Every day throughout the month of November (MOvember) the team at Yinstill has committed to publishing one blog or article each day. Since I will have the opportunity to make four contributions, I decided to offer my submissions in the form of a series. The first two will be about the semen analysis, what to expect and how to interpret the findings. The third and fourth will focus on the physical impediments that reduce sperm quality and quantity, and ideas for treatment approaches to improve sperm parameters.
Semen analysis (part 1)
When referring to sperm and the man’s contribution to fathering a child, let’s look closer at the old saying “It only takes one”. Although technically only one sperm actually enters the egg and presents its DNA for merging and replication, millions are required. Once they reach the egg, several hundred thousand sperm are required to release enzymes to break down the outer shell of the egg and facilitate the entry of that one sperm. Even the mal shaped sperm have a role to play, they clog the pathway and serve a function to prevent a potential competitor’s sperm from reaching the egg. A semen analysis serves as an outline of what is contained in the ejaculate and can give a prediction of fertility potential.
The basic fertility workup for men will most often consist of a semen analysis, basic blood tests, as well as a complete health history. If this examination is performed by a reproductive urologist, a physical exam of the testicles and associated structures will also be done. The semen analysis is really the starting point to discover if there are any issues with a man’s fertile potential (ability to fertilize an egg). It should be done at least twice to best highlight any abnormalities in quality or variations in quantity, as these numbers can fluctuate from sample to sample.
The semen analysis is performed on living active sperm and therefore requires a sample to be obtained within a maximum of two hours of it being tested. Therefore it must be collected and brought to the laboratory for testing as soon as possible after collection. Here in Vancouver, the labs require men to make an appointment for their drop off to best ensure that the sample will be evaluated within the two hour testing window. The sample is evaluated for its quantity and quality through the following criteria:
- Volume – 1.5 – 5 mm
- Sperm count / concentration – number of sperm in 1 mm of sample
- Liquefaction – usually given as either normal or abnormal (thin or thick)
- Viscosity – also given as either normal or abnormal
- Overall appearance – normal or abnormal
- pH – the overall acidity of the sample
- Motility – refers to the ability of the sperm to swim, given as a percentage, over 40% is favourable
- Motility progressive – also given as a percentage, this number refers to the ability of the sperm to move forward. 32% is the bottom value of the scale.
- Morphology – refers to the shape of the sperm cells
- Normal forms – should be above 4 %
- Abnormal forms – some labs will also provide the breakdown of where the abnormality was detected: head, body or tail of the sperm cell.
- Immature forms
- Presence of white blood cells – this can be an indicator of infection present in the urogenital system
Different labs may use different criteria, The above criteria is what is commonly used by LifeLabs in BC. A semen analysis done at a private reproductive health facility will often be more comprehensive and provides a room to produce the sample onsite.
Collection of the sperm is done by masturbation and depositing the complete ejaculate into the plastic cup provided. The size of the cup will be daunting, it is not meant to be filled. The average ejaculate volume is between 1.5 and 5 mm or ¼ to 1 teaspoon; not a lot – it will just cover the bottom of the cup in most cases.
It is recommended to abstain from intercourse or ejaculation for 3 to 4 days prior to the semen analysis. For couples trying to conceive, it is best to do the semen analysis at a time in the menstrual cycle when the woman is not ovulating.
Further information and resources:
BC BioMed information sheet for patients
PCRM – Men and Fertility
Genesis Fertility Centre – Evaluation for Men
Grace Fertility Centre – Male Factors and Infertility