Male Semen Analysis - The A-Z of a semen anyalisis and why its so vital. - Rebalance Chinese Medicine

A male semen analysis is one test you must have done when trying to conceive.

Experts estimate that male factors are to blame in up to 40% of couples who experience fertility issues. A male semen analysis is a valuable tool for couples as they begin their fertility journey. Alongside male factor issues, 40% is also due to female factors affecting fertility.  10% of infertility causes is due to both Male and Female factors and 10% is due to why we call “undetermined issues” where there is unexplained fertility for a couple.

Compared to many of the female fertility tests, a male semen analysis is non-invasive, relatively inexpensive, and produces results quickly and accurately. It takes approximately 5 minutes to collect, and I can have the results within 24 hours. I ask all my fertility clients to have their male partners sperm tested, including sperm donors for same sex couples. Its extremely important that we have a sperm test – as it does take 2 to make a baby and as sperm is half of the equation – we need to know how healthy they are. The results of a sperm test also enables me to assist you the best way I can with your treatment plan.

Fig 1 – Male Semen Analysis steps to evaluating a sperm test.

What do we measure in a male semen analysis?

Firstly, semen is the fluid a man ejaculates during orgasm. The sperm cells within the semen are the cells that can fertilize the woman’s egg. For most semen tests, the man masturbates into a container, which is then delivered to a laboratory for testing. It is important that your sperm sample is tested within 30 minuets of collection. Almost all laboratories performing sperm tests will evaluate the following semen and sperm parameters:

Semen Volume: Semen volume is the total quantity of ejaculated fluid. A normal amount is between 2 and 5 milliliters. Hypospermia is when the volume is less than 1.5 ml, which is due to for example hormonal abnormalities or ductal blockages. Hyperspermia is a large volume of more than 5.5 ml.

Sperm Count: Sperm count is determined by looking at the semen sample under a microscope. It is a measurement of how many million sperm cells there are in each milliliter of semen. In the literature it also called “Sperm concentration”.

A normal sperm count is 15 million or more sperm cells per milliliter. Oligospermia is when there is below 15 million sperm cells per milliliter. Azoospermia is if there are no sperm cells at all, see Figure 2.

Sperm Motility: Sperm movement

Sperm motility is the forward swimming motion of sperm. For a sperm to fertilize the egg, it must travel quickly through the female reproductive system. This requires a strong swimming action. The World Health Organization (WHO) grades motility as follows [1];

Progressive motility (PR): spermatozoa moving actively, either linearly or in a large circle, regardless of speed.

Non-progressive motility (NP): all other motility patterns with absent progression, e.g. swimming in small circles, the flagellar force hardly displacing the head, or only observing a flagellar beat.

Immotility (IM): no movement.

It’s normal to have more than 32% of progressively motile sperm cells (PR) or 40% as a combination of progressive motile and non-progressive motile (PR and NP). Asthenozoospermia (see figure 2) refers to a condition where a great portion of sperm in a semen sample are immotile or have reduced motility, compared to the WHO reference values.

Total Motile Sperm Count (TMSC): refers to the total number of moving sperm cells in the entire ejaculate.

It is calculated by multiplying the volume (ml) by the concentration (million sperm/ml) by the motility (% moving). Ideally, the TMSC should be above 169 million sperm cells.

Fig 2 – What a male semen analysis measures

Sperm Size and Shape – Morphology

Also known as sperm morphology. Abnormal sperm cells may be unable to move normally or to penetrate an egg. As a result, too many sperm cells of abnormal size and shape can pose a significant fertility issue.

Most laboratories will evaluate the sperm cells based on the “Kruger” criteria provided by the World Health Organization (WHO). According to the Kruger criteria, a normal sperm cell must have an oval shape with a smooth outline. At least 4% of the sperm must have an oval head with a connecting mid-piece and a long straight tail.

Take a look at figure 3 to see how a normal sperm cell should look. The condition Tetrazoospermia is when under 4% of sperm cells in a sample are normal.

Fig 3: A normal-shaped sperm cell (far left), and abnormal sperm cells (all other cells to the right).

Colour and viscosity

A comprehensive semen analysis often includes an evaluation of the color and viscosity (thickness) of the seminal fluid, as well as an analysis of the time until the semen sample liquifies. The colour should be grey-opalescent. If it appears red-brown, it may be an indication of red blood cells in the ejaculate (Haemospermia). It’s normal for the semen to liquefy in no more than 20 minutes. If it doesn’t liquefy, it may indicate the presence of an infection of the seminal vesicles and/or the prostate.

