Semen Analysis

Evaluation of the male partner is an integral part of an infertility evaluation. In approximately 40% of cases there is a male component to the couple’s infertility. The semen analysis is the first test in the evaluation of the male. A sperm sample is obtained from the male for analysis. A period of 3-4 days of sexual abstinence should occur prior to producing the sperm sample. The sperm sample is usually obtained by masturbation. If the male is unable to do this, the sample may be obtained through intercourse utilizing a special condom to collect the sample. The sperm sample is then analyzed by our lab. The volume of the ejaculate, the concentration of the sperm and the percent motile sperm are evaluated. The morphology, or the shape of the sperm, is also evaluated.

The lower limit of normal for a sperm concentration is 20 million sperm/milliliter. This cut-off, however, is not absolute. Men with concentrations below 20 million can sometimes father children. Conversely, men with concentrations above 20 million are not always able to father children. The probability of pregnancy does decrease with sperm concentrations less than 20 million. With respect to sperm motility, at least 50% of the sperm should show progressive motility to be considered normal. We use a “strict criteria” for evaluating sperm morphology (shape). Using such a criteria, 14% or more of the sperm should be classified as having normal morphology. The ability of sperm to survive overnight in culture is also evaluated in couples undergoing IVF. The “24 hour sperm survival” provides some useful insight into how the sperm will function when mixed with the eggs in an IVF cycle.

None of the above semen parameters alone or in combination provides absolute evidence of male fertility or the lack thereof. However, some authorities feel that the sperm morphology may be the most useful indicator of the sperm’s ability to penetrate and fertilize an egg. In general, two separate sperm counts, at least a month apart, should be obtained. Sperm production takes approximately 90 days. Therefore, anything that has occurred during the 90 days prior to sperm collection could have an impact on the sperm count, motility and/or morphology. If an abnormal sperm test is obtained, repeat testing 1 month later is advised. Numerous factors can be toxic to sperm including fever, illnesses, testicular trauma or infection and medications. You should inform us if you have had any illnesses or have taken any medication during the 3 months prior to producing your sperm sample.

If an abnormal semen analysis is obtained further testing of the male is sometimes warranted. This may include hormonal testing and referral to a urologist for evaluation of anatomic abnormalities. Final treatment recommendations will depend not only on the results of the semen analysis, but also on the evaluation of possible female infertility factors.