The semen analysis is one of the most important fertility tests. This is because numerous scientific studies have established that some degree of male infertility is present in almost half of all infertile couples.  Infertility is surely a “couple’s problem”.

Sperm are manufactured in the testicles and travel through the vas deferens and urethra ultimately to be ejected from the penis. Sperm require three months to fully develop, which means the sperm examined today reflect the conditions three months ago. For example, if someone quits smoking in June, the analysis may still be abnormal in September and not show the positive effects until December.

Sperm are sensitive cells and require specific, controlled, environmental conditions to develop properly.  Male infertility is often caused by conditions that artificially raise the testicular temperature such as a varicocele or repetitive long term soaking in a hot tube.  These factors are discussed in the male infertility section of the Web site.

Once the sperm are ejaculated, they must be capable of swimming in the cervical mucus through the cervix and vagina into the uterus. Conditions that impede this process can lead to male infertility.

Sperm characteristics that are typically evaluated include:

1. Volume (amount of fluid that makes up the semen, usually expressed in milliliters)
2. Sperm concentration (number of sperm in a standard given volume) Normal is 20 million sperm per milliliter.
3. Motility (percent of sperm that are moving when the semen is examined under the microscope) > 50% motile is considered normal
4. Progression (forward movement)
5. Sperm morphology (percentage of sperm with normal forms/ shapes)>14% normal forms is considered normal
6. In some cases, testing to determine the presence of male antisperm antibodies will be ordered.

Sperm also present with quantitative characteristics that can be evaluated by an andrologist with extensive clinical experience.   An andrologist is a person who has advanced education (usually a MS or Ph.D.) and training in sperm characteristics including the standard values and others such as the biochemical composition of the semen, evaluation of antisperm antibodies, etc. Andrologists are often involved in clinical research.

It is important to recognize the value of having the sample evaluated by a specialized fertility laboratory that employs andrologists and embryologists.  Unfortunately, many commercial laboratories do not have these specialists on staff and perform the semen analysis infrequently.

Managed care providers often cover services rendered by the least expensive provider.  This means that your insurance company may direct you to a specific lab because they have a contract for services.

We strongly encourage patients to choose a reproductive medicine lab even if it becomes an “out of pocket” expense.  A “missed” diagnosis of male sub fertility can have devastating consequences that can greatly increase treatment cost. A woman could be scheduled for IVF using sperm that will not fertilize her eggs thus leading to a lost cycle(s). 

We strongly prefer that sperm be collected in the laboratory but if this is problematic it can be collected at home following strict guidelines. The sample is collected by masturbation using no lubricants, which can affect sperm. This includes K-Y, water, saliva, or any other lubricant. Our office provides instructions for collection.

Other analysis may be ordered depending upon each couple’s specific circumstances. Once the degree of male infertility (if any) is determined, a treatment plan will be developed. In some cases of mild male infertility, intrauterine insemination (IUI) may be the treatment of choice. IUI involves placing the specially prepared sperm directly into the uterus. This procedure should only be conducted by a trained health care provider as unwashed sperm can cause serious allergic reactions.

In cases of moderate to severe male infertility, IVF with intracytoplasmic sperm injection (ICSI) may be recommended. Thanks to this technology, a man can father a genetically related child even if only one sperm is available in his reproductive tract.