Questions About The Semen Analysis

Why has your doctor ordered a sperm test? A basic semen analysis is the most important initial test for males undergoing an infertility assessment.

The semen analysis is an integral step needed to measure several aspects of sperm biology. Unlike the majority of female fertility tests, a semen analysis is non-invasive, requires no needles or x-rays, and generally gives results within 48 hours.

Getting a sperm test early in the diagnostic phase makes sense because the information it provides can help save time and money, by making your treatment proceed with greater efficiency. For example, if a sperm abnormality were discovered on a routine semen analysis, then the female may not need to go through more complicated testing or treatments unnecessarily.

The standard semen analysis report answers at least three key questions:

  1. How many sperm are there?
  2. Are the sperm properly motile (are they moving)?
  3. What is the overall shape/form of the sperm cells?

Here is a brief description of these factors and their relevance:

Count: The sperm count is given in concentration (sperm/ml) and total count. (Concentration multiplied by volume). Low sperm counts are usually assumed to be related to infertility. This is not always correct, since there are men with low counts who have established pregnancy. Low sperm counts can be due to structural (anatomical) or hormonal issues, but most cases are unexplained.

Motility: This is usually expressed as percentage of moving sperm. Some labs will “rate” the quality of the motility by a grading system, although this scoring is rather subjective. Also, some men with high counts and lower motility may still have normal amounts of moving sperm. In general, 10 million sperm with good motility per ml is probably acceptable. Possible causes of low motility include varicocoeles, infection, and anti-sperm antibodies.

Morphology: Normally shaped sperm. This can be reported by the older World Health Organization (WHO) standard, or the newer “Kruger or strict criteria.” Most fertility centers do not use the WHO standard because it does not correlate well with IVF results. In contrast, the strict criteria has been shown to predict fertilization rates with IVF. This test is performed by a licensed technician who looks at the sperm through a microscope, so there is variation between labs. It is best used to determine how to treat sperm for couples undergoing IVF. Most centers decide what level might require intracytoplasmic sperm injection (ICSI).

Men with an abnormal semen analysis may benefit from seeing a reproductive urologist to rule out varicocoeles (dilated veins in the scrotum) or other problems in the genital tract. Hormone and sperm antibody testing may be indicated for some men.

We also measures the total volume of the sample. Why? Human semen is produced in relatively small amounts. Most men produce 1-4ml. While normal values are given on the report, there are no known causes of infertility associated with abnormal semen volume. However, too little or too much semen may interfere with proper delivery of the semen to the female during intercourse. Although this has never been proven, a short course of artificial insemination would theoretically deal with this possible problem in selected cases. Some clinicians believe that high volumes are associated with infections of the prostate. This can be confirmed by semen cultures.