Male Fertility Testing: What to Expect During a Semen Analysis

Male fertility testing has emerged to be vital to diagnosing infertility in couples. When a couple trying to build their family has been having regular sex with no birth control for a period of six to 12 months, it can be discouraging. For many years, female fertility has been at the center of discussions around infertility. In this article we shall be addressing infertility in males, and the parameters used to test fertility in men.

What Is a Semen Analysis?

A semen analysis is a diagnostic tool that is used to assess the quality and the quantity of sperm a person produces. Men’s reproductive systems produce fresh sperm regularly. It takes about 90 days for a sperm cell to develop and reach maturity, ready to fertilize a mature female egg. The factors that could have an immediate impact on this rhythm are a person’s lifestyle, diet, stress levels, medical history, exercise routine and how much rest they get when they sleep. 

A semen analysis is done on mature sperm and the test analyses the number of sperm, how the sperm cells are formed, and how well they move. These aspects are crucial to how well any given sperm cell can gain access to a mature egg in a woman’s reproductive system and fertilize it. Let us look into this a little further. 

Process

A semen analysis is not a painful or non-invasive process. A man going to a healthcare facility for a semen analysis will be required to masturbate and ejaculate into a sterilized container provided by the facility. This process can also be done in the comfort of one’s home using an at-home testing kit. It is important to note that the at home testing kit measures fewer parameters than a lab processed test.    

Parameters Measured

Volume

Semen volume is a quantitative measure that seeks to know how much semen is contained within one ejaculation. Semen is the fluid in which sperms are carried and the normal volume of semen from one ejaculation ranges from1.5 to 5 milliliters. Apart from volume, semen will be analysed for viscosity, acidity, and sugar content. 

Count

Sperm count is another quantitative measure that seeks to know how concentrated sperm are within the semen.  This number is measured using one milliliter of semen. The normal sperm cnt ranges between 20 to 150 million sperm cells. This was a process done by a human technician in the past, but more labs are using computerized systems for the sake of efficiency. 

Motility

Sperm motility is movement and is measured in two main aspects, the first is whether they have any movement independently, and the second is whether they can move forward. Forward movement is vital to how sperm will travel from the vagina to the fallopian tube to fertilize the egg. As well, motility is also analysed comparatively to the sperm count. To put it another way, the question to be answered is, within the sperm count, how many sperm have good motility? 

Morphology

The structure of sperms is also referred to as their morphology. It has to do with how the sperm cells are formed, having head, midsection and tail. As well, if each of these parts is well formed. For example the head contains components such as a nucleus, genetic material necessary for conception and enzymes to help it penetrate the outer shell of the egg. The midsection contains the mitochondria that provide energy for movement, and the tail contains the flagellum necessary to propel the sperm forward. When sperm cells are irregularly formed, they could present challenges for natural conception.

Other Diagnostic Tests for Male Infertility

When a semen analysis produces results that fall within normal ranges, but a person is still unable to build their family, additional tests for male infertility will be conducted. Let us look at them in the following section:

Semen Culture

When a person’s seminal fluid is observed to have a higher number of white blood cells than usual, it could point to infection. Typically, a sample will be cultured for bacterial growth. If bacteria does indeed grow, it will be further tested in order to determine the best antibiotic treatment for it.

Hormone Evaluation 

When a low sperm count is detected it usually is indicative of low hormone production. Testosterone is the hormone that regulates primary and secondary sexual characteristics in men. It is also the hormone responsible for developing sperm within the testicles. This test is done using a blood sample, and one may feel mild discomfort during the drawing of blood.   

Hypoosomatic Solution Assay

Sperm cells contain plasma in the head section, which holds the nucleus and DNA material. This test is used to determine if a sperm cell has the proper capacity to fulfill its function in fertilization. Again this test will check for any infection based on the number of white bloodo cells. 

Sperm Aneuploidy by FISH (Fluorescent in-situ hybridization)

This test is a chromosomal test used to identify, count and detect any anomalies within the chromosomes. DNA anomalies can prevent the embryo from properly implanting itself in the uterine wall leading to miscarriage, and could also lead to birth defects. When counselling patients prior to fertility treatments, this information helps doctors to explain where the issues lie, and why certain treatment would be preferred over others.

Sperm Chromatin Integrity Test (SCIT)

Similar to the previous test, this test focuses on chromatin, which is made up of protein, RNA and DNA. This test assesses the quality of these, ensuring that they are complete and intact without any breaks. Breakage prevents proper fusing with the egg’s chromosomes resulting in malformation of the embryo.  

