Male Fertility Testing: What to Expect During a Semen Analysis

Male fertility plays a significant part when a couple is trying to build their family naturally. When there are challenges in having children, both partners must be examined in order for the cause of the problem to be properly diagnosed. For the most part, information and reproductive medicine has focused mainly on female infertility when people are trying to build their families naturally.

Let us shift our focus and speak on male fertility briefly, and how fertility testing for men is done. While one may have noble family building goals, it is equally important to know how best to achieve them. When it is understood what is required to produce healthy offspring, then one is well equipped to walk the journey with confidence. So let us look at what male fertility testing is and what you, as one planning to build a family can expect from the process.

What Is a Semen Analysis?

The field of reproductive health uses semen analyses as a diagnostic tool to evaluate the health and quality of sperm that a man produces. Every 70 to 90 days, a person who produces sperm naturally will produce fresh sperm. As a result, changes in lifestyle, diet or health can be seen in the quality of sperm produced. For example, if a person does not smoke and then begins smoking,  the sperm produced before and after smoking will be quite different in quality. In a sense,  what a semen analysis will reflect is the ‘current state of affairs’ in the person’s reproductive health.

The Process

A semen analysis is typically conducted in a lab, or done using an at home kit and a semen sample. The difference between the two is that the lab analysis measures more metrics than an at-home kit does. The process of obtaining a semen sample is non-invasive and painless, requiring a person to masturbate and ejaculate into a sterile cup. A process that can be done within minutes, unless a person has an issue preventing them from providing a semen sample, such as a medical condition.  

Parameters Measured

Semen Volume

Semen volume measures the amount of semen that is contained within the sperm sample. The normal volume of an ejaculation is one and half to five milliliters (1.5-5.0ml). As well, the semen itself is measured for viscosity, sugar content, and acidity, as these can have an impact on the sperm themselves.  

Sperm Count

Also known as sperm concentration, this is a measure of how many sperm cells are within the sperm sample. Within the semen volume of a normal ejaculation, 20 to 150 million sperm are expected per milliliter. 

Sperm Motility

Whether or not sperm move and how they move matters in natural fertilization. Sperm need to move independently, and they also need to move forward. Independent movement indicates that the mitochondria is supplying the necessary energy sperm need. Forward movement indicates the potential to swim from the vagina to the fallopian tube for fertilization. The speed typically does not matter too much, as sperm can survive for about three or so days after ejaculation, which in most cases is sufficient time to get to the fallopian tube. 

Sperm Morphology

This refers to the structure of sperm - the head, mid section, and tail. All these parts matter in healthy sperm. The head contains the chromosomes necessary for fertilization. The midsection contains the mitochondria which provide the sperm with energy. The tail end contains flagella which provide movement for sperm. In a normal sperm sample, the actual shape of the majority of the sperm is not regular. While this could be challenging for natural conception, it is not necessarily an indicator of infertility.

Other Diagnostic Tests for Male Infertility

Semen analyses are the starting point of most male fertility testing. When these parameters do not give a clear indication on the cause of infertility, additional tests for male infertility are done.

Hormone Evaluation 

A low sperm count typically points to the inefficient production of the hormone testosterone.  Therefore a blood sample would be taken to measure how much testosterone is being produced. Testosterone is also responsible for the development and maintenance of a man’s primary sexual characteristics.  

Hypoosmotic Solution Assay

In this test, the plasma of the sperm cell is evaluated to determine if sperm function is normal. White blood cells may be present in the seme, but if their volume is high, it could point to an infection. 

Semen Culture

If white blood cells are seen to be high, a semen culture for bacteria is conducted. The results will determine if an antibiotic will be required. 

Sperm Chromatin Integrity Test (SCIT)

This test checks to see if there are any breakages in the sperm’s chromosomes. Any breaks could prevent proper bonding with female chromosomes in the formation of an embryo.

Sperm Aneuploidy by FISH (Fluorescent in-situ hybridization)

This test is a more detailed look at the chromosomes themselves. It identifies the type of chromosomes, counts them and seeks any anomalies. 

Sperm Chromatin Integrity Test (SCIT)

The DNA, RNA and protein in the sperm is known as chromatin. This is another test used to evaluate breaks in DNA and the overall quality of chromosomes. 

Acrosome Stimulation Test

Almost half of the sperm head is covered by enzymes that help it to penetrate the egg during fertilization called the acrosome. When it penetrates the egg, the acrosome reacts to the surface of the egg, which opens up the sperm head and exposes the binding sites of the DNA within the sperm head for the female chromosomes to bond with. This test is a simulation of that process which checks if the acrosome is reacting as it should. 

Hamster Egg Penetration Test

This is another simulatory test done using a hamster egg, to check if sperm can penetrate the human female egg for fertilization.

Anti-sperm Antibodies Test 

Everyone produces antibodies which help fight disease. However, sperm cells are delicate and therefore have barriers that protect them from these antibodies. When these barriers are compromised, the integrity of sperm is also compromised, which could prevent effective fertilization.

Cervical Mucus Interaction

Sperms ideally need to swim through the cervical mucus on their way to the fallopian tube. How well they can manoeuvre through this mucus during ovulation is key to fertilization. A comparative simulation is done using ovulatory cervical mucus, the patient’s sperm and donor sperm to compare which of the two sperm samples penetrates the mucus better.

Retrograde Semen Analysis

When a man has had a medical condition or surgery on his reproductive organs, sometimes they may experience retrograde ejaculation, where sperm wind up in the bladder during ejaculation. This is tested by collecting a urine sample, after they ejaculate.

Sperm Longevity

Normally sperm tend to remain alive for a couple of days after ejaculation to give them sufficient time to reach the egg for fertilization. This test observes how long this duration is in a sperm sample. 

Transmission Electron Microscopy

This test checks for sperm defects using an electron microscope, which allows the cells to be observed at the subcellular level.

Kruger Morphology Test

This test assesses anomalies in sperm morphology that could prevent fertilization if fertility treatment protocols are used. 

Varicoceles

Varicocles are swollen veins around the scrotum which could cause obstruction, prevent the passing of a sufficient quantity sperm from the testicles, or cause limitations in sperm movement. In most cases, these exist without impairing fertility, but when extremely swollen, they could additionally create discomfort or pain. 

How to Prepare for  a Semen Analysis

To have a sufficient quantity of sperm for testing, it is recommended that one abstain from sexual activity leading to ejaculation for about three to five days. on the day of submitting the sample, one will masturbate and ejaculate into a special condom that is used in sperm collection, or into a sterile cup. As well, it is recommended that one refrain from excess alcohol and caffeine consumption. Avoiding smoking (or nicotine based products), recreational drugs, hot tubs (or situations that will increase the temperature around the testicles) is also recommended. 

Understanding Your Test Results

Your doctor will walk you through your results and what they mean for your fertility. As well, they will advise if further testing would be needed and if not, discuss with you some treatment options. Addditional testing or treatment options are determined on a case by case basis, therefore speaking with a fertility specialist under these circumstances is key.

Next Steps and Treatment Options

Treatment options are provided addressing their purpose or goal, what their benefits and side effects could be, and what risks come with the treatments. For more information and support in your family building journey contact the fertility experts at Utah Fertility Center, for quality and compassionate care. 

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