Semen Analysis

A semen analysis test is often recommended when a couple is facing problem in conceiving. While a woman may be required to undergo several tests, the man just has to have a semen analysis test. The test bares all the facts regarding the semen and the sperm. It gives a detailed report about the various aspects of the semen and the quality and quantity of sperm along with sperm motility and morphology.

Semen Analysis
Semen Analysis

WHAT IS SEMEN ANALYSIS?

Semen analysis is required as a part of infertility testing if a man is having trouble in impregnating his partner. The aim is to see if the semen and sperm produced by the male partner are normal or not. A semen analysis is also requested following a vasectomy 3 month after the procedure, to be completely certain that the man is sterile.

A complete semen analysis test measures the quantity and quality of the semen during ejaculation. It evaluates both the liquid portion called semen or seminal fluid, and the microscopic, moving cells called sperms. The quality of sperm is very important for fertility. Most of the cases of male infertility are a result of either poor quality sperm or a low sperm count or a nil sperm count.

WHY IS SEMEN ANALYSIS TEST RECOMMENDED?

A semen analysis is usually requested in the following situations.

Male infertility – A semen analysis test is usually done when a doctor suggests the test thinking that a man or couple might have a fertility problem. It’s needed to be used together with other clinical information when a doctor is investigating infertility. A semen analysis test should be done 3 months apart on two samples, second analysis can be done, if the first analysis report is abnormal. As sperm count and the consistency of semen can vary from day to day, and some conditions can temporarily affect sperm production, sperm motility and sperm concentration which may result in an abnormal report.

Vasectomy – The semen analysis test is also recommended after a man has had vasectomy to check if there is any presence of sperms in the semen, hence to determine if vasectomy was successful. Because some vasectomy which are done by placing a clamp on the tube or ring are not very effective and many women have reported that they have become pregnant after their husbands have had a vasectomy.

Vasectomy reversal – Semen analysis test is also recommended after a vasectomy reversal procedure, to see if the procedure was successful. After vasectomy reversal procedure the semen analysis test result should show presence of good quantity of sperms in the ejaculate.

SEMEN ANALYSIS TEST PROCEDURE

A semen analysis test also known as the sperm count test, is the laboratory testing of freshly ejaculated semen. A semen analysis in the laboratory begins with the physical examination of the sample including determination of pH, volume, viscosity and visual appearance of the sample. The semen volume is measured by a graduated pipette. pH is measured by pH paper and tends to increase with time. The semen should liquefy within 60 minutes of reaching the lab. Semen viscosity is assessed by estimating the length of the thread formed when releasing a drop of semen from a pipette.

After liquefaction of semen, a drop of semen is taken in a slide and is examined microscopically. The main sperm parameters to be determined now are motility, concentration, morphology and vitality. Sperm concentration is measured by volumetric dilution and hemocytometric counting of the sperm. Sperm vitality is assessed by dye exclusion test, dead cells with an intact membrane will take up the colour of the dye and stain pink/red, and live sperms will show tail curling with hypo osmotic swelling test (HOS). For sperm motility we will add 10ul of semen in a slide and cover it with a coverslip and read in 40 X magnification. And for sperm morphology staining with hematoxylin-eosin is done to analyse the shape and size of head, neck and tail and record any abnormal sperms.

Semen is the fluid which harbours the sperm and it contains other sugar and protein substances as well. Other than microscopical examination, physical examination, biochemical tests, bacteriological, serological and immunological tests are done as well.

WHERE IS A SEMEN ANALYSIS TEST DONE?

Testing should be done at a specialised laboratory that uses methods approved by the World Health Organisation (WHO); special equipment and expertise are needed to do an accurate semen analysis. Specialised laboratories such as those associated with IVF programs, perform more extensive testing. The cost of semen analysis can be found out by contacting the laboratory doing the analysis.

CAN SEMEN ANALYSIS TEST BE PERFORMED AT HOME?

Home semen or sperm analysis tests are available, but they only tell the sperm count. They don’t analyse the sperm motility and the sperm morphology. Results for tests performed at home can be available in 10 minutes. Getting a normal sperm count from a home test doesn’t mean that a man is fertile, since it doesn’t consider all the possible causes of male infertility.

WHAT ARE THE PREPARATIONS NEEDED BEFORE THE TEST

Collecting semen for a semen analysis test needs some preparation and it is very important to follow these instructions to get an accurate result.