Acrosome Stimulation Test

This is a simulation test of the bonding between sperm and eggs. The sperm head contains the enzymes needed to penetrate the egg for fertilization known as acrosome. When the sperm comes into contact with the egg, an acrosome reaction takes place which opens up the sperm head releasing the DNA within and exposing the sites that the egg’s DNA can bond to. This test simulates that bonding environment to see if the acrosome reacts as it should. 

Hamster Egg Penetration Test

This is another stimulatory test done to examine sperm penetration capability. In this case, a hamster’s egg is used in place of the female egg. Typically successful penetration of the hamster egg is an indication that the sperm can penetrate the female egg without any difficulties.

Anti-sperm Antibodies Test 

Humans naturally produce antibodies to protect them from infections. Sperm cells are vulnerable and therefore have barriers that protect them from these antibodies. Females also produce antisperm antibodies sometimes. When these protective barriers are compromised, they in turn expose and compromise the integrity of the sperm, preventing it  from effectively fertilizing the egg.

Cervical Mucus Interaction

This is another type of simulatory test done using cervical mucus. A sperm has to swim through cervical mucus on its way to fertilization. During ovulation, the cervical mucus has a particular viscosity. This test is done using ovulatory mucus, a patient’s sperm and donor sperm for comparison. The two sperm samples are placed side by side and observations are made every half hour to see how well the patient’s sperm is able to penetrate the mucus compared to the donor sperm. 

Retrograde Semen Analysis

When sperm count is low it could be because not all the sperm is coming out of the penis during ejaculation. Remember that urine and semen exit the body through the same tube in the penis. When sperm ends up in the bladder rather than out the body during ejaculation it is medically known as retrograde ejaculation. This can be observed in a urine sample after ejaculation.  Retrograde ejaculation tends to occur when a man has a medical condition, or has had prior surgery.

Sperm Longevity

Sperm longevity relates to how long sperm remain alive once they leave the body through ejaculation. Typically, a sperm cell can live for about three to five days afterward. This is a good timeframe because they need sufficient time to swim up to the fallopian tube from the vagina, if they are to succeed at fertilizing an egg. 

Transmission Electron Microscopy

This is done under an electron microscope which magnifies the sperm cell to the subcellular level. This allows for the observation of possible defects that had not been identified under a normal microscope.

Kruger Morphology Test

This test checks the shape of the sperm for anomalies under ‘strict criteria’. This enables doctors to assess if sperm can fertilize the egg when fertilization is occurring through fertility treatment protocols.  

Varicoceles

These are swollen veins found in the scrotum. When a person’s semen analysis shows a lower number of normally structured sperm, low sperm count or low sperm motility, it is possible that the swollen veins coul be creating an obstruction, lowering the chances of natural conception.

How to Prepare for  a Semen Analysis

In order to prepare for a semen analysis, one must abstain from tobacco and nicotine, drugs and alcohol and sexual activity. The purpose of abstaining from sexual activity is to avoid ejaculation in order to produce a sufficient volume of sperm for analysis. To submit a sample, one will be required to masturbate and ejaculate inside a sterile up, or a special condom used medically for sperm collection. 

Understanding Your Test Results

Your semen analysis will be reviewed by your doctor and they will explain them, what they mean, and if any further testing is required. As well, the doctor will advise you on what the next steps are with regard to your fertility. This may be in the form of lifestyle changes, dietary changes, or medical treatments as your case may be.

Treatment Options

If medical treatments are required, your doctor will then explain to you the options you  have, what the benefits, side effects as well as the risks are. Your doctor will also inform you on how long treatment will take. A treatment plan can then be drawn up and you will be informed on what you will need to do in preparation for the treatment. Contact our fertility specialists at Dallas Fertility for more information. 

FAQs:

How does IVF (In Vitro Fertilization) help with male infertility?

IVF is able to bypass some of the poor sperm parameters such as structure or motility through various protocols. In so doing, sperm can still be used to successfully fertilize eggs. 

What is ICSI, and how does it improve male fertility treatment?

ICSI (Intracytoplasmic Sperm Injection) a fertility treatment protocol whereby a sperm cell is injected directly into the egg. This significantly increases the chances of fertilization. 

Who needs ICSI?

ICSI treatment is a useful protocol for patients with low sperm count. poor sperm motility or sperm anomalies that are severe. It is also useful for patients who have had their sperm retrieved through surgical procedures, or who have not had success in previous IVF cycles.  

What is the success rate of IVF with ICSI for male infertility?

The success rate of IVF with ICSI is quite high (70 to 80 percent). However factors such as egg health, sperm quality and overall fertility diagnosis can have an impact on the success rate. 

Is there an increased risk of genetic issues with ICSI?

Yes. The risk is slightly higher, therefore genetic tests such as pre-implantation genetic testing (PGT) help to screen embryos for genetic anomalies before implantation.