Semen Analysis

Do you know that 40% of infertility is caused by sole or combined male factors?

Because of that, assessing male fertility through a semen analysis is recommended to all couples who need help getting pregnant. Terms you will see on the semen analysis report:

Count – how many sperms are there in the sample?
Motility – how your sperms are moving?
Morphology – what are the shape of the sperm

Semen analysis results will help to guide the subsequent treatment.

If your partner’s semen parameters are normal, or borderline abnormal but could be improved by sperm washing, you might benefit from the intrauterine insemination (IUI).

If the sperm count or motility is too low, in-vitro fertilization (IVF) by using ICSI might be the better option.
Consult our doctor if you have concerns about semen analysis results.

What is the new WHO semen analysis cut-off?

The 5th WHO (2009) manual semen parameter cut-off values are:

Volume > 1.5 ml

Sperm concentration > 15 million/ml
Total sperm count > 39 million
Sperm Progressive Motility (A+B) > 32 %
Morphology (% normal) > 4%

It is important to note that semen parameters vary from specimen to specimen. So, a second semen sample is usually requested if the results of the first analysis fall below the WHO reference limits.

How to collect the specimen for semen analysis?

– The ideal duration of sexual abstinence before the collection is 2-3 days.

– Complete specimen collection is important. Avoid losing the first portion of the ejaculate which has the richest sperm fraction.

– Do not use any lubricants with spermicidal agents. In the case of inability to procedure a sample by masturbation and to avoid losing the first portion of ejaculate by means of coitus interruption, non-spermicidal condoms may be used.

– Record the time of collection.
– Specimens should be brought to the laboratory within 45-60 minutes.
– Keep the specimen close to the body to maintain physiological temperature during specimen transportation.

What is the most important value in a semen analysis?

The most important value is the total motile sperm count, which is the total number of moving sperm in a specimen. Total moving sperm count is the most important predictor of pregnancy after IUI treatment, and it is used to guide what type of treatment is needed. If the total motile sperm count is less than 5 million, or there is poor fertilization or total failure of fertilization in prior IVF (jump to Multiple failed IVF in Fertility guidance), then intra-cytoplasmic sperm injection (ICSI) will be needed.

My partner’s normal sperm shape is low. What should we do?

Low sperm morphology alone (<4%) does not mean that a man is infertile. Achieving pregnancy is still possible with low morphology scores. Most studies did not concern isolated low normal morphology percentage, and there is not a clear relationship between abnormal sperm shape and tobacco, alcohol, or caffeine use. But when trying for pregnancy, the male partner should not use tobacco or recreational drugs and should limit consumption of alcohol. Taking antioxidant supplements or folic acid may improve sperm count or morphology. If there is combined low sperm morphology with poor sperm count, we will refer the male partner to Urology for further evaluation and assess other potential medical conditions such as varicocele or testicular dysfunction.

Many factors can impact the success rates of fertility treatment, including total moving sperm count, type and duration of infertility, female partner’s age and ovarian reserve, endometrial thickness etc. We will use these other factors in addition to a morphology score to predict the likelihood of conception and guide your treatment.