- Semen analysis measures the amount of semen a man produces and determines the number and quality of sperm in the semen sample.
- It is usually one of the first tests done to help determine whether a man has a problem fathering a child (infertility).
- Abnormal semen or sperm (count /motility and morphology) affects more than 40% of the couples who are unable to have children (infertile).
What’s the purpose of the test?
The purpose is to do Investigation of fertility in Male.
Identify treatment options
- Surgical treatment.
- Medical treatment.
- Assisted conception treatment.
- Determine the suitability of semen for ART – Assisted Reproductive Techniques (IUI / IVF / ICSI).
- Specimen should be collected into sterile, non-toxic, wide-mouth container, after a couple has abstained from sexual activity for 2-3 days to not longer than 5 days.
- Specimens collected following prolonged abstinence tend to have higher volumes and decreased motility.
- When performing fertility testing, two or three samples are usually tested at 2-week intervals, with two abnormal samples considered significant.
- The specimen should be delivered to the laboratory within 1 hour of collection and the laboratory personnel must record the time of specimen collection and specimen receipt.
- The sample analysis, which begins ideally within 30 mins, but absolutely within 60 mins of ejaculation.
Methods of collection:-
- Masturbation (the method of choice for all seminal fluid tests).
- By condom: Normal condoms are not recommended for fertility testing because the condoms may contain spermicidal agents. Special ones without the lubricants are to be used in case when masturbation sample cannot be given .
- By coitus interrupts: (withdrawal method). This is not recommended to patient as there is a possibility of spillage of the semen sample
- TESA / PESA
Normal Semen analysis value as per World Health Organization (WHO)
(WHO Manual for the Examination & Processing Of Human Semen (2010), Fifth Edition)
||Lower reference limit
|Semen volume (ml)
||1.5 (1.4 – 1.7)
|Total sperms number (106 per ejaculate)
||37 (33 – 36)
|Sperm Concentration (106 per ml)
||15 (12 – 16)
|Total motility (PR + NP, %)
||40 (38 – 42)
|Progressive motility (PR, %)
||32 (31 – 34)
|Vitality (live spermatozoa, %)
||58 (55 – 63)
|Sperm morphology (normal forms, %)
||4 (3.0 – 4.0)
|Other consensus threshold values
Note: PR – Progressive Motility, NP – Non Progressive Motility
What’s important in a semen analysis?
Many patients have had their initial fertility treatment decisions based on a semen analysis done at a regular medical reference lab. That’s the same place that does your blood count, cholesterol and all the other medical tests that your general doctor orders. Their semen analysis consists of a check of semen volume, sperm concentration (count), motility (movement) and standard (WHO) morphology (an estimate of those normal shapes).
A Fertility specialist usually advises to get the semen analysis done at their own center by their Embryologist because the embryologist analyses the semen as per WHO standards and does a better analysis of sperm morphology which is an important parameter of semen analysis.
Importance of Sperm Morphology
The morphology of sperm is an important parameter to determine its fertilizing ability. The Egg (oocyte) is enclosed in a protein coat called as Zona Pellucida (ZP) through which the sperm has to pass/penetrate in order to fertilize the egg. If there is any defect in sperm morphology it will find it difficult to penetrate the ZP.
Abnormal Sperm shape: Abnormally shaped sperms often contain abnormal DNA i.e. it may have an extra chromosome or short of an chromosome or the DNA is packed in head in such a way that, if it at all it penetrates the ZP, the DNA would get all tangled up when it tries to form a chromosome inside the egg. Therefore the nature has evolved a way to keep abnormally shaped sperm from getting inside the egg and thereby maximizing the genetic development potential of the embryo.
“Sperm DNA Fragmentation Test can be performed to check the integrity of sperm DNA”
The difference is very important because we think that only perfectly shaped sperm are capable of fertilizing an egg.
There are three main causes of poor sperm morphology:
- Genetic trait
- Nothing can be done if it is a genetic trait; however, the other two causes may be reversible.
- Exposure to toxic chemicals
- People can be exposed to toxic chemicals in the workplace or at home. For example, people working in automotive paint shops are often exposed to a myriad of chemicals known to be detrimental to fertility. Individuals with occupational exposure to toxic chemicals need to be mindful of the impact of these chemicals on their fertility and follow all safety guidelines. Many household items, if used without proper ventilation, can also cause problems with sperm morphology.
- Chronic smokings, obesity, use of recreational drugs are common causes of sperms getting affected.
- Increased testicular temperature
- Occupations that require individuals to spend the majority of their day sitting at a desk can also be problematic. When sitting for a prolonged time, the testicles are drawn up close to the body resulting in an increase in testicular temperature. Those individuals may be advised to get up and walk around periodically to return the testicular temperature to normal.
- Sleeping in tight fitting clothing (like jockey shorts) can increase scrotal temperature to a point where sperm morphology is affected. A varicose vein in the scrotum will increase scrotal temperature. The urologist can usually repair a varicocele surgically. However, improvement in sperm morphology is seen in only about half the cases and it may take up to 18 months to see an improvement.
TERMS USED IN SEMEN ANALYSIS REPORT
Aspermia: absence of semen
Azoospermia: describes a total absence of spermatozoa in semen. (After centrifuge sperm count is zero/HPF).
Oligozoospermia: refers to a reduced number of spermatozoa in semen and is usually used to describe a sperm concentration of less than 15 million/ml. Sperm count 5-10 sperm/HPF.
Severe oligospermia: sperm count 1-2 sperm/HPF.
Polyzoospermia: denotes an increased number of spermatozoa in semen and is usually refers to a sperm concentration in excess of 350 million/ml.
Asthenozoospermia: refers to a man who produces a greater proportion of sperm which are immotile or have reduced motility, compared to the WHO reference values.
Teratozoospermia: sperm carry more morphological defects than usual
As a final note, sperm morphology scores can change a few percent from month to month and vary considerably amongst labs evaluating the same semen specimen. A single abnormal sperm morphology score is not conclusive. This is true for all seminal parameters. When the result of semen analysis is abnormal, the test should be repeated in 1-2 months to confirm the abnormality.