Semen Analysis Laboratory

INTRODUCTION TO SEMEN ANALYSIS

A comprehensive semen analysis is one of the appropriate first steps if a couple is having trouble conceiving. In 60% of all couples experiencing infertility, a male factor is involved (40% primarily male and 20% combined male/female.) Because a comprehensive semen analysis is noninvasive, it is often the first test in any couple's evaluation.

The testes take 3 months to produce and mature sperm. Thus, there is often a 4 to 6 month delay between treatment of the man and resulting changes in the semen analysis. Since the evaluation of the woman may take several months, it is recommended that a comprehensive and accurate semen analysis be performed at the outset. Treatment of the man can then occur at the same time as treatment of the woman, and there will be no unnecessary delay once the woman's treatment is completed.

The purpose of the man's evaluation (semen analysis and, if appropriate, a consultation) is to maximize the quality of the man's semen. This may reduce the need for more complicated interventions for the female partner. It is also important to rule out significant medical problems that may be contributing to a poor semen analysis.

Semen is the fluid that a man ejaculates. Semen production occurs at several different sites. The sperm within the semen are the cells that actually fertilize the egg and are therefore the most important to assess. However, the sperm account for only 1% to 2 % of the semen volume. Problems with the surrounding fluid may also interfere with the movement and function of the sperm. Therefore, both the sperm and the fluid must be tested.

There is no absolute numerical cutoff between the semen analysis of men whose partners will get pregnant and those who won't. The partners of some men with a very poor semen analysis may conceive easily. The partners of some men with an excellent semen analysis may experience difficulty. However, men with good semen analysis results will, as a group, conceive at significantly higher rates than those with poor semen analysis results.

The semen analysis will help determine whether there is a male factor involved in the couple's sub-fertility. If so, an evaluation is usually indicated. Some findings of the semen analysis suggest certain specific potential problems. For example, an increased white blood cell count may indicate infection or inflammation. However, other abnormalities in many of the main parameters are non-specific. For example, there are a number of different causes for a decreased count or diminished movement. Some of these causes have other serious medical implications. A thorough evaluation helps determine the cause of an abnormal semen analysis and rules out medical problems.

BASIC SEMEN ANALYSIS
Almost all laboratories will report on the following information using values established by the World Health Organization.

  • Concentration (sometimes referred to as the "count"):
    This is a measurement of how many million sperm there are in each milliliter of fluid. There are various techniques for obtaining this number - some prove to be more accurate than others. Average sperm concentration is more than 60 million per milliliter (>60 million/cc). Counts of less than 20 million per milliliter (<20 million/cc) are considered sub-fertile.
  • Motility (sometimes referred to as the "mobility"):
    This describes the percentage of sperm that are moving. Fifty percent or more of the sperm should be moving.
  • Morphology:
    This describes the shape of the sperm. The sperm are examined under a microscope and must meet specific sets of criteria for several sperm characteristics in order to be considered normal. Most commercial laboratories will report WHO morphology (i.e., use World Health Organization criterion). Thirty percent of the sperm should be normal by these criteria.
  • Volume:
    This is a measurement of the volume of the ejaculate. Normal is 2 milliliters (2 ccs) or greater. The volume may be low if a man is anxious when producing a specimen, if all of the specimen is not caught in the collection container, or if there are hormonal abnormalities or ductal blockages.
  • Total Motile Count:
    This is the number of moving sperm in the entire ejaculate. It is calculated by multiplying the volume (cc) by the concentration (million sperm/cc) by the motility (% moving). There should be more than 40 million motile sperm in the ejaculate.
  • Standard Semen Fluid Tests:
    Color, viscosity (how thick the semen is), and the time until the specimen liquefies should also be measured. Abnormalities in the seminal fluid may adversely affect the sperm. For example, if the semen is very thick, it may be difficult for the sperm Forward Progression:
    This describes how well the sperm that are moving are making progress. Only when the motility (% moving) is combined with the forward progression is an accurate picture of sperm movement obtained. Unfortunately, this is often not tested by commercial laboratories. A man's motility may be normal and the fact that the sperm are moving sluggishly or almost not at all will be overlooked if the forward progression is not recorded separately.
  • Kruger Morphology:
    This is a more detailed evaluation of the morphology. Slides are specially stained and the sperm examined microscopically under high power magnification. The sperm must meet a stringent set of criteria that evaluate the shape and size of the head, midpiece, and tail in order to be considered normal. A Kruger test helps determine which of the available advanced reproductive techniques may be most appropriate and successful.
  • White Blood Cells:
    The semen may contain a high number of white blood cells, which may be an indication of either infection or inflammation. White blood cells are considered significant if more than one million are found in each milliliter of the ejaculate.

    White blood cells cannot be differentiated from other round cells normally found in the semen (debris and immature sperm) without special staining. If more than one million round cells are found in the ejaculate, a portion of the ejaculate should be specially stained to look for an increased number of white blood cells.

