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Understanding a semen analysis

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  • Liquifaction - semen should liquefy within 15-60 minutes (with 15 minutes being the norm)
  • Appearance: normal semen is opalescent and grayish. Yellowish semen may show high intakes of vitamin supplements, abstinence, or jaundice. An infection may show some red in the semen.
  • Volume: total volume can range from 1-5ml. Too much can mean it is diluted. Low volume may show past infection blocking the tubes, retrograde ejaculation, or problems with accessory glands such as the seminal vesicles or the prostate. Sometimes there is an abscence of the vas deferens.
  • Agglutination - higher amounts of agglutination (sperm sticking together) point to AntiSperm Antibodies and can affect motility by coating the sperm and bind to cervical mucus preventing proper movement and difficulty fertilizing the egg. . This is common in men who have had reproductive tract surgery.
  • Motility - rapid progressive motile swimmers are really all that matter when it comes to conception and ability to penetrate the egg. This is not distinguished in community labs - even twitching non-progressive sperm are factored into a motile %. At least 32% should be progressive (the higher the percentage of rapid progressive the better).
  • Concentration - there should be at least 15 million sperm per ml of semen. Caffeine, tobacco, alcohol, drugs, diet, exercise, and stress can also effect this. If it is very low there may be a genetic chromosomal defect.
  • Count - >39 million. This is total sperm count per ejaculate. (concentration X volume (ml) = count).
  • Morphology - at least 4% of the sperm in a semen sample should be shaped normally. Avoiding things that are toxic to sperm are very important with morphology.
  • Acidity: semen has a pH between 7.2 and 8.
  • Round Cell Concentration: immature sperm or white blood cells. Too many of these in a sample may indicate infection.

    *WHO standards 2010 - http://whqlibdoc.who.int/publications/2010/9789241547789_eng.pdf?ua=1

    For the semen analysis, the man is asked to ejaculate into a sterile container,...masturbation on demand is not so easy, mentally prepare for this part. They can also send you away with a special condom that can be brought back at a later time. It is important to refrain from ejaculation for 2-4 days before the sample is required. Often at community labs semen is not analyzed within recommended time limits. Basically, within 60 minutes the sample should be analyzed, and in my experience, this is the exception, not the rule. Obviously this can have negative effects on outcome measures. If parameters are abnormal I always recommend men going to a local fertility clinic to get a more accurate and thorough semen analysis done. A urine sample after ejaculation may also be asked for to check for retrograde ejaculation.

    Semen collection methods:
    -The specimen is best collected by masturbation into a sterile container. This is most conveniently performed in the facility provided at the laboratory however collection at home is acceptable provided the sample is rapidly transported (within 1 hour) and kept at body temperature.
    -Semen collected by interrupted intercourse is not favoured as it risks the loss of sample, particularly the first fraction of the ejaculate.
    -Semen should never be collected into an ordinary condom, which contains substances that kill sperm.
    -If religious or personal practises prohibit masturbation, a special condom (SCD) can be used that does not affect the sperm quality.

    Illness that has happened in the last 3 months should also be offered to the doctor, it takes 100 days for sperm to mature, so problems at anytime in the last 3 months could effect the semen sample. Other factors that may effect the quality of the sample are medication, excess heat, alcohol, smoking, and other important things to avoid can be found at Improving Sperm Quality.

    Also, be sure and have your tests done at a fertility lab, or a lab specially designed for male testing. Regular labs that do not understand the importance of the accuracy and timing of these tests may disregard the little things. It would be worth spending as little extra money if it is necessary. It is also worth doing more than one test because semen results can vary a lot depending on stress, illness, and many other factors.

    Terminology
    - Normozoospermia, an ejaculate falling within normal range of parameters
    - Oligozoospermia, sperm concentration of less than 14 million
    - Azoospermia, no spermatozoa in the ejaculate
    - Aspermia, no ejaculate
    - Asthenozooserpmia, low motility
    - Teratozoospermia, poor morphology (shape of sperm)

    Interesting tid bits...
    Volume - drops 20% between 30 and 50 years
    Count - count drops nearly 5% per year
    Motility - decreases by 3.1% per year