Why do a sperm analysis?

Finding out about male fertility is one of the most important things to know when trying to get pregnant. Males contribute to or are responsible for a couple's infertility about 50% of the time, and since male fertility testing is simpler and less invasive than female fertility testing, it is commonly recommended for fertility testing to begin with the man. A sperm/semen analysis is necessary to evaluate male fertility. 

Take our male fertility test and learn if you (or your partner) is fertile.

A semen analysis (also known as a sperm count) measures the quality and quantity as well as other parameters of semen that a man produces. The only way a man can find out if he is fertile or infertile is through a semen analysis.

The test may also be used after a vasectomy to make sure there is no sperm in the semen, which can confirm the success of the vasectomy.

Read more about how to increase his sperm count!

How is the sperm count performed?

You will need to provide a semen sample. The sample must get to the lab within 30 minutes. If the sample is collected at home, keep it in the inside pocket of your coat so that it will stay at body temperature while you are transporting it.

A laboratory specialist must look at the sample within 2 hours of the collection. The earlier the sample is analyzed, the more reliable the results. The following things will be evaluated:

• How the semen thickens into a solid and turns to liquid
• Fluid thickness, acidity, and sugar content
• Resistance to flow (viscosity)
• Movement of the sperm (motility)
• Number and structure of the sperm
• Volume of semen

Sperm count criteria

How do you prepare for a sperm analysis?

Do not have any sexual activity (including masturbation) that causes ejaculation for at least 24 hours before the test. However, this time should not be longer than 5 days, after which the quality can diminish.

What do abnormal sperm count results mean?

Abnormal results may suggest a male infertility problem but one abnormal result does not always mean a man won't be able to have children. Often the test needs to be repeated so the initial abnormal result can be confirmed. For example, if the sperm count is very low or very high, a man may be less fertile. The acidity of the semen and the presence of white blood cells (suggesting infection) may affect fertility. Testing may reveal abnormal shapes or abnormal movements of the sperm. However, there are many unknowns in male infertility. Further testing may be needed if abnormalities are found.

More than 40% of couples who are unable to have children are unable to do so because of problems with the man's sperm. The sperm count should be the first test done when you evaluate your fertility. A sperm analysis is completed through masturbation so it is noninvasive.

What is normal sperm motility?

Motility checks whether the sperms are moving well or not (sperm motility). The quality of the sperm (morphology) is often more significant than the count. Sperm motility is the ability to move, and there are only two types: those that swim, and those that don't. Remember that only the sperm that moves forward fast are able to swim up to the egg and fertilize it, so the others are of little use.

Motility is graded on a scale from A to D, according to the World Health Organization (WHO):

• Grade A: Fast, progressive sperm swim forward fast in a straight line (like guided missiles).
• Grade B: Slow progressive) sperm swim forward, but either in a curved or crooked line or slowly (slow linear or non-linear motility).
• Grade C: Nonprogressive) sperm move their tails, but do not move forward (local motility only).
• Grade D: Immotile sperm do not move at all.

Sperm with grades C and D are considered poor. If motility is poor, this suggests that the testis is producing poor quality sperm and is not functioning properly. This may mean that even the apparently motile sperm may not be able to fertilize the egg.

This is why doctors are concerned when the motility is only 20% (it should be at least 50%) Many men with a low sperm count say, "But doctor, I just need a single sperm to fertilize my wife's egg. If my count is 10 million and motility is 20%, this means I have 2 million motile sperm in my ejaculate. Why can't I get her pregnant?" 

Abnormal results may suggest a male infertility problem but one abnormal result does not always mean a man won't be able to have children.

The problem is that the sperm in infertile men with a low sperm count are often not functionally competent, meaning they do not fertilize the egg. The fact that only 20% of the sperm are motile means that 80% are immotile — and if so many sperm cannot even swim, there is worry about the functional ability of the remaining sperm. After all, if 80% of the television sets produced in a factory are defective, no one is going to buy one of the remaining 20%, even if they seem to look normal.

What is normal sperm morphology?