  • One should avoid ejaculating 24-72 hours before the test.
  • Ensuring a good sexual activity at least for a week before abstinence. This will result in getting active sperms.
  • Consumption of alcohol, smoking, taking drugs like cocaine, marijuana should be stopped at least 5 days prior to the semen analysis test.
  • Any kind of medicines, herbal, homeopathic, ayurvedic, anabolic steroids should be stopped. The doctor should be informed before hand if one is using any kind of prescribed medicines. Because this can affect sperm quality.
  • Any kind of hormonal medicines should be stopped too.
  • One should not give semen sample if unwell or suffering from any kind of infection.

HOW TO COLLECT A SEMEN SAMPLE?

On the day of the test, a fresh semen sample is collected. There are number of ways to collect semen either by self-stimulation or masturbation and the semen is then transferred into a sterile container.

  • Masturbation in the clinic is considered the best way to give a semen sample. This way the semen remains clean and uncontaminated.
  • Sex with withdrawal just before ejaculation, and then the ejaculate can be collected in a sterile container. But it can have some contaminants, and the first portion of seminal fluid which contains more sperm and is rich in higher DNA quality, and with higher motility, are lost in the withdrawal method.
  • Semen sample can also be collected in a condom while having sex. But the condom should not contain any lubricant or powder on it. Presence of spermicide can affect sperm quality and kill sperms.
  • Semen sample can also be collected by using electric stimulators.

If the semen is collected at home, then to ensure a good quality semen it must be kept in mind that the semen must be kept at body temperature. If it gets too warm or too cold, the results will be inaccurate, and the semen must be delivered to the laboratory within an hour of collection.

WHAT DOES THE SEMEN ANALYSIS TEST REPORT SHOW?

After the collection of the semen sample, the results should be ready within 24 hours to 1 week depending on the turnaround time of different laboratories. The semen analysis test result provides a detailed breakup of the different properties of the semen and the sperm count in the semen. When a doctor looks at a semen analysis report there are many factors that he or she needs to consider. If the doctor is looking for the cause of infertility, he may look at the report with depth and each of the following parameters are considered

  • Sperm count – A man should ideally ejaculate more than 15 million sperm in every millilitre of semen. This is considered as a normal sperm count. A count of less than 15 million is considered a low sperm count. A male with a low sperm count cannot impregnate his partner.
  • Sperm morphology – The shape of the sperm is important for it to move as well as penetrate the female egg. Every male has a certain percentage of abnormally shaped sperm. However, if the percentage of abnormally shaped sperm is high then the person is diagnosed with poor sperm morphology. The abnormalities may be in the sperm head, sperm tail and the midpiece.
  • Sperm Motility – Sperm movement or motility is important to fertility because sperm must travel all along the long trail from the cervix to the fallopian tubes to fertilise an egg. Depending on their movement the motility of sperm is divided into three different grades.
    1. Grade a – These are sperms with progressive motility. These are the strongest and swim fast in a straight line.
    2. Grade b – These sperms are with non-progressive motility that means they also move forward but tend to travel in a curved or crooked motion.
    3. Grade c – These are immotile sperms and fail to move at all.
    In a semen analysis report total motility is given as the sum of progressive motility and non-progressive motility.
    Total motility = (Grade a + b)
  • Volume of semen – The amount of semen that a man expels in a single ejaculate is measured and recorded as the semen volume. Usually the semen volume should be in the range of 2-5 ml. Men with lower volume of semen could be suffering from blockage in the ejaculatory duct and would indicate a low amount of sperm to fertilise an egg.
  • Liquefaction time – The semen on ejaculation is a thick gel like substance. It should take 15-30 minutes to liquify. Its ability to liquify helps sperm in their motility. Fertility is affected if the semen does not liquify in the said time, then the sperms would get stuck in the gel like substance and their movement would be restricted.
  • Appearance – The appearance of semen should be whitish gray and opalescent. If the semen is reddish brown in colour that means, there is presence of blood in the semen and the condition is called hematospermia. Yellow semen may be present in men who have jaundice, there could be urine present in the semen, presence of white blood cells in the semen due to infection can cause yellow semen, sexually transmitted diseases can cause yellow semen and an unpleasant odour, eating food that contains dyes can also cause yellow semen.
  • pH balance – A pH level should be between 7.2-7.8 to achieve a normal result. A pH level more than 8 would indicate that the man has infection. A low pH value would indicate a blockage in the man’s ejaculatory duct.
  • Vitality or Viability – Sperm viability refers to the percentage of live sperms in the semen sample. This is an important parameter to measure if sperm motility is low to differentiate between live non-motile sperm and dead sperm. At least 58% of the sperms should be viable.
  • Fructose level – Fructose level in the semen may be analysed to determine the amount of energy available to the semen for moving. Absence of fructose may indicate a problem with the seminal vesicles.
  • White blood cells – A high level of white blood cells is called leucospermia and might indicate an infection.

