen. Less than 2 days of abstinence can result in falsely lowered sperm counts while greater than 7 days can result in decreased sperm motility.
Specimens are typically collected by masturbation without lubrication as this can significantly affect results. For patients that are uncomfortable providing a specimen at their lab or physician’s office, it’s usually possible to arrange collection at home as long as the specimen can be brought in within the hour. Although there are more and more ‘at-home’ semen analysis tests being advertised for men questioning their fertility, we do not recommend these as they are much less accurate than a formal laboratory semen analysis.
Parting Thoughts
Even if you’re a patient with less than ideal semen analysis parameters, there’s still hope for you. Many of these values can be improved or even normalized with appropriate treatment! What’s important is that you seek out a comprehensive evaluation from a reproductive urologist with expertise in male fertility. If you have any more questions about semen analysis or male fertility, please feel free to reach out using any of the links below!