Semen Analysis

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.

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.

According to the World Health Organization, the 2010 criteria for a normal semen analysis is as follows:

Volume:

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

pH:

7.2 or higher

Sperm Concentration:

More than 15 million spermatozoa in every one mL of semen (15M/mL).

Total Sperm Count:

More than 40 x 106 spermatozoa in the whole ejaculate

Motility:

More than 40% 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. Please note: This is a very controversial test which is quickly becoming outdated as a test. Please touch base with your male infertility specialist before taking this test too seriously.

White Blood Cells:

Less than 1 x 106/mL

Vitality:

58% or more live.

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.

Collecting a Semen Sample

When you make your appointment, we ask that you abstain from ejaculation for at least 3 days. This allows us to obtain a sample on the day of your clinic visit that is representative of your reproductive potential. The primary and preferred method of collection is through masturbation in one of our private clinic rooms. 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.

It is standard practice to obtain a minimum of two semen analyses several weeks apart. Since men’s sperm counts 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.

It is possible to do your own semen analysis at home. In fact, many couples get quite good at it. You can find all the supplies you need at Amazon.

DNA Damage and Genetic Sperm Studies

No Specific Cause is Found in 23% of Men with Male Infertility

A specific reason for a man’s infertility will not be identified in one of four men. New studies are being developed to help assess the level of DNA damage and genetic abnormalities found in sperm. For those men with severely low sperm counts (oligospermia) with or without poor motility (oligoasthenospermia) as well as men who have had recurrent pregnancy losses, these new tests may help shed light on the 23% of men seen in infertiliy clinics with idiopathic male infertility (when no specific cause is found).

The Sperm of Infertile Men May Have High Levels of DNA Damage

Sperm are self-propelled cells that are aerodynamically designed to carry a tremendous amount of genetic information long distances up to an egg. To do this, the DNA that it carries must be tightly condensed and packaged just right so that it can fit in the head of a sperm (that is only 3 micrometers wide) and remain undamaged as it travel’s from a man into a woman’s reproductive tract. The etiology of sperm DNA damage is multifactorial. The reasons include, but are not limited to, mutations that affect how the DNA is packaged, infections, smoking, chemotherapy and cancers. DNA damage has been associated with lower sperm counts, lower motility, a greater number of inflammatory cells in the semen (leukocytospermia) and increased levels of reactive oxygen species.

Who Should Ask About These Tests? Does it help?

There is a growing body of data that suggests that men with severely low sperm counts (oligospermia) with or without poor motility (oligoasthenospermia) and couples with recurrent pregnancy losses may benefit from having DNA damage tests performed on the semen.

If levels of DNA damage are consistently high, treatable causes such as infection or inflammation must be thoroughly investigated by your male fertility specialist. If high levels of DNA damage persist without any apparent reason, it is important for couples to know that success rates with assisted reproductive techniques such as intrauterine inseminations and in vitro fertilization may be lower. For so many couples who are plagued by the question of “why?”, DNA Damage tests help provide one more piece of the fertility puzzle that can help couples navigate along their reproductive journey.

DNA Damage Tests Are Not Perfect

DNA Damage Tests come in all shapes and sizes. The medical field has created some colorful acronyms such as TUNEL, COMET and Halo. Other names include SCSA. Using different approaches, they all aim to assess the integrity of sperm DNA. Unfortunately, they all suffer from several shortcomings. First, the tests look at populations of sperm. This is a problem since at the end of the day, you just need one good sperm per one egg. At this time, we are unable to individually test a single sperm so that it can then be used for fertilizing an egg once it is deemed normal. Second, there is no consensus as to which test measures DNA damage the best. A laboratory often picks the one that can be performed most easily in their specific facility. Which ever test your laboratory uses, just make sure that they have done all the necessary work to standardize its results.

Click Here to see the Halo Test

Sometimes It’s a Matter of Having Too Much or Too Little Genetic Information

A new study called FISH (Fluorescent In Situ Hybridization) is shedding new light on genetic causes of male infertility. Simply put, we all have 46 chromosomes. To make this work, a sperm carries half of the genetic material (23 chromosomes) and an egg has the other half (also 23 chromosomes). After fusing with a sperm, a fertilized egg will then have the proper total number of 46 chromosomes.

New data suggest that when sperm get created in the testicles of infertile men, the sperm may have inappropriately received either too much or too little genetic information (a gain or a loss of chromosomes). As a result, the fertilized eggs from these men may have an abnormal amount of chromosomes (aneuploidy) and be genetically abnormal. This may result in a loss of pregnancy or offspring with genetic abnormalities such as Down’s Syndrome (when there is an extra chromosome 21). Studies of infertile men with FISH have shown that these men are 10x more likely to have sperm-specific abnormalities in the number of chromosomes. This new sperm test is still evolving and is only being performed at select centers. It may help explain infertility in men with severe oligospermia and couples with recurrent pregnancy losses.

Click Here to see the Halo Test

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