Understanding a semen analysis and male fertility. This is how we understand male fertility. This is usually the screening test because it’s a functional test for how things are working. Important factors to understand.
How are we preparing for a semen analysis? And what is the test?
Semen analysis is where we take an ejaculated sample of sperm, and then we analyse it under the microscope. We’re actually looking for a few different variables when we look at this. So, we’re looking at the volume of sperm, the pH, the concentration of the sperm, the motility, and the morphology. And that’s giving us an idea into how the body is functioning. So, when you’re preparing for semen analysis, you need at least two to three days of abstinence. So, no intercourse, no ejaculation.
We want to make sure that we’re getting a good enough sized sample to be able to evaluate the sperm. So, 2-3 days of abstinence.
Different variables and what they all mean?
So the first one is volume. So if you have low volume, that’s a concern that is either a collection situation. It is awkward. So sometimes there’s spillage or leakage. And if you have that, we always recommend you tell whoever’s receiving the sample because it’s going to put it in a different perspective for me than if I think your body just makes low volume.
The volume comes from both the sperm, but also from the seminal fluid from the seminal vesicles. And that’s going to help give it enough of a sample to have the right pH and to protect the sperm in the vagina. Remember that the vagina is really acidic. And so we have the sperm in the vagina. It’s all going to die. But the seminal fluid, that ejaculate is actually very alkaline.
So it’s protective for the sperm so it can exist in the vagina and not just get killed. And then the sperm quickly swims into the female reproductive tract. So it goes through the cervix and actually makes its way to the fallopian tubes and out the ends of the tubes really rapidly.
Fun fact is that the egg must be fertilised while it’s in the fallopian tube. So the sperm has to go there and it has some chemo attractant properties attracting the sperm into the tube that it’s actually inside. Fascinating.
So, the sperm quickly exits. So the size of that sample is important as is the pH. A good example of what these things can tell us when it’s off is that a low volume and an acidic sample. So, a low pH can be really worrisome for cystic fibrosis. Cystic fibrosis is what we call an autosomal recessive disease, meaning it’s a silent carrier disease.
When a person inherits two copies of the cystic fibrosis mutation, you have cystic fibrosis, which is really characterised as a bad lung disease. However, male carriers of just one cystic fibrosis gene can have something called CBAVD, congenital bilateral absence of the vas deferens.
So that’s what volume and pH. If we get a sample that is abnormal with a really low volume, sometimes we ask for a repeat sample. If it’s just low, but there was no spillage and the pH is normal, we’ll often ask for a longer non-ejaculatory window. So, we’ll say, Hey, can we go one week without any ejaculation? And then let’s see if we have enough volume to give us normal results from the other factors. And then that may change how we counsel when it comes to fertility treatment, but at least we can get a more accurate representation of what’s in the sample.
Did you know that on average men can make 100 to 200 million sperm a day? They’re germ cells, but essentially they make a sperm. And the lifespan of a sperm is about 90 days, takes 72 days to develop across the course of the testes actually start on one side and develop as they get to the other side. And then about 18 days to migrate through that ejaculatory system until they get into the sample.
So, when we’re looking at the concentration, how we define this is the number of sperm that are made per millilitre. So normal is at least 15 million per millilitre. Understanding that’s the low end of normal average for reproduction is going to be about 40 to 50 million per millilitre. So, if you’re 15, you’re going to have lower chances of fertility than somebody who’s totally up at 40 to 50 million per ML. Sperm concentration is often a reflection of the signals from the brain. So, your signals from the brain are helping drive sperm production.
So FSH and LH from the brain are driving the production of testosterone and sperm. They develop together. A good example is if somebody is taking testosterone, which can happen because, you know, maybe you have fatigue or low libido and you get placed on testosterone to try to feel better. And you do testosterone is like male birth control. It tells the brain to stop sending out FSH and LH. And then suddenly it also halts sperm production.
And that can last for months or years, depending on how long you’ve been on it. So, a better option is if you have low testosterone and you’re feeling symptomatic, make sure your physician knows you want to get pregnant because then they’re going to put you on medications like Clomid or HCG or things that do not inhibit the body’s ability to make sperm. So that’s going to be something you’re going to want to ask about.
And just for definition purposes, we call this oligospermia if you have low sperm counts and we call it azoospermia if you have no sperm. So, azoospermia, we’re always curious, is this an obstruction? Sperm is being made, but can’t get into the ejaculated sample, or is there no sperm being made either from testicular failure or from lack of brain signals? One thing that can destroy the testes is being at too hot of an internal temperature. And one of these things can actually be from having undescended testes as a child.
So if your testes were not brought down into the scrotum at an early enough age, it may have resulted in destruction of some of those germ cells or the ability of the testes to function. So that’s always another big warning sign to me too, is having prior history of undescended testes or testicular surgery.
