Semen analyses can seem intimidating for many men and their spouses; however, this should not be the case. Male infertility is a common condition affecting one in 10 men (up to one in 20 men having no sperm at all in their ejaculate). We can help up to 70% of men who have no sperm in their ejaculate have children.
Interpreting Your Analysis
The most important point to keep in mind when reviewing the results of a semen analysis is that it is similar to the stock market. By this, we mean that it will be up in the future, and it will be down in the future. Semen analyses vary day-to-day, week-to-week, and year-to-year. Sperm total motile counts (TMC) vary widely from two to 200 million over the course of a year. The cause of these variations is not entirely known. This is the reason that we ask all of our patients to obtain at least two semen analyses.
The data generated from a semen analysis can seem very confusing at first. It is a very unique test and one of the few laboratory tests that still relies on a human or a computer counting the number, motility, and morphology (shape) of sperm cells under a microscope.
A semen analysis has data on the volume of sperm in milliliters (ml). Typically, a volume of >1 milliliter is thought to be normal. We also study the following things:
- Sperm concentration in millions/milliliter
- Percentage of sperm that are motile—or able to swim—as percent motility
- Total motile count (millions of sperm in the ejaculate that are mobile)
- Presence of round cells or white blood cells
- Morphology of the sperm (shape)
The standard data we use to compare numbers on a semen analyses is from data compiled by the World Health Organization (WHO 2010) (Figure 1). The WHO 2010 criteria examined over 4,000 men on multiple continents to establish these reference ranges for normal fertile men.
Morphology (Shape)/Normal Sperm Percentage
Morphology or percent normal sperm are usually recorded by the Kruger Strict Criteria. This criteria was developed by a pathologist to classify the shape or morphology of sperm. Surprisingly, most men actually have 96% abnormally shaped sperm.
So, if a man has at least 4% of his sperm that are not abnormally shaped, it is considered normal. Data remains very conflicting on the impact of abnormal morphology (called teratozoospermia). A previous meta analysis by our group demonstrated that teratozoospermia did not have an impact on either fertilization or pregnancy outcomes. (Hotaling et al, Fert & Steril, 2011.)
Total Motile Count
Perhaps the most important aspect of a semen analysis is the total motile count or TMC. The total motile count is the number of sperm that are motile in the ejaculate. A total motile count of over 20 million is considered normal. Above 20 million sperm, increasing numbers of motile sperm do not result in increased pregnancy rates.
From 20 million down to one sperm, there is a decrease in the chances of a successful pregnancy. Typically, a total motile count of over five million will allow a man’s sperm to be used for intrauterine insemination (IUI) of sperm or in-vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI).
More details of artificial reproductive techniques will be provided by a thorough discussion with a reproductive endocrinology and infertility specialist.
Terms of Semen Analysis
A brief description of the semen analysis terms are something many patients find helpful:
- Asthenospermia means that the sperm have poor motility or do not swim well.
- Azoo means an absence of any sperm.
- Oligo means fewer than normal sperm.
- Pyospermia refers to a condition where there are many, many white blood cells in the sperm, usually from the prostate. So, azoospermia means no sperm, and oligospermia means a total motile count of <20 million. Severe oligospermia is defined as <1 million motile sperm. To make all of these conditions even more complicated, any of these prefixes can be used in combination with each other.
- Teratozoospermia refers to abnormally shaped sperm.
- Zona pellucida is the egg coating.
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