Rudi Hayden

Urologist

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Blood-tests Explained


Disclaimer:

This website is intended to assist with patient education and should not be used as a diagnostic, treatment or prescription service, forum or platform. Always consult your own healthcare practitioner for a more personalised and detailed opinion

Semen Analysis


At a Glance

Why Get Tested?

To learn about the health of your reproductive organs, particularly if your partner is having trouble becoming pregnant, or after a vasectomy to determine if the operation was successful

When to Get Tested?

When you think you might have a fertility problem or after you have had a vasectomy

Sample Required?

A semen sample collected in a sterile, wide-mouth container provided by the lab, usually collected on-site; sample must be analyzed within one hour of collection. Two separate collections on two separate days may be required when testing for fertility problems.

Test Preparation Needed?

Sexual abstience for 2-5 days before sample collection; carefully follow instructions provided

The Test Sample

What is being tested?

A semen analysis measures the quantity and quality of the fluid released during ejaculation.It evaluates both the liquid portion, called semen or seminal fluid, and the microscopic, moving cells called sperm. It is often used in the evaluation of male infertility.

Semen is a viscous, whitish liquid that contains sperm and the products from several glands. It is fairly thick at ejaculation but thins out, or liquefies, within 10 to 30 minutes.Sperm are reproductive cells in semen that have a head, midsection, and a tail and contain one copy of each chromosome (all of the male's genes). Sperm are motile, normally moving forward through the semen.Inside a woman's body, this property enables them to travel to and fuse with the female's egg, resulting in fertilization. Each semen sample is between 1.5 and 5.5mL (about one teaspoon) of fluid, containing at least 20 million sperm per mL, and varying amounts of fructose, buffers, coagulating substances, lubricants, and enzymes that are intended to support the sperm and the fertilization process.

A typical semen analysis measures:

  • Volume of semen
  • Consistency (thickness) of the semen
  • Sperm concentration (density)
  • Total number of sperm (sperm count)
  • Sperm motility (percent able to move as well as how vigorously and straight the sperm move)
  • Number of normal and not normal (defective) sperm in terms of size and shape (morphology)
  • Coagulation and liquefaction
  • Fructose (a sugar in semen that gives energy to sperm)
  • pH (acidity)
  • Number of immature sperm
  • Number of white blood cells (cells that indicate infection)

Additional tests may be performed if the sperm count is low, has decreased motility, abnormal morphology, or if the seminal fluid is found to be abnormal. These additional tests may help identify abnormalities such as the presence of sperm antibodies, abnormal hormone levels (testosterone, FSH, LH, prolactin), excessive number of white blood cells, and genetic tests for conditions that may affect fertility, such as Klinefelter syndrome, cystic fibrosis, or other chromosomal abnormality.

In some instances, radiologic testing using ultrasound, CAT scanning, or MRI may be employed. A biopsy of the testicle may also be needed. Sometimes a test called cryosurvival is done to see how well semen will survive for long-term storage if a couple would like to store sperm for future pregnancies.

How is the sample collected for testing?

Most laboratories require samples to be collected on-site as the semen needs to be examined within 60 minutes after ejaculation in order to maintain the quality of the specimen.

Semen is collected in a private area by self-stimulation. Some men, for religious or other reasons, might want to collect semen during the act of intercourse, using a condom. If this is the case, the health care provider should provide the condom or sheath because lubricated condoms can affect test results.

Sperm are very temperature-sensitive. If collection is done at home, the sample should be kept at body temperature (98.6oF/37oC) by keeping it next to the body during transportation. It should not be left at room temperature for an extended period of time and should not be refrigerated.

Sperm motility decreases after ejaculation; thus, timing and temperature are critical to obtaining accurate information. Poor sampling may require repeat testing.

Is any test preparation needed to ensure the quality of the sample?

To give sperm a chance to replenish, abstain from ejaculating for 2 to 5 days before the sample is collected. Longer periods of abstinence may result in a greater volume of semen but decreased sperm motility. You may also be asked to avoid alcohol consumption for a few days before the test as well. Follow any instructions that are provided.

The Test

How is it used?

