Infertility Causes > Man > Semen Analysis

Overview - Evaluation - Treatment Options - Diagnosis

Obtaining and Delivering the Sample

A semen sample is usually obtained by masturbation with collection of the ejaculate into a sterile specimen container. No lubricants should be used. There are also specially designed condoms that can be worn during intercourse to collect a semen sample. (These do have to be special condoms, which are available through your physician.) Two to three days of abstinence is suggested before obtaining a sample for analysis. Longer periods of abstinence may increase the count, but the percentage of sperm that are actively motile will decrease. Conversely, shorter periods of abstinence may result in some decrease in the number of sperm present.  Two to three days of abstinence before a semen analysis provides the most accurate results.
 
The sample should be submitted for analysis as soon as possible after collection. It is preferable to collect the sample at the office or laboratory where the analysis will be performed. Specially designed rooms just for this purpose are usually available. If you are going to collect the sample at home, keep it at body temperature while transporting it to the laboratory. Placing the container under your arm, inside your pants, or in your bra will accomplish this. The sooner the sample is provided to the laboratory after collection the better.

Interpreting Semen Reports
Examples of two reports of semen analysis results are provided below. It is easy to see that there is much more detailed information available in the second report. The first is a report fairly typical of a laboratory that does not really specialize in evaluating semen samples.

Clinical Laboratory - Community General Hospital
Any City

Date: ___________       Patient Name: ___________________ 

SS#:  ___________   Physician: ___________________

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Test                                   Result Expected             Range Units
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Semen analysis - Fertility

Semen Volume                          2.5                         2.0 - 5.0  mL

Sperm Motility                           65                          60-100   %

Sperm Count                            89                          60-150   M/mL
 
There is nothing wrong with this type of analysis, and often for a first test, this is fine. If it is perfectly normal, it's probably pretty reliable but this information is obviously limited. If there is any question at all about the normalcy of the results from this type of laboratory, the second test should be done by a laboratory that can do a more detailed analysis. There is obviously far more information and detail provided by the second sperm analysis. This test was analyzed by a laboratory that specializes in evaluating sperm samples. Following is an explanation of the information obtained and what the results mean.

Coagulum present: The ejaculate normally Acoagulates into a jellylike blob within a few minutes of ejaculation.

Liquefied in: The coagulum should begin to break down and liquefy within thirty to sixty minutes of ejaculation.

Volume: Two to four cc=s is normal. Larger or smaller volumes may present a problem in getting enough sperm to the cervix either because there is not enough seminal fluid to protect the sperm in the vagina or because the sperm present are diluted in too large a volume.

Viscosity: This is a measure of the overall stickiness of the sample.

Motility: This is the measure of the rate at which the sperm move. Good sperm motility is vital to their ability to fertilize an egg. Only those sperm with rapid progression can reach and fertilize an egg. Sperm may also be slowly progressive (moving, but not moving well, or moving in very erratic patterns), nonprogressive (alive and shaking, literally, but not moving), and immotile (alive but not moving at all). Some distinction about grade of motility is important and sometimes missing from more cursory evaluations.

Viability: The percentage that are alive regardless of their motility.

Agglutination and aggregation: Measures of the extent to which the sperm are stuck to each other or stuck to material within the ejaculate.

pH: The pH of the seminal fluid must be within the range of 7.2 to 8.0 to protect the sperm from the very acidic environment of the vagina until they can reach the cervix.

Sperm concentration: The number of sperm present in one cc.

Total count: The sperm concentration multiplied by the volume. 
 
Fructose: Fructose is the sugar present in the seminal fluid. It functions as an energy source for the sperm and is produced in the seminal vesicle. Absence of fructose suggests an obstruction in the path of the sperm from the testicles to the penis.

Leukocyte concentration: Leukocytes are white blood cells, and their presence suggests an infection, often of the prostate gland. This is reported as the number of white cells per 100 sperm present.

Morphology: This is the microscopic assessment of the appearance of the sperm.  There are two techniques for evaluating morphology. The standard technique is done much more superficially and with this technique, most laboratories use sixty percent normal sperm as their cut-off point for a normal semen analysis. The second technique uses the Astrict criteria. With this technique, the sperm are much more critically assessed, and a sperm must be perfectly normal to be so considered. Under these criteria, more than fourteen percent normal-appearing sperm is outstanding, and more than four percent is probably normal. The use of the Astrict criteria for evaluating morphology is validated by the good correlation between normal appearance by these criteria and the fertilizing capacity of a sperm. Most labs specializing in semen analyses will use the Astrict criteria.

Total motile normal sperm (also known as TMNS):This is the bottom line of the semen analysis. This is the number of sperm that are normal by strict criteria and possess rapid progressive motility. In other words, this is how many sperm in the sample are capable of fertilizing an egg. The TMNS provides the physician with a number that he or she can use to determine which treatment alternatives will offer a couple an acceptable chance of conception.

OTHER TESTS OF SPERM FUNCTION

Sperm penetration assay: A test in which sperm are incubated with specially prepared hamster eggs (actual fertilization cannot occur). The ability of the sperm to bind to the eggs and penetrate them is measured. The results of this test correlate moderately well with the ability to penetrate a human egg: If there is good penetration in this assay, there is a very good chance the sperm are capable of penetrating a human egg.

Sperm antibody tests: These tests check for the production of antibodies by either the male or female. Antibodies are substances that can either immobilize or even kill the sperm before the sperm can reach the egg.  In order to detect antibodies, a tube of blood is drawn from the woman and incubated with a sperm sample in the laboratory and examined microscopically.

Mannose test, acrosome reaction test: Before a sperm can attach to and fertilize an egg, it must undergo a process known as capacitation. Capacitation involves changes in the membrane of the head of the sperm that are necessary to allow attachment to, and penetration of, the egg. These tests measure the ability of the sperm to undergo capacitation and allow identification of sperm that may not be able to fertilize an egg in spite of an otherwise normal semen analysis. These tests can be particularly useful in cases of unexplained infertility or prior to an ART procedure. These are also known as sperm function tests (SFTs).

SCSA:  Sperm Chromatin Structure Assay  This is one of a group of tests that are used to try to evaluate the integrity of the DNA inside the sperm.  Other tests in this category include the toluidine blue test (TB), TUNEL (terminal nick-end labeling) assay.

Sperm washing or Percoll gradient: Techniques used to isolate the healthiest and most motile sperm. A semen sample is subjected to one of these procedures prior to, for example, inseminations.

Testicular biopsy: A technique in which a small piece of the testicle(s) is surgically removed and microscopically evaluated. The value of this procedure in terms of suggesting ways to improve the sperm count is questionable at best. With the availability of microinsemination techniques such as ICSI (intracytoplasmic sperm injection), a testicular biopsy may be worthwhile in that if it demonstrates the presence of even a few very immature sperm, these can now be used to achieve fertilization and pregnancies.

© 2005 Jarrett Fertility Group