Andrology Laboratory Analysis

Semen Analysis

Semen analyses can seem intimidating for many men and their spouses. In fact a lot of men feel that both having to do the test and having it interpreted by a doctor is an assault on their masculinity. This should not be the case; male infertility is an incredibly common condition affecting one in 10 men with up to one in 20 men having no sperm at all in their ejaculate. Further, a lot of the information found on the internet can be misleading and intimidating. Despite how dire some of the men feel when they come to us, we can help up to 70% of men who have no sperm in their ejaculate have children.

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 almost exclusively on a human or a computer counting the number, motility, and morphology (shape) of sperm cells under a microscope. Perhaps the most important point to keep in mind when interpreting 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 this variability is not entirely known. This is the reason that we ask all of our patients to obtain at least two semen analyses.

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 report the concentration of sperm in millions/milliliter, the percentage of sperm that are motile—or able to swim—as percent motility, the total motile count (millions of sperm in the ejaculate that are mobile), the presence of round cells or white blood cells, and the morphology of the sperm. The gold standard for reporting semen analyses are the World Health Organization (WHO 2010) criteria (Figure 1). The WHO 2010 criteria examined over 4000 men on multiple continents in order to establish reference ranges for normal fertile men by establishing the lower fifth percentile of this group or the values that comprise “normal” for 95% of the men. As mentioned previously, there are no cut offs that preclude natural conception on a semen analysis.

Figure 1: Semen analysis reference ranges from WHO 2010 criteria

Ejaculate volume ≥ 1.5 mL
Sperm conentration ≥ 15 million sperm/mL
Motility ≥ 40%
Progressive Motility ≥ 32%;
Morphology ≥ 4% normal

Morphology or percent normal sperm are typically recorded by the Kruger Strict Criteria. This criteria was developed by a pathologist to classify the shape or morphology of sperm. What many find surprising is that most men have 96% abnormally shaped sperm. Thus, if a man has at least 4% of his sperm that are not abnormally shaped, this is considered to be 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.)

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 significantly increased pregnancy rates. From 20 million down to one sperm, there is a linear 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:

  • Azoo means an absence of any sperm.
  • Oligo means fewer than normal sperm.
  • Asthenospermia means that the sperm have poor motility or do not swim well.
  • Teratozoospermia refers to abnormally shaped sperm.
  • Pyospermia refers to a condition where numerous white blood cells are present in the sperm, typically from the prostate. Thus, 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.

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