About one-third of infertility cases are caused by male factor infertility. The first step is to get an accurate fertility diagnosis from a reproductive endocrinologist at West Coast Fertility Centers. Fertility assessments are equally as important for men as they are for women.  Typically, the fertility doctor will order a semen analysis. 

What is a Semen Analysis?

The semen analysis is the basic study of a semen sample obtained by ejaculation. The male will either bring in his semen sample to West Coast Fertility Centers or he can use one of the collection rooms at our new facility.  The sample is examined in the andrology laboratory where it is assessed according to reference values ​​established by the World Health Organization.

Semen is a whitish, viscous liquid, which contains sperm and different liquid substances. The sperm is the male reproductive cells, capable of fertilizing the oocytes (female reproductive cells) and thus give rise to a new life.

The semen is expelled through the penis at the time of ejaculation.

A semen analysis measures the amount of semen a man produces. It also shows the number and quality of sperm in the semen sample.

The quantity of ejaculated sperm and its concentration are determined in the quantitative analysis, that is, the number of sperm per milliliter of the analyzed sample.

In the qualitative analysis, semen characteristics such as its viscosity, color and acidity (pH), and sperm characteristics, such as morphology (shape), mobility (movement capacity) and vitality (strength) are studied.

It is important to mention that the amount and quality of sperm can vary between samples.

For this reason, two or three samples are often recommended to obtain an accurate analysis of sperm quality and fertility potential. These samples are typically provided several weeks apart.

The number and function of sperm cells can be affected by various diseases. It can take several months for the sperm quality to return to normal after a high fever. In this case, samples are analyzed several month apart months to ensure a more accurate result.

The Semen Analysis measures parameters such as:

• Number of spermatozoa

• Mobility of the sperm (progressive and total)

• The vitality of sperm

• Number of immature sperm

• The size and shape of the sperm

• Number of WBCs (white blood cells)

The values ​​below summarize the normal range for some of the most important parameters:

• Sperm volume  > 1.5 ml

• Sperm concentration  > 15 million sperm/ml

• Sperm motility  > 32% with progressive mobility

• Morphology > 4% normal forms

Why undergo a semen analysis?

Between the ejaculation of the sperm in the vaginal cavity and the fertilization of the ovum (oocyte) in the tube, the sperm will have to go a long way. They must first pass a natural filter of the cervical mucus during the ovulatory phase.

Once they have passed this mucus barrier, the "filtered" sperm will be able to continue their way in the fallopian tubes until reaching their final goal: the ovum. This process allows selection of sperm which reach the egg. Out of a tens of millions of sperm cells released in the ejaculate only a few tens of thousands will reach the oocyte.

Semen analysis is done as part of a fertility evaluation. It is also often done following a vasectomy (male contraceptive/sterilization procedure) to verify that there is no sperm in the semen and, therefore, that the procedure has been performed successfully.

How is a Semen analysis performed?

Here are the instructions for a correct sample collection:

• The collection must be into a sterile container with a wide mouth and with a sealing cap.

• The sample must be obtained, either at the patient's home or at the fertility center where the sample is to be analyzed, usually through masturbation. A sample obtained through intercourse in a special condom is also valid. If the man is not able to obtain the sample through masturbation, they should inform the doctor who has ordered the analysis.

• All ejaculated semen must be collected. If for any reason the ejaculated semen has not been collected in its entirety, the laboratory should be notified prior to analysis.

• Once the sample has been collected, the container must be covered tightly and taken to the andrology laboratory within one hour of ejaculation.

• During transport to the center where it is to be delivered, the sample must be protected from intense cold or heat. It is recommended to keep the sample near the body, to keep it at body temperature.

• If the person to whom the sample belongs has been taking any medication, such as antibiotics or anti-inflammatories, in the days prior to obtaining the sample, or has suffered any illness or fever in the previous two months, he must report this to the doctor and to the laboratory. 

Preparation for the Semen analysis

It is recommended to avoid any sexual activity that involves ejaculation for 2 to 7 days prior to obtaining the sample for analysis. The donor of the sample is recommended to maintain proper hand and genital hygiene to avoid contamination of the sample. During the eight hours immediately prior to obtaining the sample, ointments should not be applied to the penis.

Risks and contraindications

If you have personal or religious issues with producing a sample though masturbation or have erectile or ejaculatory dysfunction please notify your doctor. For some people, obtaining a semen sample through masturbation can be psychologically uncomfortable, but in no case should it entail a health risk.

