Male Fertility Testing: What to Expect During a Semen Analysis

Key Takeaways

Male fertility is central to family building because it is the other half of the conception process. When a couple has been actively trying to build their family, i.e. having unprotected sex, for a period of more than six months to a year, without a pregnancy occurring, it raises concerns. It has been discovered that in 50 percent of such cases, the issues have to do with the male infertility. This brings to the forefront the vital role male fertility testing plays in the diagnosis and treatment of fertility challenges.

Male fertility testing is done at a professional healthcare facility where sperm are analyzed, alongside other medical parameters. This is vital to diagnosing issues related to the male reproductive system that could be preventing a person from building their families. Due to the limited information regarding male fertility and male fertility testing, this article will be addressing what a semen analysis is, alongside other tests for male infertility.

What Is a Semen Analysis?

A semen analysis is a diagnostic measure used to determine the volume of sperm a person has, as well as its quality. Normally, a person who produces sperm naturally produces fresh sperm about every three months or so. Their medical history, natural hormone production, diet and lifestyle contribute greatly to the quantity and quality of sperm they produce. 

Certain parameters are measured in order to determine causes of male infertility, in order to determine ways to improve sperm health for better reproductive outcomes. So let us look into the process of a semen analysis, as well as the parameters that are measured, to get a better understanding.

Process

A process of semen analysis is not painful, as well, it is non-invasive. A semen analysis can be conducted at home or at a healthcare facility. When the test is an at-home analysis, the kit will measure two main parameters, which we shall discuss later in this article. When done at a lab or in a healthcare facility, there are additional parameters measured in comparison to the at-home test.  

Parameters Measured

Volume

This parameter measures the amount of semen produced. A normal ejaculation has a volume of about one and half to five milliliters (1.5-5.0ml). Within this parameter, other factors such as the sugar content, acidity and viscosity of the semen are also analysed, as they contribute to the likelihood of fertilization. 

Count

Sperm count is another thing that is evaluated in a semen analysis. It is a determination of how concentrated the sperm cells are within one milliliter of semen. It is expected that there will be about 20 to 150 million sperm cells per milliliter. 

Motility

Sperm motility has to do with the way sperm move. Sperm motility is measured on two prongs. The first is whether sperm are able to move independently and the second is whether sperm are able to move in a forward direction. This is vital because this movement is what gets the sperm from the vagina to the fallopian tube for fertilization in natural conception. 

Morphology

Sperm morphology has to do with the sperm cell’s structure. The structure of a sperm cell consists of the head, which mainly holds chromosomal information; the midpiece of the cell consists of mitochondria which provide the energy required to swim and; the tail which is responsible for the actual movement of the sperm. 

Not all sperm cells have a ‘normal’ appearance. In fact, In a normal semen sample, about 35 percent of the sperm cells have a regular shape. While this may present challenges in natural conception, it does not mean that they are incapable of fertilization.

Other Diagnostic Tests for Male Infertility

While the sperm analysis is an effective tool for diagnosing challenges of male fertility, there are other parameters that are also considered. A semen analysis is the starting point of testing for male infertility, but when the semen analysis does not raise any issues of concern medically, additional diagnostic measures are taken. 

There are a variety of tests for male infertility that enable professional healthcare providers to provide solutions to their patients who are facing challenges building their families. Let us touch briefly on other types of diagnostic tests for male infertility that are available.

Hormone Evaluation 

Hormone evaluation is done when a person’s semen sample displays a low sperm count. Low sperm count is often attributed to the low production of testosterone. Testosterone is the hormone that produces and supports primary and secondary male sexual characteristics.  

Hypoosomatic Solution Assay

This test is usually done on the sperm cell’s plasma to determine sperm function and if it is capable of fertilization. It is normal for sperm cells to have a few white blood cells, however, when the volume of these is high it could indicate an infection. This would require further testing. 

Semen Culture

A semen culture is typically done when the seminal fluid has been observed to contain a higher number of white blood cells than usual. In this test, a lab technician will culture the sperm sample for bacterial growth. If the culture produces any bacteria, further analysis will be required to identify the type of bacteria, as well the most effective antibiotic for treatment. 

Sperm Chromatin Integrity Test (SCIT)

This is a test that is one on the chromosomes in the sperm cell. It is used to determine if there are any breaks in the DNA strands, which could prevent the chromosomes from joining with the female chromosomes. 

Sperm Aneuploidy by FISH (Fluorescent in-situ hybridization)

This test is used for three things - to identify chromosomes, to count the chromosomes, as well as detecting any anomalies the chromosomes may have. These results are helpful particularly when it comes to counselling patients prior to fertility treatments. 