    If the white blood cell count is elevated, semen cultures should be performed on a subsequent specimen. Unfortunately, the semen culture cannot be performed on the original specimen as it must be the first step performed on the specimen in order to keep it sterile.

SPECILIZED SEMEN TESTS
In certain situations, specialized tests are needed. These depend on the findings at the time of the analysis and can often be performed on that specimen.

  • Spun Specimen:
    Even if no sperm are seen on the test slide, the sperm count may still not be zero (i.e., there may be very low numbers of sperm in the ejaculate). This has very important implications as it may determine if the couple can conceive using advanced reproductive techniques. This must be assessed by spinning down the specimen so all of the sperm are concentrated in a pellet on the bottom of the tube and then examining the pellet underneath a microscope.
  • Viability:
    Sperm may be alive, but not moving. A specialized staining technique is used to determine what percentage of the sperm are alive and is indicated when the motility (percent moving) is less than 30%.
  • DNA fragmentation test:
    The genetic integrity of the spermatozoan is essential for normal embryo development. A high level of DNA fragmentation in sperm cells may represent a cause of male infertility that conventional examinations - sperm concentration, motility analysis, morphology assessment - cannot detect.  Results reported in the scientific literature have shown that regardless of the assisted reproductive technology used, an elevated level of DNA fragmentation above the critical threshold will significantly compromise the possibility of a successful pregnancy.

 This test provides a reliable analysis of sperm DNA integrity that may help to identify men who are at risk of failing to initiate a healthy ongoing pregnancy. Information about sperm DNA integrity may help in the clinical diagnosis, management and treatment of male infertility and may be of prognostic value in assessing outcome of assisted conception treatment.

  • In vitro sperm activation :
    For diagnostic purposes and for IUI. Intrauterine insemination (IUI) is a procedure that involves placing sperm inside a woman’s uterus to facilitate fertilization. This fertility treatment does not involve the manipulation of a woman’s eggs, and therefore is not considered an assisted reproductive technology (ART) procedure.
  • Oxidative stress :
    Oxidative stress occurs when the production of potentially destructive reactive oxygen species (ROS) exceeds the bodies own natural antioxidant defenses, resulting in cellular damage. Oxidative stress is a common pathology seen in approximately half of all infertile men. ROS, defined as including oxygen ions, free radicals and peroxides are generated by sperm and seminal leukocytes within semen and produce infertility by two key mechanisms. First, they damage the sperm membrane, decreasing sperm motility and its ability to fuse with the oocyte. Second, ROS can alter the sperm DNA, resulting in the passage of defective paternal DNA on to the conceptus.

RESULTS & TREATMENT

More than 50% of men will have a treatable cause of male factor infertility. These factors include varicoceles (dilated veins in the scrotum), infections, hormonal abnormalities, abnormalities in the seminal fluid, ductal blockages, and difficulties with erections and ejaculation. When these conditions are treated, a man will often see a significant improvement in his semen analysis.

Those men with poor semen analyses whose conditions are not treatable may still have the option of using advanced reproductive techniques to achieve a pregnancy. Even those men with no sperm in the ejaculate may be able to have some living sperm procured from them through other methods and achieve a pregnancy using advanced reproductive techniques. Those few men who produce absolutely no sperm at all will have this information so that they can explore other options.

FINDING A LABORATORY FOR SEMEN ANALYSIS

  • Expertise: Semen testing is a sophisticated and technical field. An improperly or incompletely performed semen analysis may miss significant problems. Unrecognized problems may significantly delay a man's treatment. Unlike many other lab tests, a semen analysis relies completely on the expertise of those performing it. Make sure that the lab has sophisticated protocols and well-trained, specialized technicians.
  • Timing: In order to get accurate test results, the specimen must be processed within one hour of collection. If not, the measurement of the movement of the sperm may be extremely inaccurate. With any lab you use, make sure that the analysis is performed on site and not shipped elsewhere for evaluation.
  • Thoroughness: As a semen analysis is being performed, certain findings may indicate the need for additional tests. Ideally, you should use a laboratory that has the capability to do complete initial testing as well as the flexibility to do the appropriate follow-up testing on the same specimen.
  • Comfort and convenience: In order to maximize your results, it is important that you are as relaxed and comfortable as possible. Ideally, the specimen should be collected at the laboratory itself.

If your physician has recommended that you have a semen analysis at our laboratory, these are most likely some of the reasons:

At Medical Supervision we:

  • Are committed to state-of-the-art medical and scientific expertise.
  • Perform all semen analyses within one hour of production.
  • Perform the necessary secondary or additional testing on the same specimen. This maximizes the information obtained from the semen analysis and will limit the number of semen analyses you will need.
  • Give you the option of producing a specimen at home or in the office. Our private collection rooms are comfortable and equipped with appropriate materials.

Communicate your results promptly and thoroughly to your doctor, helping you and your physician create an appropriate plan in a timely manner.