Sperm morphology is whether the sperm are normally shaped or not. Ideally, a good sperm should have a regular oval head, with a connecting mid-piece and a long straight tail. If too many sperm is abnormally shaped (this is called teratozoospermia, when the majority of sperm have abnormalities such as round heads, pinheads, very large heads, double heads, or absent tails) this may mean the sperm are functionally abnormal and will not be able to fertilize the egg. Similarly, globozoospermia is when sperm are round-headed without acrosome.

Many labs use Kruger "strict " criteria (developed in South Africa) for judging sperm normality. Only sperm which are "perfect" are considered to be normal. A normal sample should have at least 15% normal forms (which means even up to 85% abnormal forms is considered to be acceptable!)

What is sperm clumping, or agglutination?

Under the microscope, this is seen as the sperm sticking together to one another in bunches. This impairs sperm motility and prevents them from swimming up through the cervix towards the egg.

Putting it all together, one looks for the total number of "good" sperm in the sample: the product of the total count, the progressively motile sperm, and the normally shaped sperm.

What does the presence of pus cells in the semen signify?

While a few white blood cells in the semen is normal, many pus cells suggest the presence of seminal infection. Unfortunately, many labs cannot differentiate between sperm precursor cells (which are normally found in the semen) and pus cells. This often means that men are overtreated with antibiotics for a "sperm infection" which may not even really exist!

Some labs use a computer to do the semen analysis. This is called CASA, or computer-assisted semen analysis. While it may appear to be more reliable (because the test has been done "objectively" by a computer), there are still many controversies about its real value, since many of the technical details have not been standardized and vary from lab to lab.

What does a normal semen analysis report mean?

A normal sperm report is reassuring, and usually does not need to be repeated. If the semen analysis is normal, most doctors will not even need to examine the man. However, remember that just because the sperm count and motility are in the normal range, this does not necessarily mean that the man is "fertile". Even if sperm display normal motility, this does not always mean that they are capable of "working" and fertilizing the egg. The only foolproof way of proving whether the sperm work is by doing IVF (in vitro fertilization)!

What are some reasons for a poor semen analysis report?

Poor sperm tests can result from:

• incorrect semen collection technique, if the sample is not collected properly, or if the container is dirty
• too long a time delay between providing the sample and its testing in the laboratory
• too short an interval since the previous ejaculation
• recent systemic illness in the last 3 months (even the flu or a fever can temporarily depress sperm counts)

What to do after an abnormal sperm analysis count?

If the sperm test is abnormal, this will need to be repeated several times over a period of 3-6 months to confirm whether the abnormality is persistent or not. It takes six weeks for the testes to produce new sperm, which is why you need to wait before repeating the test. It also makes sense to repeat it from another laboratory, to ensure that the report is valid.

Are dead sperm common in sperm count analysis (Necrozoospermia and Asthenospermia)

Most men will not have any idea what these two terms mean because the conditions are extremely rare. Asthenospermia is a condition characterized by a lack of sperm movement, also known as reduced sperm motility. There is a good chance some of the sperm in your semen analysis sample lacked movement, but patients with asthenospermia can be complete with 100% of the sperm being immobile. 

Asthenospermia is often mistaken for necrozoospermia at first glance. Necrozoospermia is diagnosed when all sperm in multiple semen samples are dead. Semen analysis must be completed multiples times to verify the condition because small factors like improper semen collection and use of a spermicidal lubricant can cause what looks like necrozoospermia. In asthenospermia, the sperm are not dead, just not moving, but both instances can look the same under a microscope. 

So, just because you recently received a semen analysis report that showed dead sperm does not mean there is a medical problem. As long as 60% of the sperm are moving and ready to fertilize the egg you are in good shape. Even if your number is slightly lower than 60% you can still conceive a child. 

What else could affect sperm count?

Several factors can affect the sperm count and other semen analysis values. A man may have a lower sperm count if he has physical damage to the testicles, has gone through radiation treatment of his testicles, or has had exposure to certain drugs (such as azathioprine or cimetidine). A man with a higher level of estrogens may have lower sperm counts.

Some of the common causes of male infertility are extremely high fever, failure of the testicles, obstruction of the tubes that carry semen to the penis, and a less than normal amount of sperm in the sample.