Around 40% of couples have trouble getting pregnant due to male infertility problems. Similar to blood tests, semen analysis is conducted to understand various required features that fall in the normal range. There have been various developments related to the procedure of semen analysis, which has become more accurate, reliable, and highly informative.
A semen analysis needs to be performed by an andrology laboratory, which specializes in semen analysis. The basic techniques of semen analysis are in practice for more than 50 years. Recently, more advanced equipment and methods are utilized for the assessment of characteristics of sperms ranging from simple sperm count to functional property, capacity, and motility parameters of sperms.
What is semen analysis? What is the criteria for semen analysis?
Semen analysis is a male fertility test for assessing male reproductive health and male fertility evaluation. This is an important test for screening the fertility problems of male partners. The analysis involves the following:
- The quality of sperms,
- The morphology (shape and size),
- The count of sperms in semen,
- The motility of sperms (the ability to move),
- Presence of anti-sperm antibodies
- The ability of sperms to survive after one day
- Presence of any other abnormalities or infection
For normal semen analysis, all samples are properly weighed and also checked for the presence of toxic agents (cytotoxicity).
Sperm morphology is typically assessed using standard WHO criteria.
Assessment of sperm factors to understand whether in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is more suitable, etc.
Why undergo semen analysis?
If a couple is trying to get pregnant for over a year and fails to conceive, the doctor will ask both of them to run a few tests. The tests will help diagnose the underlying fertility problems and improve your chances of conception. In 40% of cases, male fertility is causing problems of conception in a couple. Semen analysis is done for understanding fertility causes in male partners and feasible options for couples to get pregnant.
Semen analysis is also used for a man who has undergone a vasectomy (surgical male sterilization process). This test will determine if there are a good amount of sperms present in semen and that the couple needs to take precautions to avoid pregnancy.
How to prepare for semen analysis
A doctor will recommend you to stay abstain from sex or ejaculation for 2-5 days before collecting the sample. This ensures the accuracy of analysis as a shorter or longer period may affect the reliability of results.
Before producing the sample, inform your doctor if you have suffered any illness or fever within a month prior to the test. This is because illness can adversely affect sperm count. Also, it is not advisable to produce the sample if you have had cancer treatment or you have exposed to any harsh/toxic chemicals within 3 months prior to the test. In such cases, it is best to postpone the appointment.
The semen samples are collected in a natural manner (masturbation). To ensure that the sample is not contaminated, laboratories provide sterile containers. Most clinics avoid the use of lubricants and condoms.
The patient is provided with a private room. Wash your hands and genitals with water or you can produce the sample at home and deliver it within an hour to the laboratory. During transportation, the container must be maintained at body temperature and never refrigerate the sample. The information related to the time of collection and method of collection is noted down. If the results are abnormal, the doctor will recommend the best course of action.
How is semen analysis conducted?
The semen analysis procedure is standard and its been in use for years. The normal semen analysis will include following:
Total sperm count is an indication of the function of sperm concentration and semen volume. Low semen volume may be related to low total count even with a normal concentration while high volume may indicate low concentration with high volume.
The complete analysis of total sperm count, sperm concentration, and total semen sample volume gives an indication of the fertility potential of men. The analysis is done by centrifugation of the semen specimen at 3000 g for 15 minutes.
Sperm morphology analysis involves the analysis of sperm according to a variety of types based on shape and structures. A set of approximately 200 sperms is taken and the structure of these sperms is analyzed. Any defects observed are noted. The presence of more abnormal sperms in the semen means a lower likelihood of fertility.
Motility refers to the swimming ability of sperms, required to travel through the cervix to the egg. Sperm motility analysis is based on the count of moving sperms in the given sample. Sperms that move in a straight line are considered healthier than the others. The more number of fast-moving sperms means higher chances of conception.
If a couple is planning to freeze sperm samples for future use, a cryo survival test is done to check if sperms are surviving in a frozen state In certain cases a retrograde ejaculation test, or Kremer test (sperm mucus penetration test), or sperm function test may be indicated.
Second sample analysis
If abnormality is observed in the first semen analysis, then a second semen analysis is conducted with a span of 3-6 weeks. If the second semen analysis test is also abnormal, you will be advised to consult the urologist or fertility specialist for further treatment.
What are normal results?
The semen analysis report will indicate the comparative values of normal range and abnormal values in detail. Most clinics refer to WHO standard manuals for comparing the results of semen analysis. The manual contains well-defined normal values of sperm density, motility, and morphology. Thus it is easy to discriminate between normal and abnormal semen samples.
Semen analysis count:
The normal sperm count is approximately 20million sperm per ml.
|Sperm concentration||20 million/ml or more|
|Motility||50% or more with forward progressive or 25% or more with rapid linear progression within 60 min after collection|
|Morphology||50% or more with normal morphology|
|pH||7.2 to 7.8|
|Total sperm count||40 million or more|
|White blood cells||Fewer than 1×106 per ml|
|Zinc (total)||2.4 mol or more per ejaculate|
|Citric acid (total)||52 mol (10 mg) or more per ejaculate|
|Fructose (total)||13 mol or more per ejaculate|
|Viability||75% or more alive|
Semen analysis morphology:
Sperm morphology and motility are measures of the fertility potential of men. Semen analysis based on shape and structure is carried out using high power microscopy. The semen analysis time is around 20-30 min.
The semen analysis normal report will show the count, structure and motility in normal range as given in above chart.
What do abnormal results mean?