Semen pH

Semen is typically a slightly alkaline substance, with a normal pH of 7.2-8.0. An abnormally high or low semen pH can cause sperm death. It can also impact the ability of the sperm to swim quickly and/or effectively penetrate the egg.

Sperm Vitality

Sperm vitality relates to how many sperm cells are alive and intact. Dyeing the semen with colour determines sperm vitality. The dye stains the dead sperm cells, since they are not intact anymore. The percentage of live sperm should be above 58% to consider it as normal. If it’s below that level, the diagnose is Necrozoospermia.

White blood cell infiltration

It’s normal for semen to contain some white blood cells. However, many white blood cells in a sample may indicate the presence of an infection, which can decrease semen quality. A normal semen sample will  contain below 1 million white blood cells/ml.  (WBC per ml). On the other hand, Leukospermia is when it is above 1 million WBC per ml.

Presence of zinc, fructose, and glucosidase in the semen

The accessory glands release a range of different nutrients in the male reproductive system. Some of these include zinc, fructose and glucosidase. In order to consider a semen sample as normal, the markers should be above a certain limit:

Zinc:≥2.4µmol/ejaculate
Fructose:≥13µmol/ejaculate
Glucosidase ≥20 µU/ejaculate.

What do we need to assess semen quality?

A sufficient first line sperm quality test needs to assess the following:

  • Semen volume
  • Sperm concentration
  • Sperm motility
  • Sperm morphology
  • Total Motile Sperm Count (TMSC)

For myself – Sperm Morphology is one of the most important details that I want to know when treating fertility couples.

Male semen analysis: what, when, where, and how? 

 A sperm test is that – an example of how a male’s sperm is at that particular time. Sperm can also be affected by stress, illness and poor sleep.

If a semen sample presents with low motility (less than 4% normal forms) we recommend retesting in 6 weeks. If it is still low – we will then refer you to an andrologist for further investigation. When treating male fertility – we will also request another test after 4 months of treatmemt to see how things may have changed.

 In general, men with better semen parameters have a better chance of achieving a pregnancy with their partner faster. Optimizing these parameters as much as possible is therefore beneficial for fertility. So, what parameters do we need to be able to conceive naturally?

 We need a minimum of 14% normal forms (normal Morphology) ideally this should be 14-30% normal forms and a progressive motility of at least 62% with 57% moving in a forward’s direction. The total Sperm Concentration count needs to be a minimum of 196 million.

It is vitality important that your male partner, potential sperm donor or sperm donor have their sperm tested. Unlike females – it takes 3.5 months to develop sperm from a tiny cell into an adult sperm. As sperm are produced every 3.5 months – it is easy for us to assist with any sperm issues such as motility and morphology. We can assist with sperm health using lifestyle changes, a male fertility supplement (we recommend naturobest), acupuncture, and Chinese herbal medicine.

Sperm has declined dramatically in the last 20 years and the World Health Organization now states that normal morphology for fertility is 4% normal forms! 20 years ago, this would have been considered severely infertile. This is the main reason that when a couple is considering trying to conceive, I ask for the male to have a sperm test straight away – a simple sperm test can save months of frustration, heartbreak, emotional upheaval and money in the long term.

As already mentioned, – a male sperm test is quick, non-invasive, relatively inexpensive (it costs approx. $80 at City Fertility) for a basic sperm test and I can have the results within 24 hours.

When you decide to begin trying your GP, gynaecologist or myself can write you a request form to have the test done. You will need to book in for your test.

Prior to your test you should refrain from having sex for 2 days – as we need a minimum of 2 days abstinence. Once you have ejaculated into the sample pot it is then barcoded, taken out the back and analysed under the microscope – recording the volume, concentration, temperature, viscosity, colour and then the sample is loaded into the counting chamber and your sperm is analysed on high power under the microscope. A report will be made, and 2 scientists will sign off on the report. Once this is done – the sperm test results are then emailed to me or your GP / health practitioner.

Make sure that you are also taking a male preconception mutlivitamin as well as these are designed to assist with sperm production – they should also contain Vitamin E, Zinc, Selenium, Vitamin C, magnesium as a basic male prenatal. We highly recommend MyGen or Naturobest Male conceive as a preconception multi.

If you would like to know more on how we can help you – please call us on (07) 3999 8535

Dr Julia Bartrop worked in Pathology for 16 years and has had personal experience looking at semen samples under the microscope. She has seen the decline in sperm and an increase in sperm morphology abnormalities over this time.

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