Male Fertility Testing: What to Expect During a Semen Analysis

Over the years there has been an increase in the number of men consulting fertility specialists due to the realization of the fact that they account for 50% of all fertility issues. Healthy sperm production and function are essential for reproduction. Male fertility testing is crucial for understanding reproductive health and identifying potential issues that may affect conception. 

A number of factors may lead to male infertility; both internal and external and thus it is important to identify them and seek treatment. Let us find out the why, when, where and what of male fertility testing.

What Is a Semen Analysis? 

Semen is the thick whitish- gray fluid responsible for transporting, nourishing and protecting the sperms that is usually released during ejaculation. When a man is suspected of having fertility issues, one of the ways to establish a diagnosis is through semen analysis. Also known as sperm count, it is the process of assessing the quality and quantity of semen and sperm. 

Process

For Semen analysis to be done, a sample is obtained either through self- stimulation and ejaculation into a sterile jar or collected in a condom after sexual intercourse. It should be noted that samples collected from home or away from the health facility should be  presented to the specialist within 30 minutes of ejaculation. Additionally the ejaculation should be carried in the breast pocket to maintain body temperature. A patient is advised not to engage in sex or masturbation for a period of 2-5 days prior to sample collection. A follow up sample will then be required after 2 weeks.

Parameters measure

Some of the key factors to be checked during semen analysis include:

• Sperm count: also known as sperm concentration is the number of sperm present per millilitre of semen which ranges from 20-150 million sperm per millilitre. 
• Volume of sperm: this is the amount in millilitres of semen produced per ejaculation. A normal range is between 1.5 - 5.0 milliliters. 
• Sperm motility: is the movement of sperm; good sperm should have a forward movement.
• Sperm morphology: the structure of the sperm and its shape. A normal sperm should have an oval head where DNA is housed and a long slender tail which helps the sperm to swim towards the egg for fertilization. 
• Presence of white blood cells: high amounts would indicate an infection or perhaps an inflammation.

Other Diagnostic Tests for Male Infertility 

Whereas semen analysis may diagnose male infertility, some results may be inconclusive thus requiring further analyses and treatment. Some of these tests include:

Hormone Testing

Hormone testing is the measure of various hormone levels in the body, usually determined from blood or urine samples. Various hormones are tested including: 

• Testosterone: the main male hormone primarily produced in the testicles. Generally, testosterone levels decrease with age. Lower than normal levels may cause erectile dysfunction. 
• Follicle stimulating hormone: this hormone is produced by the pituitary gland and helps ensure sperm mobility and sufficiency.
• Thyroid stimulating hormone: thyroid disease presents in two ways namely hypothyroidism and hyperthyroidism. The former leads to immature sperm cell production while the latter adversely affects spermatogenesis.
• Luteinizing hormone: this hormone regulates the production of testosterone by stimulating leydig cells which are located in the testes and produce testosterone. Together with the follicle stimulating hormone, this hormone works to ensure healthy sperm production and testosterone balance.

Genetic Testing 

Genetic testing is key as any abnormalities in the sperm mobility and production can affect reproduction. According to a study by utah university,  genetic testing for males involves three key tests namely:

• Karyotype: This test shows if there are abnormalities in chromosomes such as missing or extra ones. There are 23 pairs of chromosomes. A man with extra chromosomes will have XXY chromosomes in place of XY. 
• Y-Chromosome Microdeletions (YCMD): as the name suggests, small sections of the Y chromosomes, which are responsible for the male traits and fertility, are deleted. When this happens a man may not be able to sire a child. 
• A patient diagnosed with low sperm count is usually recommended to have these two tests.
• Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Gene Mutations: the CFTR gene is responsible for movement of salt and water. When it mutates it causes formation of thick mucus in the lungs and digestive tract, a condition known as Cystic Fibrosis (CF). These mutations can cause reproductive tract abnormality and infertility by hindering sperm transportation.

How to Prepare for a Semen Analysis 

Sufficient preparation before a semen analysis is important to ensure accurate results. It involves:

1. Avoiding sexual activities that may lead to ejaculation to ensure a good sperm count. 
2. Avoiding medication that may interfere with sperm quality.
3. Avoid alcohol intake 
4. If testing away from the heath facility, submit the semen at room temperature within 30 minutes.
5. Avoid excessive heat like saunas and tight underwear as this could affect sperm production.

Understanding Your Test Results 

Upon giving a sample for semen analysis, a patient should expect to receive their results within a few days. After testing, a normal result should declare no indication of infection, active sperm, normal values for volume and quantity of sperm as shown in the table below. An abnormal test result may not necessarily mean infertility, therefore further tests may be necessary for a conclusive diagnosis and treatment.

Normal semen analysis test results

Source: https://healthcare.utah.edu/fertility/treatments/diagnostic-testing/semen-analysis

Next Steps & Treatment Options 

Once the diagnosis is in, what next? Well, the male fertility doctor will schedule a meeting to discuss the results and suggest further tests based on the diagnosis since semen analysis alone cannot conclusively determine male infertility. Hormonal and genetic testing as well as imaging are some of the tests that may be prescribed for a conclusive diagnosis. After diagnosis, treatment options may include hormonal therapy, surgical procedures, or assisted reproductive techniques. These may involve In Vitro Fertilization (IVF), where fertilization occurs in a lab before the embryo is placed in the uterus, or Intracytoplasmic Sperm Injection (ICSI), where a single sperm is directly injected into an egg. The recommended approach depends on the specific condition diagnosed.

Male infertility should not seem like a death sentence. There is help that can be accessed at our Fertility Associates of Memphis clinic. Book your appointment today and curate a personalized treatment plan with our fertility specialists and begin your journey to fatherhood.

FAQs:

How does IVF help with male infertility?

IVF (In Vitro Fertilization) overcomes sperm-related difficulties by facilitating egg fertilization outside the body in a carefully monitored laboratory setting.

What is ICSI, and how does it improve male fertility treatment?

ICSI (Intracytoplasmic Sperm Injection) enhances fertilization success by injecting a single sperm directly into an egg, making it a valuable option for men with low sperm count or poor sperm movement.

Who needs ICSI?

ICSI (Intracytoplasmic Sperm Injection) is advised for men facing significant sperm abnormalities, prior unsuccessful IVF attempts, or cases where sperm is obtained through surgical methods.

What is the success rate of IVF with ICSI for male infertility?

ICSI success rates depend on various factors, including sperm quality, egg health, and the general fertility diagnosis. In some cases, success rates can reach 70–80%, but individual outcomes may vary based on medical history and treatment circumstances.

Is there an increased risk of genetic issues with ICSI?

There is a small increase in the risk of genetic abnormalities, but preimplantation genetic testing (PGT) offers a way to assess embryos for possible issues before implantation, improving the chances of a healthy pregnancy.