When a couple is having issues getting pregnant, one of the first fertility tests a doctor will do is known as a semen analysis or sperm count. Fertility problems that are caused by male-only factors make up about 20 percent of all cases, and fertility problems with combined male and female factors make up another 30 to 40 percent of cases. Therefore, semen analysis is an important and easy test for couples who are trying to conceive.
Semen is the fluid that is released during ejaculation during sexual intercourse or masturbation. It is made up of sperm and seminal fluid, which is fluid from various structures in the male anatomy that nourish the sperm and help them travel to their destination. In each ejaculation of about 2 to 5 millileters of fluid, there are about 200-300 million sperm. But these sperm make up only about 2 to 5 percent of the total volume of the fluids.
Sperm are necessary for fertility. Because a male has both X and Y chromosomes, a single sperm can carry X or Y DNA. That means that the individual sperm that fertilizes the female’s egg will determine whether a baby is male or female.
What does the semen analysis look at?
A semen analysis looks at a number of factors and pieces of data. The basics include the volume of fluid, the viscosity of the fluid (how thick or thin it is), how rapidly the fluid changes viscosity, and more.
This test also includes looking directly at the sperm to assess the following:
How many sperm are present (sperm count)?
Do they move? Do they move normally (motility)?
And are they shaped normally (morphology)?
A semen analysis is also done after vasectomy to ensure the procedure was a success and that there are no sperm present.
How do you prepare for a semen analysis?
To prepare for the semen analysis, there aren’t a lot of specific instructions. The biggest thing is the timing. A man needs to be sure that he has not ejaculated by any means within two or three days of the test. This gives the body the best chance to provide an accurate sample. The other requirement is that it cannot have been more than five days since the last ejaculation: If a man does not ejaculate frequently enough, he can have lowered sperm quality.
How is the semen collected?
Semen analysis is a first-line fertility test because it is relatively easy to carry out, painless, and risk-free. Because the male partner is at least as likely as the female to be the cause of the fertility issues, it’s easiest to start here.
To perform a semen analysis, the man is given a clean container with a lid and is asked to masturbate into the container. (Some practices allow the use of special condoms to collect the semen.) Clinics prefer the test sample be provided in the office because it usually ensures more accurate results.
If the sample is collected at home, it must be brought to the clinic or doctor's office right away. It should also be kept at body temperature for this process. Plenty of movie and television plot lines use this part of the process as a punchline, but don’t let the Hollywood versions worry you. If you are concerned or have questions, your doctor can give you solid information in a manner that is not embarrassing.
What does an abnormal result mean?
An abnormal result may mean different things depending on what the abnormality turns out to be. For example, if there is a low number of sperm, there are treatments that could either enhance the number of sperm or make the sperm that is available usable. If there is an absence of sperm, a different type of fertility treatment may include the use of donor sperm, or at least an investigation into why there was no sperm.
A practitioner will help you determine the best course of action depending on what the source of the problem is. While not everything can be fixed, many times you will be able to at least get enough healthy sperm to attempt certain types of fertility procedures, like intracytoplasmic sperm injection (ICSI), which only require one sperm.
Can you retest the semen?
Retests are always available (with a fresh ejaculation needed each time). The factors screened for in the analysis can change based on many things, including diet, medications, frequency of ejaculation, and other factors. This means that sometimes a semen analysis will need to be repeated. For example, a repeat may be done after a treatment is done to test the effectiveness of that treatment.
Are over-the-counter sperm count tests available?
There are over-the-counter tests for the basics of the semen analysis. For about $30, one can get a kit to test semen at home. However, these tests are not as accurate nor as complete as those available at the doctor’s office. But there are companies working on an app for that, too.
Ultimately, this test is not something to get overly concerned about in the beginning of fertility treatment. It is done to get a baseline of the male factor in possible fertility issues. Remember: Since the numbers do fluctuate, retests are available, particularly after treatments are tried. Be sure to talk to your practitioner for other advice.
Diagnostic Evaluation of the Infertile Male: A Committee Opinion. American Society for Reproductive Medicine (ASRM). 2015.