Possible pathologies

In medical terms, if the results of the analysis are normal, this is called normozoospermia. The more the results of the semen analysis deviate from normal, the higher the likelihood of infertility. The pathologies that can be identified are:

• Azoospermia - total absence of sperm in the ejaculate

• Oligozoospermia - decreased concentration of sperm

• Asthenozoospermia - abnormal motility of sperm cells

• Teratozoospermia - sperm with abnormal morphology 

• Necrozoospermia - no living sperm cells in the ejaculate 

• Pyospermia – high volume of semen

• Hypospermia – low volume of semen

Note: Another examination allowing a semen analysis is the postcoital test. This examination allows the study of the behavior of sperm in the cervical mucus after sexual intercourse.

Understanding Your Semen Analysis Report

The semen analysis results have to be interpreted by a physician in context of the patients medical history. Keep in mind that it is common for one or more parameters to be slightly altered in healthy people.

The most important parameters in the Semen Analysis are:

• Volume: The amount of semen in an ejaculation

• Viscosity: Semen is usually a slightly viscous liquid. To study its viscosity, a thin stick is immersed and removed, it is normal to form a thread less than or equal to 2 cm. If the thread is higher, the viscosity will be increased and the semen will be very sticky.

• Liquefaction: The newly ejaculated semen is quite consistent and viscous. But after a few minutes, it begins to liquefy and in half an hour it has a consistency similar to water. In pathological situations, lumps may appear or even solidify the entire sample.

• Color and smell: At first glance, you can study the color of the semen, which should be pearly white. It may be yellow or green during infections, red if it has traces of blood or transparent if there are few sperm cells. The usual smell of semen can be altered when bacteria are present, leaving a smell of rot.

• pH: With this parameter, you can know the degree of acidity or alkalinity that semen has, usually it has to be between 7.2 and 8. When the pH is lower, that is, more acidic, it may be due to the failures of the seminal glands. When the pH is higher, that is, more basic, and can suggest a genitourinary infection.

• Concentration: In order to study the number of sperm in each milliliter, the microscope analysis of the collected sample is used. This is how the sperm count in a specific field is counted one by one, and then a fairly accurate estimate is made. Only complete sperm are counted, that is, with head and tail. Typically, sperm concentration is greater than or equal to 15 million per mL.

• Number of sperm per ejaculation: Once the volume of semen that is ejaculated and the concentration of sperm have been determined, the total number of sperm that would be in the ejaculate can be easily calculated. Usually, the number of sperm is greater than or equal to 40 million in each ejaculation.

• Motility: The different patterns of sperm movement have been studied and classified into three types: progressive (which go forward), non-progressive (which move but do not go forward) and immobile. Typically, at least 40% of the sperm move and more than half of them have a progressive pattern. When these conditions are not met, it is termed as asthenozoospermia. It is a frequent cause of male infertility.

• Morphology: refers to the sperm shape. Using strict criteria there should at least 4% of sperm cell with a completely normal shape. When there are fewer it is called teratozoospermia.

• Vitality: The study of sperm vitality consists of detecting how many sperm cells are actually dead at the time of ejaculation. For this, stains that paint dead sperm are usually used. Presence of an excessive number of dead sperm cells is referred to as necrozoospermia.

• Agglutination: Detects antibodies against sperm. In normal situations, more than half of the sperm should not join the pellets that are used to perform this analysis.

Sperm DNA Fragmentation: DNA fragmentation index (DFI) is a test that evaluates the genetic integrity of sperm. Studies demonstrate that men with high rates of sperm DNA fragmentation are at an increased risk for infertility, their partners may be at increased risk for miscarriage. It is not part of a standard semen analysis but may be recommended in some cases to further evaluate sperm quality.

Medically assisted procreation solutions at West Coast Fertility Centers

For cases of male factor infertility West Coast Fertility offers treatments that can achieve pregnancy with the partner's sperm through intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection. We work closely with fertility trained urologists to treat complex cases of male infertility which require a combination of medical and surgical approaches to collect sperm. West Coast Fertility also offers treatment with donor sperm obtained from a licensed sperm bank.

The probability of achieving a pregnancy does not depend exclusively on the results of the sperm analysis, which is based on reference values and is not necessarily indicative of fertility. A consultation with one of our Reproductive Endocrinology physicians is recommended to put the semen analysis results into perspective and come up with a detailed recommendation for the couple.