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Semen Analysis

Come back soon to view a video on the Semen Analysis Process

Come back soon to view a video in which Dr. Kuang created during research where a fluorescent microscope was used to find sperm that could survive chemotherapy treatments.

Dr. K, what is a normal SA?

A careful quantitative and qualitative examination of your semen is the foundation upon which your male infertility evaluation is built upon. The volume, the viscosity, the color and the pH of the semen is determined. Then using a microscope, a drop of the semen is examined to count all the sperm within it. This will determine the sperm concentration, then we will see how many are moving which is the sperm motility. Finally, the sperm will be assessed for how normal they look which is called the sperm morphology. Additionally, the number of round cells is counted. This is important because if there are too many round cells, then this can be a sign of infection or inflammation that should be treated if possible.

According to the World Health Organization, the criteria for a normal semen analysis is as follows:

Volume:

2.0 mL or more (As a reference point, one teaspoon is 5.0 mL)

pH:

7.2 or higher

Sperm Concentration:

More than 20 x 106 spermatozoa in every one mL of semen.

Total Sperm Count:

More than 40 x 106 spermatozoa in the whole ejaculate

Motility:

More than 50% should be motile.

Morphology:

The head should be oval and smooth. Round, pyriform, pin, double and amorphous heads are all abnormal. The midpiece should be straight and slightly thicker than the tail. The tail should be single, unbroken, straight and without kinks or coils. A minimum of 100 sperm must be counted for a credible morphologic evaluation.

White Blood Cells:

Less than 1-5 x 106/mL

Vitality:

50% or more live.

Dr. K, are there other sperm tests that we can do to better assess my reproductive potential?

Recently, more sophisticated tests have been developed to better assess the “health” or quality of sperm. These tests include the Sperm Chromatin Structure Assay (SCSA), the TUNEL assay, the Halo assay and the Comet assay. While preliminary research has suggested a correlation with these assays and outcomes with IVF, more studies are needed before we can say with certainty how they pertain to your reproductive capacity.

Dr. K, how many days do I need to abstain from ejaculation before providing a semen sample and how many samples will I need to give

Collecting a Semen Sample

It is best to abstain from ejaculation for at least 3 days. This allows us to obtain a sample that is most representative of your reproductive potential. The primary and preferred method of collection is through masturbation. If you prefer, you can actually collect it at home and bring it in within one hour. Please place the sample near your body during transit (A great place is in the front pocket of your shirt). No lubrication should be used while obtaining the sample since it can actually hurt your sperm and give us a false impression of your fertility potential. Due to religious, cultural or personal reasons, some men are only able to obtain a semen sample through sex. If this is the case for you, please let us know and we can make special provisions for a special condom designed for this purpose.

A minimum of two semen analyses several weeks apart will be needed for your fertility evaluation. Since a man’s sperm count can fluctuate over time, we like to base our evaluation on more than one semen sample. This allows us to more accurately assess your fertility potential. Moreover, having to masturbate and ejaculate into a cup is not the most comfortable situation and the first semen sample may consequently may not reflect a man’s “best stuff”.

Dr. K, I have prostatitis. Can that impact my fertility potential?

Some men who face the challenge of male infertility actually harbor low levels of inflammation in their prostates (prostatitis). It is most often due to low levels of infection. Often the tip-off that something is not quite right is the finding of inflammatory cells called leukocytes in the semen analysis. When there are more than 1-5 Million/mL leukocytes in the semen, it suggests that the prostate may be inflamed. The inflammatory cells often release Reactive Oxygen Species (ROS) which are chemical agents that harm innocent bystanders such as sperm (Pasqualotto et al. , Urology 55(6): 881-885, 2000). Preliminary research suggest that sperm react to the toxic presence of leukocytes by undergoing a process of cell death (Hu et al., Prostate Cancer and Prostatic Diseases 1-5: 1365, 2006). When this is diagnosed, the treatment involves antibiotics, frequent ejaculation (to clear the leukocytes out of the reproductive pipes) and anti-oxidants. The anti-oxidants like Vitamin E & C can also help to minimize the deleterious effects of ROS on sperm.

