Semen analysis results you need to know

Out of all the infertility couples, it has been observed that 30% of the cases are related to male infertility. So gone are the days when infertility was mainly associated with women. Nowadays, every infertile couple must get their male partner tested too. The breakdown of infertility reasons in couples is as below:

  • One-third of infertility cases involve the female partner
  • One-third of infertility cases are related to the male partner. 
  • The other third involves both partners or is unexplained infertility, which means there is no known cause.

To determine male infertility, semen analysis is an important fertility test. A semen analysis test does not just measure the sperm count. One has to understand how to read the sperm analysis report so that one understands any sperm-related fertility issues that may be at play.

It is naturally an anxious time awaiting the test results, especially if the couple wants to have a child soon. So in this blog, we will explain the semen analysis results you need to know. 

How do you prepare for a Semen Analysis test?

According to the World Health Organization (WHO), a semen sample should be taken two days after sexual intercourse and seven days. If the first results are abnormal or borderline abnormal, the tests are repeated after a month.

  • The sperm are sensitive to temperature, so avoid high heat exposure in the two to three months before your test, which means avoiding sitting in a hot tub, using car seat warmers, and high-heat exposure in the workplace.
  • Any exposure to high heat or high fever means waiting several weeks for your sperm counts to return to normal. 
  • Avoid smoking, drinking alcohol, caffeine, and recreational drugs the week before your semen analysis. Giving up these habits for the long term will help in improving your sperm quality.
  • Your doctor might want you to have the semen analysis while continuing with your medications (to see if they are causing a problem), or they may want you to stop the medication or switch to an alternative. Never stop taking a prescription drug without first talking to your doctor.
  • Be mentally prepared to take the test: one should be in a calm state of mind to give the sample. Some men fear having their “manhood” judged, religious objections to collecting the sample, or embarrassment regarding the collection method.

Please consult your healthcare provider and discuss your situation freely with them about your concerns. Also, remember that semen analysis is an important step towards parenthood. 

Semen analysis results you need to know.

After the tests and the result are in your hand, your doctor will explain the meaning of various parameters. However, remember that various labs have various normalcy ranges, so the best judge is your doctor. 

Semen Ejaculate Volume: Semen does not only contain sperm; as a matter of fact, less than 5% of semen is made up of sperm. Healthy semen includes fluids from: 

  • The bulbourethral glands, which contain mucus to help the semen swim
  • The prostate gland, which includes zinc-rich fluid to maintain the DNA stability of the sperm
  • The seminal vesicles, which include important nutrients for the sperm
  • The testes are where the sperm comes from

Normal levels of semen volume: a healthy semen ejaculate contains anywhere between 2 millilitres to 5 millilitres of fluid. If the patient has low semen volume, it could be due to:

  • Obstruction of the vas deferens which is the duct that carries sperm from the testicles to the urethra
  • Absence or blockage of the seminal vesicle
  • Partial retrograde ejaculation
  • Hormonal imbalance.
  • Stress levels during the test also contribute to the volume. Find ways to reduce your anxiety and talk to your doctor.

If the patient has an abnormally high volume, it might be due to inflammation of the reproductive glands.

Total Sperm count: This is the pure total number of sperm found in the provided semen sample.

The normal value of Total Sperm count: To achieve pregnancy, there must be at least 20 million per millilitre (m/mL) sperm per ejaculate. But under normal conditions, 40 million to 300 million sperm per mL of fluid is present. 

  • Having a lower-than-normal count of sperm is sometimes called oligospermia. 
  • Azoospermia is when no sperm cells are found in the semen sample.
  • Lower sperm count levels mean: 
    • Chronic or undiagnosed health problems such as diabetes or celiac disease
    • Duct problems
    • Ejaculation problems such as retrograde ejaculation
    • Exposure to toxic substances
    • Hormonal imbalances
    • Infection
    • Varicocele
    • Medications also can cause low sperm counts 
    • A recent illness accompanied by high fever  
    • Exposure of the scrotum to heat, as in a hot tub. 
    • Smoking, obesity, and excess alcohol intake contribute to low sperm count.

Azoospermia, which is the total absence of sperm, might be caused by a duct problem, a hormonal imbalance, or a problem with the testes.

Sperm Concentration: This measures the number of sperm found in one millilitre of semen.

Normal values of Sperm Concentration: A healthy concentration means at least 15,000,000 (or 15 x 10^6) sperm per millilitre.

Low sperm concentration could be due to a low sperm count or an abnormally high ejaculate volume.

Sperm Motility: This is the percentage of sperm which moves since, for fertilization to occur, sperm should swim till the female reproductive tract meets the egg. Being able to swim properly to meet the egg is essential. Progressive motility means a forward movement in a line or large circle.