WHAT DOES A NORMAL SEMEN ANALYSIS TEST REPORT SHOW?

To render a semen analysis report as normal, the results of the semen analysis conducted as part of an initial assessment of male infertility should be compared with WHO (World Health Organisation) reference values. A normal sperm report is reassuring and usually does not need to be repeated,

The World Health Organisation (WHO 2010) published reference values to help work out how an individual semen analysis result compares to a population of fertile men. A semen analysis within the reference range does not guarantee that a man is fertile, but it gives a guide as to whether the man is likely to be fertile. A normal semen analysis report shows a good semen quality, but in addition to that other factors that can affect the couple’s chances of getting pregnant which include the couple’s frequency and timing of sex, the length of time the couple has tried to get pregnant, and the age and fertility of the female partner.

Semen Analysis Test – Normal Values

Parameter Definition Reference Range
Semen Volume Total amount of fluid ejaculated >= 1.5 mL
Sperm Count The total number of sperm in the
measured volume of ejaculate
>= 15 million per mL
Total Sperm Number Total number of sperm in the ejaculate >= 39 million
Sperm Motility Number of motile sperm compared to non-motile sperms and is reported as Percentage. Total motility >= 40% motile sperms within 60 minutes of ejaculation.

Progressive motility >= 32%

Sperm Viability Or Vitality The number of sperms in the sample that are alive as a percentage of the total number of sperms >= 58%
Sperm Morphology Number of ideally shaped sperms as compared to imperfectly shaped sperms and reported as percentage of the total number of sperms >= 4%
White Blood Cells Large number of WBC can be a sign of infection in the reproductive tract < 1 million per mL
Semen pH Measured to test if the semen is acidic or alkaline. >= 7.2
Sperm Antibodies Normally done in specialised laboratories using methods approved by WHO <= 50% motile sperm Showing antibody activity

The above table shows the reference ranges (modified) from WHO laboratory manual for the examination and processing of human sperm.

 

semen-analysis-normal-values
Semen Analysis Test – Normal Values

WHAT DOES AN ABNORMAL SEMEN ANALYSIS TEST REPORT SHOW?

An abnormal semen analysis report would mean that either the sperm count is low, or maybe the test results show poor sperm motility or morphology. The acidity of the semen and the presence of WBC (suggests infection) may also affect fertility.

It is important to note that only one poor result won’t mean a man is infertile. Semen analysis can be affected by a recent illness, anxiety and other various factors. The doctor would suggest one or two follow up tests to confirm the test. All the parameters of semen analysis are to be considered together. If after 2, 3 repeat semen analysis tests the abnormal result persists the doctor would suggest some other tests and some minor alterations to lifestyle or medication. Latest developments in reproductive medicine have made it possible to treat many infertility issues. In case of an abnormal report again an andrologist could be consulted who would understand the semen analysis report in detail and suggest the best infertility treatment available.

Semen Analysis – Abnormal Results

Abnormalities Definition
Aspermia
Absence of semen
Azoospermia
Absence of sperm in the semen
Hypospermia
Low semen volume
Hyperspermia
High semen volume
Oligozoospermia
Very low sperm count
Polyzoospermia
Abnormally high sperm count in the ejaculate
Asthenozoospermia
Poor sperm motility
Teratozoospermia
Sperms that have morphological defects
Necrozoospermia
All sperms in the ejaculate are dead
Leucospermia
A high level of white blood cell present in the semen
Hematospermia
Presence of red blood cells in the ejaculate

 

semen-anaylsis-abnormal-results
Sperm/Semen Analysis : Abnormal Results

THE FACTORS THAT CAN INFLUENCE A SEMEN ANALYSIS REPORT

  • Incorrect semen collection techniques, if the sample is not collected properly or the container is not sterile.
  • Time delay between providing the sample and testing the sample in the laboratory.
  • Too short an interval since the previous ejaculation.
  • Recent illness in the last 3 months (even flu or a fever can temporarily lower sperm counts).
  • A physical damage in the testicles can produce low sperm count, or a man who has gone through radiation treatment of testicles or had exposure to certain drugs have low sperm counts. Failure of the testicles, obstruction of the tubes that carry semen can all affect sperm count.
Are any other tests done other than semen analysis as a part of male fertility testing?