Dr. K, I’ve heard about sperm autoantibodies? What are they and are they a problem?

Antibodies are proteins that our bodies produce that bind other proteins. While they often help protect our bodies, they can also cause fertility problems when they bind to sperm. These sperm autoantibodies are actually found in up to 10% of men who present with infertility and are often the result of inflammation, infection and obstruction. Sometimes, a cause is never found. Additionally, sometimes

How do you diagnose sperm autoantibodies ? Dr. Kuang will work with you and the andrology lab to get an accurate assessment of your sperm. One sign of antibodies is that the sperm will often clump into groups of sperm. If this is seen, antibody tests will be performed to confirm the presence of these proteins. Sometimes, the cervical-mucus test (where sperm are tested to see how far they can swim through a woman’s cervical mucus at the time of ovulation) may also identify men who have sperm that cannot swim well due to antibodies.
What can you do about the autoantibodies? Dr. Kuang will perform a careful medical history and thorough physical exam looking for any obvious causes that can be treated. Special techniques of sperm washing and preparation can be used to circumvent the inhibitory properties of sperm autoantibodies. This is one more step toward optimizing a man’s reproductive capacity to help a couple reach their fertility goals.

Dr. K, when I ejaculate, the volume seems a little low? What does that mean?

When you ejaculate, more than 85-90% of the volume comes from your seminal vesicles (an organ that supplies the energy and nutrients that sperm need for their long journey in a woman’s reproductive tract). Fluid with sperm from your testicles actually makes up only a small percentage of your ejaculate. The seminal vesicles and prostate are important because they surround your sperm with a comfortable environment filled with the proper nutrients to help sperm on their journey out your penis and into your partner’s reproductive tract. In order for the proper amount of ejaculate to be produced and expelled, the seminal vesicles must be present; the proper nerve signals must be properly sent and the path out to the tip of your penis must be wide open.
For some men facing infertility, the volume of semen is low. Most commonly, it is due to a collection that was suboptimal. If you are able to collect a representative sample and the volume is truly low, we will make sure that the sperm are not going backwards into your bladder (retrograde ejaculation) by looking at your urine after you ejaculate. A significant number of sperm in the urine is often indicative of retrograde ejaculation. After a thorough history and a comprehensive physical exam, another part of the evaluation will likely include taking some pictures of your prostate and the seminal vesicles via ultrasound to answer whether there is some blockage that is preventing the fluid from the seminal vesicles from getting out to the tip of your penis. Based on his findings, Dr. Kuang will help you and your partner determine what the next step may be in helping you build a healthy family. It may include options such as medications to help increase the nerve signals to the seminal vesicles or treatments to relieve an area of blockage.

Dr. K, I been on supplemental testosterone for a while. Is that going to be a problem for my fertility?

It is becoming more common to see young men who have been on testosterone or steroid supplements. In 1994, it was estimated that 1.1 million adults or 0.5% of the adult population stated that they had used anabolic steroids in the past. The reasons that the supplements are started often involve a desire for increased energy, improved sexual performance or improved physical performance in sports. What many of these men don’t realize is that when a man takes testosterone or steroids, no one remembers to let the brain know. As a result, the brain sees a sudden surge of testosterone/steroids in the blood stream and thinks that it is all coming from the testicular factory. It falsely interprets that the factory has gone into overdrive and is making too much of everything including sperm. As a result, it begins to shut down the factory. Consequently, sperm production is reduced or even completely stopped which results in oligospermia or azoospermia. Please let me know if you think you are on or have been on these types of supplements since it can significantly alter your reproductive treatment plan. While 80% of these men may see a return of sperm to their ejaculate or even have sperm in the testicles that can be used for IVF, it can take sometimes 1 or 2 years before we see the return of sperm.

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