SEMEN ANALYSIS TESTING

• What must I do to get a semen analysis?
• Why is semen analysis important?
• What is semen?
• What is the role of sperm?
• What is evaluated in semen analysis?
• Exactly how is semen analysis done?
• Will semen analysis tell me if I am fertile?
• Can any laboratory do semen analysis?

SEMEN AND SPERM ANALYSIS

The sperm analysis is one of the first tests ordered for couples who are trying to conceive. The following information discusses why the sperm analysis is important and provides you with the background to understand the significance of the components of the analysis, more importantly, your own specific results.

What must I do to get a semen analysis?

Scheduling :
Semen analysis is done at our office 7 days a week by appointment only.
Call us between 9 a.m.-4p.m. to schedule an appointment. At that time, we will be glad to answer any questions you may have.

Dr. Brandeis will speak to all patients having sperm analysis before the testing or on the day of testing, and will be available to discuss any questions you may have when you get the report.

Making the sample:
• Dr. Brandeis advises 3-5 days of abstinence before the day of testing.
• The sample should be produced by masturbation directly into a sterile sample cup    (may be bought at a local pharmacy or provided by our office) no more than 2    hours before the analysis is to be done.
   • You may produce the sample at home, but it is preferable that you produce it in       our office in a private room that is reserved for this purpose.
• Label the container with your name, date and time of collection.
  • If you are producing the sample at home, keep the sample at body temperature      by putting the sample cup into a plastic bag and keep it in your pocket until you      submit it.

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Getting The Results:

1. A complete semen analysis report will be faxed to your physician and made     available to you within 1-2 days.
2. Once you have a copy of the report, Dr. Brandeis will be available to discuss the     results with you.

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Why is semen analysis important?

A comprehensive semen analysis is important because in more than half of all couples who have difficulty conceiving, a deficiency in sperm count or quality is found (male factor).

Other male factors may include - Difficulty in maintaining erection

• Problems with ejaculation
• Testicular disorders
• Blocked sperm passages.

Causes for sperm disorders may include:

• Previous surgery
• Chronic medical problems
• Specific medications
• Previous chemotherapy or radiation
• Genetic causes.

In any case, if your semen analysis indicates a problem, Dr. Brandeis will refer you back to your urologist if you already have one, or to a male fertility urologist to determine your underlying problem and manage it appropriately.

Most times, the couple can continue to pursue their fertility efforts while this is being done because there are techniques for assisted reproduction that can overcome a sperm problem for purposes of conceiving.

In general, sperm quality is constantly changing in the same person.

• The sperm population changes every 90 days (the time it takes for sperm cells to    develop and mature).
• Even if someone already has children, there is no guarantee that he continues to    be fertile or that his sperm is adequate.
• If the semen analysis is done when one has high fever, is under medical    treatment, or starts to take new medications, the analysis should be repeated 3    weeks later.

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What is Semen?

Semen is the fluid that a man ejaculates; it carries the sperm cells produced in the testicles.

• In men with normal sperm count, the sperm cells make up only 1-2% of the    volume ejaculated.
• Semen, which is produced at various sites in the testicle, can contain substances    that may interfere with sperm movement and function (ability to fertilize the egg).

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What is the role of sperm in fertility?

Only 1 sperm cell is needed to fertilize an oocyte (egg cell).

• Spontaneous pregnancies can occur even when the total motile sperm count is    less than 1 million per milliliter (M/ml) of semen.
• However, the reference value for a ‘normal’ semen analysis is at least 20 M/ml.
• Whether the sperm count is 1 million or 100 million, only about 200 sperm cells    reach the woman’s fallopian tubes, where fertilization occurs, after intercourse or    insemination.

But prolonged infertility is also common even when a semen analysis is repeatedly normal, and no female problem is identified.

This condition is usually referred to as unexplained infertility, and this may imply inherent functional defects in the sperm cells or the egg cells or both.

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What characteristics are evaluated in a semen analysis?

Volume (of the ejaculate)

• At least 2 milliliters (ml) – about half a teaspoonful - is considered normal.
• Too little semen may not allow the sperm to reach the entrance to the uterus    which they must enter in order to get to the fallopian tubes.