Other than the basic semen analysis test and depending on its result, a doctor may also order a physical examination, blood work to check hormones, genetic testing to check for chromosomal disorders, scrotal or renal ultrasound, pelvic MRI, post ejaculatory urinalysis to check for retrograde ejaculation, testicular biopsy.

FERTILITY TREATMENT AT MEDICOVER FERTILITY AFTER A SEMEN ANALYSIS TEST

Medicover Fertility offers a wide range of advanced technology in fertility treatments to enable men to overcome severe fertility issues so that they can father their own biological offspring. It is an international brand with high success rate and has 10 clinics in North India.

Once the fertility of the man has been established with the semen analysis test and the other male fertility testing the course of fertility treatment is determined. Men who have low sperm count, but normal sperm motility and sufficient sperm morphology can be considered for IUI (Intra uterine insemination) treatment.

When sperm motility is very low the IUI treatment is not recommended because even though the sperm are placed in the uterus, if they do not have motility, they won’t be able to travel to the fallopian tube and fertilise the egg. In this case IVF would be recommended by doctors.

Men who have nil sperm count, low sperm count, low sperm morphology and motility may be recommended with ICSI (Intra cytoplasmic sperm injection). In men with nil sperm count sperms are retrieved directly from epididymis over testes, the method is called PESA (Percutaneous Epididymal sperm aspiration). Men who have low sperm count for them sperm can be retrieved directly from the testes, the procedure is called TESA (Testicular sperm aspiration), another method of sperm retrieval procedure in men with non-obstructive azoospermia, is called Micro-TESE (Micro-dissection TESE).

Related questions:

Q1) What is semen?

A) Semen is the whitish grey organic fluid that is secreted by the gonads of males. It carries the sperm and fructose and other enzymes that help the sperm to survive to facilitate successful fertilisation.

Q2) How to eject sperm for test?

A) Masturbation in the clinic is considered the best way to give a semen sample. This way the sample remains clean and uncontaminated. Electric stimulators are also used to eject sperm for test. There are other methods too

Q3) How to check Semen analysis?

A) Male fertility is diagnosed through a number of tests, the most important being the semen analysis test. After collection, the semen sample is sent to a laboratory where it is assessed for various factors such as volume of semen, semen count, motility and morphology.

Q4) What to do before a sperm analysis test?

A) Before a sperm analysis test, sample needs to be collected. Hands must be washed thoroughly before taking samples and a man should be refrained from using any lubricants, saliva or spermicide which might affect sperm quality. A man can either give a sample by masturbating in clinic, or some labs might provide semen collection condoms.

Q5) How often should sperm count be checked after vasectomy?

A) Semen analysis to check for sperm count should be done 3 months after vasectomy to see if the procedure was successful.

Q6) What is the best way for us to get pregnant with low sperm count and vitality?

A) I would recommend IVF treatment over IUI treatment since you have a poor sperm vitality.

Q7) What is the cause for yellow colour semen? Do I need to get it checked?

A) Yes, best is to consult a doctor to know the reason. Because a yellowish semen may be due to sexually transmitted diseases, jaundice, presence of very high white blood cells, infrequent ejaculation. In some cases, there may be presence of urine in the semen, and some dietary changes like eating food that contain yellow dyes can also cause yellow semen.

Q8) What is the cause for green coloured semen?

A) A person who is suffering from a prostrate infection might have green coloured semen. Also, some sexually transmitted disease like gonorrhoea can cause green colour semen.

References :
1. https://www.verywellfamily.com/what-if-your-semen-analysis-results-are-abnormal-1960164
2. https://labtestsonline.org/tests/semen-analysis
3. https://andrologyaustralia.org/your-health/semen-analysis/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254491/
5. https://patient.info/health/sperm-test-semen-analysis
6. https://www.medicalnewstoday.com/articles/318893.php
7. https://www.babymed.com/male-infertility/male-fertility-testing-spermanalysis-semenanalysis-and-sperm-count
8. http://infertilityanswers.org/what_are_sperm_antibodies
9. https://www.andrologyaustralia.org/wp-content/uploads/Factsheet_SemenAnalysis.pdf
10. https://www.healthline.com/health/semen-analysis#normal-results

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