Sperm Chromatin Integrity Test (SCIT)

Chromatin is genetic material consisting of DNA, RNA and protein found in the sperm cell. The SCIT test is used to assess the quality of a person’s chromatin, as well, if there are any breaks in a person’s DNA. This is particularly crucial because DNA breaks also affect the quality of an embryo. 

Acrosome Stimulation Test

The acrosome is a section above the sperm covering about 40 to 60 percent of the head which contains enzymes that help the sperm to penetrate the egg for fertilization. When the sperm head comes in contact with the egg, an acrosome reaction takes place, exposing DNA binding sites that the egg’s chromosomes can bond to. This test simulates this bonding environment, to examine if the acrosome reacts as it should. 

Hamster Egg Penetration Test

As the name suggests, this test evaluates the sperm’s ability to penetrate the female egg using a hamster egg. If the sperm can penetrate the hamster egg, chances are high that there will be no challenges penetrating and fertilizing the female egg.

Anti-sperm Antibodies Test 

This test is used to determine if the barriers that protect sperm from the body’s natural antibodies have been compromised, exposing the sperms. As well, females sometimes may produce antisperm antibodies. These antibodies not only compromise the integrity of the sperm, they also prevent the sperm from effectively fertilizing the egg.

Cervical Mucus Interaction

This particular test seeks to observe how well sperm are able to penetrate the cervical mucus during ovulation. This is done by creating a type of wall or barrier using ovulatory mucus, then placing the patient’s sperm together with donor sperm side by side. Observations are noted down every half hour, to determine which of the sperm penetrates better. Ideally, the patient’s sperm should effectively maneuver the cervical mucus.

Retrograde Semen Analysis

Retrograde ejaculation occurs where a majority of sperm end up in the bladder at the point of ejaculation. This is usually observed in men who have had a medical condition or surgery prior. When a person has retrograde ejaculation, the semen can be found in the urine after ejaculation.

Sperm Longevity

This test seeks to observe how long sperm remain alive after ejaculation. This is critical to fertilization because at the very least, sperm need to stay alive for as long as it takes to reach and fertilize the eggs. 

Transmission Electron Microscopy

This particular test is done using an electron microscope to assess sperms at the subcellular level. At this degree of magnification, it is possible to observe in greater detail if the sperm cells have any defects.

Kruger Morphology Test

This test is also known as the ‘strict criteria’ morphology. It assesses the shape of sperm cells to determine if there are any anomalies. This is particularly useful in diagnosing whether sperm will be able to fertilize the egg under 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

Before testing can begin, it is recommended that a person abstain from ejaculating for about two to three days and in some cases, up to five days. This is because they will be required to submit a ‘fresh’ sperm sample, and by abstaining from ejaculating, they are likely to produce a sufficient volume for analysis. In order to submit a sample for analysis, one will be required to masturbate and ejaculate into a sterile container or a special condom used for sperm collection.

Understanding Your Test Results

Once the results of your semen analysis become available, your healthcare provider will explain to you what each parameter is and how it connects to your fertility. If further testing is needed along the lines of any of the other male fertility test previously mentioned, they will advise on which test will be required and the purpose it serves. Additionally, they will walk you through your new test results, informing you of what the implications are on your fertility.

Next Steps and Treatment Options

Once it is clear what the issue is, your healthcare provider will then provide guidance on your diagnosis, as well as walk you through possible treatment options. During this discussion, they will also address both the benefits and the risks of the treatment options presented. From that point, a treatment plan can be determined. If you have any further questions and would like support in your family building journey, contact our specialists at San Diego Fertility Center. Our experts are happy to walk with you and help you overcome the challenges you may be facing in building your family. 

FAQs:

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

The nature of IVF protocols is that treatments are often able to bypass some of the sperm-related challenges because the eggs can be fertilized directly in a controlled lab environment. 

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

ICSI (Intracytoplasmic Sperm Injection) is an assistive reprodutive treatment whereby one sperm cell is injected directly into an egg. This increasing the chances of fertilization, particularly in cases where the male partner had a low sperm count or sperm motility issues.

Who needs ICSI?

ICSI treatment is typically recommended for men who have severe sperm anomalies, who have not had success with previous IVF treatments, or who have had their sperm retrieved via surgery. 

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

While success rates typically are between 70 and 80 percent, this could be affected by other factors such as a person’s overall fertility diagnosis, the health of the egg, as well as the quality of the sperm. 

Is there an increased risk of genetic issues with ICSI?

With this treatment, there is a slightly higher risk of genetic abnormalities, however, tests such as preimplantation genetic testing (PGT) are valuable in prescreening embryos for potential concerns, before implantation.

This blog is for informational purposes only and should not be considered medical advice.  Please consult with your physician or a qualified healthcare provider for any health concerns or before making any decisions related to your health or treatment.