The volume may be low if

• The man is anxious when producing the specimen.
• All of the sample is not caught in the collection container.
• The channels that lead from the testicle to the tip of the penis are blocked, or
• The man is dehydrated at the time of semen collection.

Concentration (sperm count)

• Average sperm concentration is at least 60 million cells per milliliter of semen   (60M/ml) in men who are younger than 40.
• Counts of less than 20M/ml are considered sub-fertile.

Motility (percentage of moving sperm and quality of motion)

• 50% or more of the sperm cells should be moving rapidly in a forward    
   straight-line pattern.
• If the sperm cells move slowly or are simply shaking in place, this may indicate
   • Abnormalities in the sperm tails or
   • Factors in seminal fluid that interfere with sperm movement.

Strict morphology by Kruger criteria

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Morphology refers to the microscopic appearance of sperm cells.

• Strict criteria developed by Kruger in the 1970s are used to carefully evaluate the    sperm head, mid piece and tail.
• Multiple studies have shown that sperm morphology determined by strict Kruger    criteria is a useful and reliable way to distinguish between fertile and sub-fertile    men.
• Sperm cells with normal head shapes and rapid tail motion are best able to    penetrate the egg cell so fertilization can occur.
• At least 14% of the sperm in a given sample must have normal shapes by strict    criteria.

Secondary characteristics

The following information is also recorded:

• Semen color and odor
• Viscosity (how thick the semen is)
• Sperm agglutination (whether there is clumping of sperm cells)
• Time it takes for the semen to change from the gel-like ejaculate to a more liquid    form.
• Presence of round cells without tails may represent immature sperm or white    blood cells (WBC )
    • WBC in a concentration of more than 1M/ml usually indicates an infection in the        genito-urinary tract which must be treated.

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Exactly how is a semen analysis performed?

Sperm Volume:

The volume is determined by transferring the sample into a test tube with volume markings. (The other secondary characteristics listed above are also noted at this time).

Sperm Count :

A tiny drop of semen is placed on a counting device meant to be viewed under a microscope.

• The device contains a grid of 100 squares.
• The total number of sperm cells - both moving and non-moving - counted in 10    squares of the grid is equivalent to the number of sperm in millions (M) per    milliliter (ml) of semen.

Because the number of sperm in each field varies, the technician usually counts the number of sperm in 10 squares on 3 different parts of the grid, and the average of these three counts is taken.

For example, if the average number for 10 squares is 98 cells, the count is recorded as 98 M/ml.

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Sperm Motility:

While doing the sperm count, the technician also classifies the moving sperm according to speed and forward movement.

• Motility is recorded as the percentage of total moving sperm, and the overall    quality of movement.
• Grade 1 is slow or moving in place, Grade 2 is moderate, Grade 3 is rapid.

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Sperm Morphology:

• A small drop of semen is spread on a glass slide in a thin layer which dries    immediately.
• The slide is then stained with a special preparation to more clearly outline the    head, mid piece and tail for microscopic evaluation.
• The technician classifies the visible characteristics of at least 200 individual sperm    cells on a tally sheet (listing normal head shapes, head defects, mid piece defects    and tail defects).
• These are reported as a percentage of the total cells counted.

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Will a semen analysis tell me if I am fertile?

Even if the sperm cells appear normal and the sperm count is normal, this does not guarantee that the sperm will be able to penetrate the egg cell.

However, in most cases where sperm count and morphology are normal, there’s a very strong likelihood that the sperm can penetrate the egg.

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Can any laboratory do semen analysis testing?

For fertility patients, it is recommended to do this at a fertility laboratory rather than a general laboratory.

• A fertility laboratory has specially trained technicians who routinely perform    comprehensive and detailed semen analyses on a daily basis. - - Even reference    laboratories only provide limited analysis on their semen analysis report.
• A poorly done or incomplete semen analysis will not give your doctor enough    information to indicate your next step. You may have to repeat it at a fertility    laboratory.

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‘ANALYZING THE SEMEN ANALYSIS’

If you wish to learn more about the semen analysis, check out this Power Point presentation of one of Dr. Brandies' recent lectures about this basic fertility test.

Analyzing the semen analysis.pps (15.1 Mb Power Point ,Slide show)