Semen Analysis

SEMEN /SPERM TESTING

Question 1. What is a semen test?

Semen testing or semen analysis is the laboratory testing of freshly ejaculated semen that usually has been produced by masturbation. It is an essential part of the testing of the male partner. A semen analysis checks the amount of sperm present as well as assessing the quality of sperm under the microscope in terms of the number, shape and its ability to move actively.

 Question 2. What is required before the Test?

It is also important that the man does not have sexual intercourse or masturbate for two to five days before the test, as frequent ejaculations could lower the sperm count.

 Question 3. How is semen collected for testing?

Assessment of semen should be done on a freshly ejaculated semen sample (within two hours of being produced). For the test, a semen sample is best produced into a jar by masturbating. It is preferable that semen collection is done in a private room at the laboratory. It can also be collected using a condom during normal sexual intercourse. It is important that none of the semen sample is lost. As sperm are mostly in the first part of the ejaculate, losing the first part of the ejaculate can falsely lower the sperm count. Too long a period between ejaculations may also lower the sperm quality.

An individual’s semen quality can vary considerably between samples, even in fertile men. Sperm counts can be affected by illness. Fevers and infections can temporarily lower a sperm count for several months. At least two semen analyses are needed to properly check fertility. These tests should be at least six weeks apart.

 Question 4. What does a semen analysis report cover?

A number of different aspects are recorded in a semen report, including:

Semen volume;

Sperm number;

Their ability to move (motility);

The shape of the sperm (morphology).

The percentage of live sperm is also reported, along with:

pH levels;

White blood cells;

Sperm antibodies (Not routine test)

A semen analysis will include testing of:

Semen volume

Semen is a mixture of fluids from several organs of the male reproductive tract. The testis contributes only 5% of the semen volume but, naturally, all of the sperm. Most of the seminal fluid is produced by glands at the base of the bladder, namely the seminal vesicles and prostate. The total amount of fluid ejaculated is measured as part of the semen analysis. Men normally produce two to five millilitres (ml) of semen when they ejaculate.

Sperm Number

This is commonly referred to as a sperm count. As part of the semen analysis, the number of sperm in a measured volume of the ejaculate is counted. The sperm concentration is reported as the number of sperm per millilitre (ml) of semen.

Sperm Motility

This is the ability of sperm to swim or move forward. The number of moving (motile) sperm compared to non-motile sperm is reported as a percentage of the total number of sperm. Some laboratories measure the speed and nature of sperm movement, but it is still unclear whether these additional tests add anything to managing infertility.

Sperm Morphology

This is an assessment of the sperm’s shape and physical features. As part of the semen analysis, the number of sperm that are abnormally shaped is compared with the number of normally shaped sperm. This is recorded as a percentage of the total number of sperm. Sperm can have abnormally shaped heads or tails, which affect their movement and ability to attach to an egg. When checked using correct WHO methods, this morphology result can give a good indication of the sperm’s chances of fertilising an egg in the test-tube (in vitro).

Unlike sperm from other species, it is quite common for men to make a large number of abnormally shaped sperm (up to 86 to 95 per cent). In very rare circumstances, the sperm of some men all have round heads (globozoospermia) and these men will not achieve a pregnancy naturally.

Semen pH

Levels are measured to determine if the ejaculate is acidic or alkaline. Semen should be slightly alkaline. More acidic semen, combined with a low amount (volume) of semen, can mean there is a possible blockage in the ejaculatory ducts or even the absence of the seminal vesicles.

White blood (inflammatory) cells

Often found in semen, large numbers of white blood cells in the ejaculate can be a sign of an infection of the reproductive tract. However, it can also happen for unknown reasons.

Assessment of sperm antibodies in semen

This is an important test normally done in specialised laboratories using methods approved by the World Health Organisation. Sperm antibodies can happen in some men when the immune system considers its own sperm to be foreign and develops antibodies against them. Sperm antibodies commonly happen in men after vasectomy. Antibodies attach themselves to the sperm to reduce the sperm’s movement. The sperm clump together, making it difficult to pass through the mucus in a woman’s cervix. Also, in the fertilisation process, sperm and egg recognise each other by substances (receptors) on their surface. If antibodies are bound to sperm, these receptors are covered by the antibodies and stop the sperm from sticking (binding) to the egg.

 Question 5. What is a normal semen analysis result?

The World Health Organisation (WHO) has published the following measurements to help work out if semen analysis results are normal.

Normal semen analysis

Measurement of all these parts of the semen specimen gives the doctor some suggestion of the level of fertility. A low sperm count does not always mean that there is no chance of achieving a pregnancy. Some men with a low sperm count but with properly moving and normal shaped sperm can achieve pregnancies.
The doctor carefully assesses the results of the sperm test and links these results to other important factors such as the period of time that the couple has been trying to achieve a pregnancy. In general, couples who have been unable to achieve a pregnancy for three years or more have a very low (less than 10%) chance of this happening in the following 12 months without medical intervention.

 Question 6. Are other tests done as part of a semen analysis?

Sometimes, men may need to provide a urine sample after ejaculation if the doctor thinks there is an ejaculation problem (retrograde ejaculation). The urine is checked for sperm.

 Question 7.  I feel embarrassed to donate Semen to the laboratory. I there any other way I can check my sperm quality? 

Yes. A recent introduced home test kits for checking sperm quality is available. It provides rapid screen to health and quality of sperm. This saves you any embarrassment of a clinic visit until you are comfortable with donating your semen to the laboratory. However, for more complete assessment of sperm health, a laboratory based testing is required.