The semen analysis test report or normal report will be produced in two days. The semen analysis results will be discussed with you and further treatment options are recommended accordingly.
Some of the abnormal conditions are listed below:
- Aspermia is an absence of semen despite male orgasm.
- Azoospermia is a complete absence of sperm (spermatozoa) in the semen.
- Oligozoospermia is related to a decreased number of normal motile sperm cells in the semen (compared with azoospermia, which means no sperm in the ejaculate). It includes laborious terms such as asthenozoospermia, teratozoospermia, and oligoasthenoteratozoospermia.
- Teratozoospermia is related to abnormal morphology of sperms.
- Leukocytospermia or pyospermia is related to a high number of white blood cells in the semen
- Necrospermia refers to the death of sperm.
The conditions like “azoospermia” i.e. the absence of any sperm in the semen are easily diagnosed by semen analysis. Oligospermia mainly related to testicular problems is a condition of decreased numbers of sperm in the semen (< 15 million sperm/mL). Oligozoospermia can be considered as a less severe form of azoospermia.
Oligozoospermia is mostly associated with external factors such as pollution, obesity, lifestyle factors such as smoking habits, etc. Other possible causes may be hormonal problems, exposure to heat or chemicals, wearing too tight clothes, or others. Doctors usually advise the patients for simple lifestyle modification and to avoid factors that adversely affect the process of normal sperm production. There are few drugs that can be prescribed for the treatment of oligospermia. Doctors may also recommend certain surgically correctable approaches to treat the condition.
Both azoospermia, and oligozoospermia, may also be associated with hereditary factors that are influencing hormonal imbalance in person.
Azoospermia is further classified as:
Obstructive (normal spermatogenesis): caused by blockage of the tubules or ducts that convey the sperm from the testicles to the penis or,
Non-obstructive (diminished or absent spermatogenesis): the absence of sperm as a result of problems related to sperm production.
Other causes of obstructive azoospermia include trauma, or infections to testicles, side effects of certain medications and drug use, previous surgery, kidney failure that may prevent ejaculation through ducts and tubules. In such cases, your doctor may suggest a surgical sperm retrieval option.
Your doctor will conduct additional tests, ask for your complete medical and family history, and will assist in the formulation of an appropriate treatment plan.
Some men with infertility, particularly with azoospermia, may have normally functioning testis, but gamete production/function is abnormal.
Varicoceles are another common attributable cause of male infertility and it is related to venous dilation of the spermatic cord. In men with varicocele, the temperature of testicles is significantly increased than standard temperature. This affects heat transfer in the spermatic cord and also reduces the blood flow of testicles. It is also associated with abnormal semen characteristics and pain in the scrotal region. The condition is conservatively managed with a simple observation. Poor sperm production decreased sperm motility, and mitochondrial dysfunction are the key effects observed in men.
The condition can be corrected with surgery and it will improve the sperm concentration, its morphology, and even motility and thus improving the chances of conception. Varicocelectomy is a highly effective male infertility surgery that is said to improve the semen parameters so that couples do not require any assisted reproductive treatment.
Oligoasthenoteratozoospermia is the most common cause of male infertility wherein the morphology features, sperm count, and motility factors all are abnormal. In this case, the male partner is assessed for general and complete fertility health to identify the causative or contributing factors.
Abnormal sperm morphology results and what it means?
Teratozoospermia is a condition when large numbers of sperms are of abnormal shape. The shape of the sperm determines its ability to swim and also its ability to penetrate the egg. Poor sperm morphology can be associated with genetic reasons or genetic mutations. For example, globozoospermia is related to sperms with the round head instead of oval. The condition is often observed in heavy smokers. Overall the poor sperm morphology thus affects the fertilization procedure and hence the fertility of men.
In case of any abnormal semen analysis, the doctor may suggest additional tests including physical examination, test for hormonal levels (testosterone, etc.), ultrasound test for testis, scrotum, etc., more specialized semen analysis for the presence of certain enzymes or sugar, egg penetration test (hamster test) and if required genetic screening test as per the abnormality detected.
Necrozoospermia where sperms are dead is a rare cause of infertility. When sperms are not moving but viable, fertility options such as ICSI are recommended. Herein sperms cells are directly injected into the egg for fertilization. However, if sperms are completely dead, there are no treatment options to resolve the problem. In some cases, doctors may perform a testicular biopsy to retrieve some viable sperms and use them in assisted reproductive treatment options.
In Leukocytospermia conditions, sperms are not necessarily abnormal but may indicate infection. The presence of a high percentage of white cells may affect sperm’s ability and reduce the overall fertility.
What is the next step?
Once the problem areas are identified, your doctor will discuss with you if it is genetic factors responsible, or some physical impediments that can be treated.
In many cases, the conditions are treatable and your doctor may suggest simple lifestyle changes, or prescribe medications to resolve the problem. Natural conception is possible in such cases and no additional assisted reproductive treatment is required.
In more complex cases, wherein sperm count is very low but they are healthy in nature, surgical collection of sperms for processes like IVF or ICSI is a suitable option.
In severe cases, where men are unable to produce any sperms and tests cannot be treated to resolve the issue; the doctor may suggest other viable options for conception such as using donor sperms.
How to do semen analysis
If you and your partner are trying to get pregnant for more than 12 months but still haven’t succeeded, it is time to conduct fertility tests for both. Find a suitable semen analysis near you and submit the semen sample for analysis.
The semen analysis test cost:
The cost of the semen analysis starts from 100 rupees to 4000 rupees depending upon the analysis required in your case.