Semen analysis results for normal values of Sperm Motility: In a healthy motility rate, at least 40-50% of the sperm should be moving, and the quality should be a 2 or higher on a scale of 0 to 4.7

Semen analysis results for sperm motility: Poor sperm motility is known as Asthenozoospermia and could be caused by illness, certain medications, nutritional deficiencies, or poor health habits like smoking. Low sperm counts also cause poor motility; in most cases, the exact cause is unknown.

Semen Viability or Vitality: This value indicates the percentage of live sperm in the semen sample. This value is used to assess sperm motility and to differentiate between live non-motile sperm and dead sperm.

Semen analysis results for normal vitality: In a healthy and fertile male, at least 50% of the sperm cells should be viable. If more than 50% of the sperm is immotile, further testing may be needed.

Semen analysis results for Abnormal vitality: When all sperm in the semen sample is dead, it is called Necrozoospermia. The same reasons for low sperm count are attributed to Necrozoospermia.

If the male uses a non-fertility-safe lubricant or a regular condom during the sample collection, the sperm can get killed. Inform your doctor if you used lubricant or a regular condom to produce your semen sample. Before collecting the sample, ask your doctor about fertility-approved lubricants and special condoms recommended for semen sample collection.

Sperm Morphology: This parameter refers to the shape of the sperm cells. The head, midsection, and tail are tested in terms of their measurements and proportions between each.

Semen analysis results for normal Sperm Morphology: The requirement for a healthy sperm is that at least 4% should have a normal shape.

Semen analysis results for abnormal Sperm Morphology: The term used for poor sperm morphology is Teratozoospermia. 

It is difficult to get the same results in every lab regarding sperm morphology. The evaluation is somewhat subjective, so the scores may vary, even if tested in the same lab using the same scoring techniques. However, if all the other semen parameters fall within normal limits, then male fertility could still be considered normal even if sperm morphology is a bit off.

Semen Liquefaction: This measures the thickness and gelatinous of the ejaculate. Semen Liquefaction is required for the sperm to adhere to the cervix and for the sperm to swim better.

Semen analysis results for normal Semen Liquefaction: In healthy semen, liquefaction happens within 20 minutes of ejaculation.

Semen analysis results for abnormal Semen Liquefaction: If the semen liquefaction gets delayed, then there might be issues with the prostate, the seminal vesicles, or the bulbourethral glands, which are also known as the male accessory glands.

The doctor might prescribe a post-coital test (PCT) in such delayed cases. PCT evaluates the female partner’s cervical mucus after sexual intercourse. In PCT, If sperm is present and moving normally, delayed liquefaction is not considered a problem.

Semen pH: Semen pH measures the acidity and alkalinity of the semen. In normal conditions, the seminal vesicle fluid should be more alkaline, while the prostate fluids should be more acidic so that their combination balances each other out in the semen. Higher acidic semen kills the sperm and prevents fertilization.

Semen analysis results for normal Semen pH: The pH must be somewhere in the range of 7.2 to 7.8.5. 

Semen analysis results for abnormal Semen pH: A low pH also indicates other abnormalities, such as low volume of semen or low sperm counts. Then the doctor will check for any obstruction or absence of the vas deferens.

Semen analysis results affect conception.

From the above parameters, one can arrive at a picture of their natural chances of fathering offspring. But there is a lot of hope, even if the results are poor. The options depend on the female partner’s fertility and age. Some of the options to consider are:

  • Hormone treatments: These treatments help in improving the sperm count. 
  • IUI- Intrauterine insemination: This is an ART method where a semen sample is collected from the male. The semen sample is washed in a special process and then pushed through a catheter via the cervix into the woman’s uterus. 
  • IVF or IVF with ICSI: In IVF treatment, sperm and egg are fertilized in a lab to form an embryo. Healthy embryo(s) are transferred to the woman’s uterus. If an IVF-ICSI combination is used, then only a single sperm cell is directly injected into an egg. This is a good option for men with very low sperm counts.
  • Lifestyle change: as mentioned earlier, excess use of tobacco, alcohol, drug usage, obesity etc., are poor health habits leading to lower sperm counts. These habits should be eliminated, and males should move towards a healthy lifestyle.
  • Sperm donor: This is a fast-growing option where the desired sperm is acquired from a donor.
  • Surgery: Any blockages or varicocele are removed surgically to improve sperm counts. Micro-surgical repair may be considered, especially for a vasectomy reversal. 
  • Testicular sperm extraction: For extremely low sperm count, zero sperm count, or no ejaculation, a testicular sperm extraction is considered, where the sperm cells are extracted via a needle from the testicles. This procedure is followed up with an IVF and ICSI.

Men should understand that maintaining good general health is good for healthy sperm production. If there are any untreated conditions, such as celiac disease, diabetes, or a thyroid imbalance, they should be tackled first. 

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