A semen analysis is used to determine whether a man might be infertile—unable to get a woman pregnant. The semen analysis consists of a series of tests that evaluate the quality and quantity of the sperm and the environment they reside in, the semen.

The semen analysis also can be used to count sperm after a man has had a vasectomy, a procedure that prevents sperm from being released within the ejaculate and that is considered a permanent method of birth control (99.9%) when performed by an experienced surgeon. If sperm are present in the semen, whether still active or not, the man and his partner will have to take precautions to avoid pregnancy. He will have to return for one or more sperm counts until sperm are no longer present in his sample(s).

When is it ordered?

A semen analysis is performed when a health practitioner thinks that a man or couple might have a fertility problem. Male factors are implicated in up to 50% of infertility cases. Male infertility can have many causes, some that can be treated successfully. If male factors are involved, analysis of the semen is necessary to determine what is inhibiting fertility and, when indicated, to evaluate the feasibility of using assisted reproductive technology (ART) to facilitate pregnancy.

A semen analysis to determine fertility should be performed on a minimum of two samples at least seven days apart over a period of two to three months. Sperm count and semen consistency can vary from day to day, and some conditions can temporarily affect sperm motility and numbers.

When a semen analysis shows abnormal findings, the test is repeated at intervals as determined by the health practitioner.

A semen analysis is also typically ordered following a vasectomy to confirm success of the procedure and repeated as necessary until sperm are no longer present in the semen sample.

What does the test result mean?

The typical volume of semen collected is between 1.5 and 5.5 milliliters (mL) of fluid per ejaculation. Decreased volume of semen would indicate fewer sperm, which diminishes opportunities for successful fertilization and subsequent pregnancy. Excessive seminal fluid may dilute the concentration of sperm.

The semen should initially be thick and then liquefy within 15 to 30 minutes. If this does not occur, then it may impede sperm movement.

Sperm concentration (also called sperm count or sperm density) is measured in millions of sperm per milliliter of semen. Normal is at least 20 million or more sperm per mL, with a total ejaculate volume of 80 million or more. Fewer sperm and/or a lower sperm concentration may impair fertility.Following a vasectomy, the goal is to have no sperm detected in the semen sample.

Motility is the percentage of moving sperm in a sample and graded based on speed and direction travelled. At least 50% should be motile one hour after ejaculation, moving forward in a straight line with good speed. The progression of the sperm, best measured using an automated system, is rated on a basis from zero (no motion) to 4, with 3-4 representing good motility.If less than half of the sperm are motile, a stain is used to identify the percentage of dead sperm. This is called a sperm viability test.

Morphology analysis is the study of the size, shape, and appearance of the sperm cells. The analysis evaluates the structure of the sperm, whereby greater than 50% of those cells examined must be normal in size, shape, and length. The more abnormal sperm that are present, the lower the likelihood of fertility. Abnormal forms may include defective heads, midsections, tails, and immature forms. More than 14% should have normal heads. To see an image of a normal sperm, see the MedlinePlus Medical Encyclopedia page on sperm.

Semen pH should be between 7.2 and 7.8, fructose at 150-600 mg/dL, and there should be fewer than 2000 white blood cells per mL. A pH of 8.0 or higher may indicate an infection, while a pH less than 7.0 suggests contamination with urine or an obstruction in the ejaculatory ducts.

Agglutination of sperm occurs when sperm stick together in a specific and consistent manner (head to head, tail to tail, etc.) suggesting an immunologic cause to infertility. Clumping of sperm in a nonspecific manner may be due to bacterial infection or tissue contamination.

Is there anything else I should know?

In an evaluation of a man's fertility, each aspect of the semen analysis is considered, as well as the findings as a whole.Each part of the semen analysis either contributes to confirming male fertility or, if abnormal, lessens it. While abnormal results decrease the chances of fertilization, some couples with poor results may still conceive, with or without assistance, and those with apparently good results may experience difficulties.

Several factors can affect the sperm count or other semen analysis values, including use of alcohol, tobacco, caffeine, many recreational and prescription drugs (e.g., cimetidine), and some herbal medicines such as St. John's wort.