Male infertility testing is an important part of making an accurate infertility diagnosis. Recent studies have shown that between 40% and 50% of infertility cases are due to male factor infertility. While there are a few male fertility problems that are visible, such as hypospadias, undescended testicles, and impotence, the majority of fertility issues in men are not obvious.
Ideally, the male should be tested first as male infertility testing is not as invasive or complicated as female infertility testing. Although there are a variety of tests that can be used to assess a man’s fertility, the most common, and perhaps important, is the semen analysis.
What is a Semen Analysis?
A semen analysis is a simple test that assesses the formation and maturity of sperm as well as how the sperm interact with the seminal fluid. To do semen analysis, a fresh semen sample (no more than a half hour old) is collected and then analyzed in a laboratory for a variety of different factors. Men who are uncomfortable with the idea of semen collection in a clinical setting may be able to provide their sample in the comfort of their home so long as they live close to their fertility clinic. Check with your fertility clinic first, though, as many prefer that the sample be provided on-site. Semen can also be collected using a special type of condom for those men that have troubles providing an "on demand" sample by themselves.
In order to ensure the best possible sample, and therefore get the most accurate results, it is necessary to:
- Abstain from sex for two to four days prior to the day of testing
- Use a clean, sterile container
- Avoid spilling or leaking any of the collected semen
- Avoid using a lubricant, which can kill sperm
- Keep the sample at room temperature
Once your sample arrives at the lab, it will be assessed for many different factors. First, the fertility doctor will examine the semen.
- Semen Volume: Normal semen volume can range from between 2 and 6ml. If the volume is found to be abnormal, either too low or too high, it is likely that there is a problem with the seminal vesicles and/or prostate. A low semen volume will make it difficult for sperm to make its way to the cervix while a high semen volume will decrease the concentration of sperm by diluting them.
- Viscosity: This refers to the semen’s ability to return to a liquid form shortly after ejaculation. If semen does not liquefy, or if it becomes too thick, then there is likely an infection in the seminal vesicles and prostate.
- pH Balance: Semen should have an alkaline pH in order to protect it from the acidic vaginal fluids. If the semen has taken on a more acidic pH, then a problem with the seminal vesicle can be suspected.
- Fructose: This sugar is a necessary component to seminal fluid as it provides sperm with energy. Lack of fructose indicates a block somewhere along the male reproductive tract.
Once analysis of the semen has been conducted, your fertility specialist will move on to examining the quality and quantity of sperm.
Often compared to tadpoles because of their shape, a sperm cell is not visible to the naked eye and needs to be examined under a microscope. During a semen analysis, sperm are assessed on their volume, motility, morphology, and the presence of clumping.
- Sperm Count: How many sperm are present in your semen sample is important as too few can significantly decrease your chances of conceiving. A man is considered to have a low sperm count if his sample is found to have less than 20 million sperm per ml. A diagnosis of a very low sperm count is given when sperm volume falls below 10 million per ml. Men that are found to have no sperm in their semen are said to be azoospermic.
- Sperm Motility: This part of the test assesses how well your sperm can swim. Obviously, the stronger the swimmers, the better as it is quite a journey for the sperm to make it from the uterus to the fallopian tubes. Sperms are evaluated according to a four-level grade system:
- Grade 4 sperm are known to have progressive motility meaning they are the strongest and swim fast in a straight line.
- Grade 3 sperm (non-linear motility) also move forward but tend to travel in a curved or crooked motion.
- Grade 2 sperm are labeled as non-progressive motility because they do not move forward despite the fact that they move their tails.
- Grade 1 sperm are immotile meaning that they fail to move at all.
- Morphology: A sperm’s shape is also an important factor when it comes to conception. Ideally, sperm should have an oval head that is connected to a mid-piece and a long, straight tail. Abnormally shaped sperm will likely not be able to fertilize an egg. If too many abnormally shaped sperm are present in a semen sample, then it is likely that all sperm have some type of problem with them.
- Clumping: Obviously, if sperm is sticking together, there is a problem as clumping prevents proper motility of the sperm.
In addition to this criteria, the presence of white blood cells (or pus cells) will also be assessed. While a few white blood cells are normally found in semen, an abundance of these cells can indicate a seminal infection.
Semen Analysis Results
Ssemen analysis results are only as good as the fertility team performing the test. If semen has not been collected properly; the test was performed too long after semen collection; not enough time between ejaculations was given; or if a man has had a systemic illness within the last three months, results of the test may be incorrect.
So long as the test was done properly and the results are normal, there is no reason to repeat the test. However, if the results come back abnormal, it is likely that additional semen tests will be done. Why the repeat? Quite simply, sperm counts and quality naturally fluctuate. As production of sperm can take several months, it is likely that re-testing will be performed several weeks apart over the next three to six months.
Once a proper diagnosis has been made, you can begin to investigate your male infertility treatment options. Just which form of fertility treatment is best for you will depend upon the cause of your infertility.