Let’s Talk About Tests, Baby: Understanding Semen Analysis
In this post, you’ll learn to interpret a semen analysis as a starting point for understanding your or your male partner’s fertility. If you and your partner have been struggling to conceive or if you’ve just been curious about your reproductive health, you may have had a sperm count test.
Firstly, you should know that the routine semen analysis is a blunt instrument. Far from the holy grail of sperm testing, think of it as a very basic screening test. Problems with the test include:
wide variability in results for one individual from one week to the next
disagreement by experts over which parameters of the test are most predictive of male infertility
no analysis of sperm DNA (crucial to knowing the sperm’s quality) is included
Considering that wide variability in results, you should have several semen analyses done over a period of weeks or months—more data points provide more reliable conclusions, right? But if you’re comparing sperm tests, they should be done with the same abstinence time (Krammer-Pojer).
All that said, the basic semen analysis can reveal some red flags. The test looks at three main factors:
sperm count—the number of sperm in the sample
sperm morphology—the shape of sperm (a normally-shaped sperm has one head, one body and one tail)
sperm motility—if and how the sperm move (they should swim forward)
The test also notes a few characteristics of the semen including viscosity, color, and time to liquefaction (healthy semen comes out as a gel and becomes liquid within 30 minutes). Viscosity is measured after liquefaction occurs. When abnormal, these aspects may indicate infection or plumbing problems and could explain why the sperm aren’t arriving to their destination.
How do I interpret my results?
| Semen Parameters | 2010 WHO Reference Values | |
|---|---|---|
| Volume (mL) | ≥1.5 | |
| Sperm concentration (106/mL) | ≥15 | |
| Total sperm concentration (106) | ≥39 | |
| Total motility (% motile) | ≥40 | |
| Progressive motility (%) | ≥32 | |
| Vitality (% alive) | ≥58 | |
| Morphology (% normal) | ≥4 | |
| Leukocyte count (106/mL) | <1.0 | |
| Viscosity | Normal | |
| Time to Liquefaction | Complete in 30 minutes | |
| Color | Whitish, Gray, Opalescent |
(Cooper et al. 237)
Use the above guidelines from the World Health Organization (WHO) to see where your sperm sample falls. You’d like your numbers to be comfortably above or below the given limits.
It’s important to know that these criteria really are a low bar for your sperm sample to clear. Previously, I wrote about the precipitous decline in male fertility in the past 50 years in Maximize Your Mojo, Part 1. Following this downward trend, the World Health Organization (WHO) lowered their standards for a fertile sperm sample in 2010. While the current guidelines represent a definite slackening of the line for male fertility, in their defense, the WHO did use data from fertile men—men whose partners were able to conceive in a year or less of trying (Cooper et al. 232).
What red flags should I look for?
Low volume
Low concentration
Hyperviscous samples
Low motility
Low % normal forms
No sperm in the ejaculate
High amount of round cells (leukocytes or immature sperm)
100% immotile sperm
Completely dead sperm
Other tests for a more complete picture:
If your numbers exceed the above, kudos! I wish they told the whole story. Unfortunately, they don’t . . .
There are other tests that should routinely be part of a male fertility work-up, but sadly are not. These are hormone tests which can indicate an imbalance by tracking your levels of
Testosterone
LH and FSH
Prolactin
Another cause of male infertility is Sperm DNA Fragmentation (SDF). Healthy sperm carry genetic blueprints in their heads which contain all the genetic information from the male partner. The SDF is a measure of how intact these blueprints are. We now believe that fragmented DNA in sperm can lead not only to low conception rates, but also to higher rates of miscarriage (Krammer-Pojer). Sperm DNA gets broken through oxidative stresses like cigarette smoking, exposure to environmental pollutants, and many means. However, the sperm DNA fragmentation tests are not routinely offered because there's not yet consensus over whether the testing is predictive of pregnancy outcomes. It's hard to parse out the sperm DNA fragmentation as a factor versus many other possible factors contributing to infertility (Progyny). We do, however, know that sperm with above 14% normal morphology have an excellent prognosis for IVF (Krammer-Pojer). So if your morphology is above this level, that gives some assurance that SDF is not severe.
What can I do to improve my sperm and semen potency?
To reduce oxidative stress and improve semen:
See your doctor to rule out a varicocele—the most common physical cause of male infertility.
Consider the substances you’re putting into your body--smoking (including marijuana), illicit drugs, alcohol, and medications can negatively impact male fertility. Review your medications with a urologist in case any can be adjusted or changed with fertility in mind (e.g. SSRIs).
Eat plenty of fresh fruits and veggies as antioxidants are crucial for semen health.
Avoid hot tubs, saunas, tight-fitting underwear, cycling shorts, and motorcycles—anything that would heat up the testes.
Exercise moderately. Long-distance cycling would not be the best choice
See a Chinese Medicine practitioner at DHH for acupuncture, herbs, and supplements like vitamins and antioxidants to improve your reproductive health.
REFERENCES:
Cooper, Trevor G., et al. “World Health Organization Reference Values for Human Semen, Characteristics*‡.” Human Reproduction Update, vol. 16, no. 3, 2009, pp. 231–45. Crossref, doi:10.1093/humupd/dmp048.
“How to Test for Sperm DNA Fragmentation?” Progyny, progyny.com/education/male-infertility/how-to-test-for-sperm-dna-fragmentation/.
Krammer-Pojer, Dr. Olivia. Treating Male Fertility Problems with Chinese Medicine: February 8-9, 2020 Retrieved from http://healthyseminars.com
“Semen Analysis and Test Results” Healthline, www.healthline.com/health/semen-analysis#normal-results.