Overview

stained semen analysis

Getting a semen analysis can be intimidating for many men and their spouses. But there’s no need to feel intimidated or embarrassed. Male infertility is a common condition affecting one in 10 men. In fact, up to one in 20 men having no sperm at all in their ejaculate. Even if you have no sperm in your ejaculate, this doesn’t mean you’ll never be able to have a child. We can help up to 70 percent of men who have no sperm in their ejaculate have children.

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Interpreting Your Analysis

The most important point to keep in mind when reviewing the results of a semen analysis is that your semen is like stock market. In other words, the amount of semen you have in your ejaculate naturally goes up and down. 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. Researchers don’t know exactly what causes these variations. This is the reason that we ask all of our patients to get 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 to count the number, motility, and morphology (shape) of sperm cells under a microscope.

What Do Doctors Look For in a Semen Analysis?

A semen analysis measures the volume of sperm in milliliters (ml). Typically, a volume of more than 1 milliliter is considered 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 can move and swim)
  • Presence of round cells or white blood cells
  • Morphology of the sperm (shape)

Number Standard

The standard data we use to compare numbers in 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.

Figure 1: Semen analysis reference ranges from WHO 2010 criteria

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

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 four percent of his sperm that are not abnormally shaped, this is usually considered normal. Data is unclear on how or whether abnormal morphology (called teratozoospermia) impacts fertility. 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 part of a semen analysis is the total motile count or TMC. The total motile count is the number of sperm that are motile (sperm that swim) in the ejaculate. A total motile count of over 20 million is considered normal. If you have more than 20 million motile sperm, this doesn’t result in increased pregnancy rates.

If you have fewer than 20 million motile sperm, your chances of having a successful pregnancy go down. 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).

Making an appointment with a reproductive endocrinology and infertility specialist will give you more details about artificial reproductive techniques.

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