And it’s the number of forward-moving sperm. Most seminalities we’re looking for at least 40% modal, but just like concentration, that’s the low end of normal. 60% or more is going to be your normal level of conceiving. So, you’re a little bit subfertile if you’re a 40 or above, but you’re not into the infertile zone. When you have abnormalities in your motility, it can be from like lifestyle or environmental factors. So, this is the development of the sperm and now they can’t move.
What are they being exposed to? And then there’s a functional value called the total modal sperm count, TMS, volume times concentration times motility. And that’s really giving us an idea of the application of the functionality of the sperm. Do you have enough to get the job done? Even though everybody always says it just takes one sperm, we really want those sperm to be able to migrate towards the egg. They have to exert enough pressure to crack open the egg and get a sperm inside. And so if you just have a very low count that are actually moving and able to get the job done, it becomes less likely that they’re going to be able to fertilise that egg.
A normal total modal sperm counts, usually around 40 million moving sperm and suitable enough for IUI is going to be at least 20 million moving sperm. You lose about half of the sample in the wash process for IUI. And we like to see at least 10 million to go into the body for IUI.
Morphology is the shape of the sperm. And I find it fascinating because so many sperm are abnormally shaped and you can see that here. You have sperm with two heads, two tails, a big head, a small tail, all these different abnormalities. Interestingly, you need to look at a semen analysis because there’s two different ways that we report on morphology. The old one is called the WHO, the World Health Organisation. That level, you needed 15% more to be normal. In the Kruger or the strict morphology, we need 4% or more to be normal. And again, this is the low end of normal functionality is better the higher that it is.
Looking for IVF Clinic in Bangalore? At Dr. Kamini Rao Hospitals, the process of evaluating male fertility is much more than just looking at numbers on a test report. The hospital follows strict, well-established procedures for semen analysis, which are carried out by experienced embryologists using state-of-the-art laboratory equipment. This ensures that the results are not only accurate but also dependable. What makes this approach even more special is that each report is carefully reviewed with the individual patient in mind. Factors such as hormone levels, lifestyle choices, past medical history, and the couple’s fertility goals are all taken into account during the interpretation of the results. Whether the findings are within normal ranges or indicate some abnormalities, patients are given clear and understandable advice on what to do next. This may include making changes to their lifestyle, seeking medical treatment, or exploring more advanced options like intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI). With years of experience and leadership in the field of reproductive medicine, Dr. Kamini Rao Hospitals provides complete, science-backed care to couples at every stage of their path to parenthood.
At Medline Academics, the instruction of male fertility and semen analysis serves as essential diagnostic methods in Andrology Training. Trainees acquire a thorough understanding of how semen parameters indicate hormonal function, anatomy, lifestyle influences, and fertility potential through organized academic programs, clinical experience, and practical learning. Focus is given not just to interpreting reports but also to linking findings with clinical decisions, from advising couples to selecting suitable interventions like IUI, IVF, or ICSI. Medline Academics empowers healthcare providers by linking scientific theories to practical clinical approaches and Andrology Certificate Course, enabling them to handle male infertility with assurance and accuracy. We also started Fellowship in Radiology course in Bangalore.
When you have abnormally shaped sperm, this is typically an indication for ICSI or intracytoplasmic sperm injection because it does help improve fertilisation rates. We like to think in science structure equals function. If it’s abnormally shaped, can it do its job? And what is a sperm’s job? To hold the DNA in the head and protect it, to swim to where it needs to be, and to fertilise an egg. And so it needs to be able to do all three of those jobs. We also think that sperm morphology is probably influenced by lifestyle, at least to some degree. And so this is why things like heat, sitting in a hot tub or a sauna, it can be really bad for the sperm.
Ask him the different things you put in your body, probably sugar. And some of those processed and refined foods are not excellent for production of sperm. So those antioxidants and your fruits and your vegetables and your whole grains, those are going to be the things that are going to be the best.
All right. And then your semen analysis can also report round cells. Now, round cells cannot always be differentiated, but these can be immature sperm. They can be white blood cells or red blood cells. And so, depending on what they are, you might sometimes be told to take an antibiotic or an anti-inflammatory medication and then repeat the analysis to see if there’s less abnormal round cells that are present.
If we imagine there’s a lot of stalled cars on the highway, is it hard for the sperm, even if they’re normal to get to where they need to go? So, the semen analysis is a really important tool because it tells us a lot, hormone production, anatomy, lifestyle. If it’s normal, we’re good. But if it’s abnormal, we’re going to start to talk about, are there lifestyle factors that we can change? Are there medications that can help? Are there further evaluations that may be needed? Do we need to do chromosome testing or genetic testing? Do we need a sperm extraction procedure? Is this suitable for intercourse, potentially suitable for IUI, which is intrauterine insemination? Or are we in an IVF zone? And if we’re an IVF, do we need ICSI or a sperm extraction or even advanced procedures? So the semen analysis is a diagnostic test that is extremely important for those of us in the fertility world.
Everybody needs to get a semen analysis. If you’re trying to conceive and get problems just because you’ve had prior success, doesn’t mean the sperm is fine at this moment.