Diagnostic Workup: What Is a Semen Analysis?

Carefully conducted examination of a man’s semen provides much more than the usual reference of a “sperm count.” Semen analysis (SA) provides an indicator of how a man’s reproductive hormonal cycle is functioning, the quality of his sperm cells in shape, motility, and quantity, and the potency of his reproductive tract.

The World Health Organization has a manual (WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction, Fourth Edition) which provides technical recommendations and standards for performing the basic techniques involved in SA from a clinical standpoint. In short and from the patient’s perspective, a semen analysis consists of:

  • Abstaining from ejaculation for 48 to 72 hours prior to testing;
  • Obtaining a semen sample via masturbation, using a sterile receptacle, either at patient’s home or clinic, depending on the length of travel time;
  • Turning in recently obtained sample to clinic or lab, where it will be assessed.

Generally, assessment occurs within a few hours, but you may or may not get your results on the same day–check with the lab to be sure. The following parameters will be observed and noted:

  • Volume–low volume may be associated with incomplete collection, retrograde ejaculation, ejaculatory duct obstruction, or androgen deficiency;
  • Motility–both percentage and quality i.e. how fast and straight the cells swim; clumping may suggest inflammatory or immunologic problems;
  • Morphology–looking for normal oval heads, mid piece, and tail; mal-shaped cells may represent altered testicular function; slow liquefaction of semen may be an of indicator glandular dysfunction;
  • Presence of white blood cells–indicating possible infection.

According to the WHO, fertile semen specimens should have at least 20 million sperm, with at least 50% of the sperm motile and at least 30% with good morphology. Normal volume is 2-5 cc.

Who Benefits From It?

Since roughly half of all infertility cases are due to male-factor causes, a semen analysis is one of the very first tests conducted when conception is not occurring. Relatively inexpensive, painless, and less physically invasive than many of the female’s diagnostic infertility tests, the simple but thorough examination of a man’s sperm can answer a great many questions early in the diagnostic phase. To proceed with any infertility treatment when only the female has been examined would be potentially wasteful of time, energy, and money.

What Are The Stats?

The authors of one study concluded that results of semen analysis alone are not useful in estimating a couple’s fertility potential. Generally, it may be said that morphology may have a greater impact of all the parameters; volume and motility problems can usually be overcome with several assisted reproductive techniques.

An older study used the percentage of morphologically-normal sperm to predict fertilization and pregnancy in an IVF program, concluding that there was more success in the groups with normal sperm morphologic features greater than 14%. Another study demonstrated that a newer way of looking at sperm morphology, the sperm deformity index (defined as the average number of deformities per sperm assessed), is a reliable predictor of fertilization outcome via in vitro.