After learning about male infertility, as a couple, you may have paid dozens visit to your male infertility doctor, but there is some self-learning to be done which no doctor bothers to educate their patients. Here is the entire process of conceiving a baby. Are you doing something fundamentally wrong to conceive a baby?
Why Semen Analysis Can Never be Good or Bad?
In this section, you will learn about what is sperm motility important, why fructose is important in your semen analysis, what do you mean by sperm morphology, why a large number of sperm cells die inside the female body? There is no meaning of some absolute numbers in semen analysis. With equivalent numbers, one man can go ahead becoming a father, and other may still be waiting for years. Please read the below section carefully.
No doctor will tell you this concept in details. Conceiving a child is just a matter of chance of ONE sperm meeting ONE egg. But you are always playing with some probability theory while dissecting a case of infertility.
Since this article deals with male infertility and its sperm functions, we assume everything is fine with female anatomy and fertility.
Understand the three basic parameters of semen analysis with the simplest of language without any medical jargons.
Sperm count – It is the number of sperm cells in one ml of semen. So 20 mil/ml means 20 million sperm cells in one ml of semen. But if the total volume of semen is 3 ml, then the total count of sperm cells would be 60 million.
Morphology – It refers to the size and shape of a sperm cell. Some sperm cells would be tails missing, some without heads etc. Deviation from normal shape and size accounts for bad morphology of the sperm. Alway some sperm cells would be normal and others with bad morphology. But it is the percentage of good vs bad that matters.
Motility – It is the ability of sperms cells to move forward and efficiently. You would notice in your SA report that one of the categories of sperm motility is forward progressive – which means how many percentages of sperms cells are able to swim forward. Non-progressive category sperm cells are unable to move forward despite their zig-zag movement.
With this basic understanding, let us proceed to understand why PROBABILITY rules the process of fertilization.
What Happens to Millions of Sperm Cells
After male ejaculation, millions of sperm cells are deposited into the vagina of the female partner. Without using the medical names of the female reproductive anatomy, here is the simplified version of what happens before fertilization.
Contrary to popular perception, sperm and ovum cells do not fertilize right after intercourse. Sperm cells travel inside the uterus and may sit for a few days before they fertilize with the ovum. Hundreds of millions of sperm vie for a single egg cell.
You might have heard a common term called ovulation in women. This is nothing but the process of eggs being released. This happens anywhere between day 10 to day 20 of the menstrual cycle – day 1 being the day when the period starts. A hormone called luteinizing hormone (LH) surges, triggering the release of the egg that’s most ripe.
Another important change happens during ovulation in a woman’s body – that is the secretion of cervical mucus. The narrow passage forming the lower end of the uterus is called cervix. Cervical mucus is a fluid secreted by the cervix. As women approach ovulation, there is an increased flow of cervical mucus in their body. This is a very important fluid which protects the sperm cells inside the very hostile environment of the vagina.
Sperms can fertilize only when the eggs are released by the process of ovulation. So if the intercourse is done any earlier to the day of ovulation, sperms can sit for 24-48 hours inside the female body, waiting for the available egg to fertilize.
After getting deposited into the vagina of the woman, the vaginal acidity is a very hostile environment for a sperm cell to be alive. Many cells die within hours. Here comes the need of the sperm to swim actively forward and go stick to the cervical mucus which provides a protective environment. The amount of secretion of cervical mucous generated by female body also dictates how many sperm cells actually live.
Like any normal human body function, any outside agents are rejected by the body’s immune system. Similar things happen when male sperm cells enter the female body. The immunity system of the female body gets active and counters the foreign cells entering the body. Some of the sperm cells die in this process.
In this process, only 1% of the released sperm into the vagina actually enter cervical mucus and ascend higher into the female reproductive tract. It is to be noted that 99% of millions of sperm cells are not taking any forward journey here. So the remaining 1% of sperms have to be really large in number to survive the further onslaught and have to be strong morphology and motility wise.
How long Egg and Sperm Cells Live
Egg cells typically live around 24 hours after the ovulation. And the survival time of the sperm cells inside the female reproductive tract is around 85-90 hours ( 3-4 days).
Since sperm cells can stay inside women’s reproductive tract for 85 hours around, you do not necessarily target the 24-hours ovulation window to get pregnant. So 2-3 days prior to the day of ovulation will still help you get conceived if everything goes with text book perfection.
Understanding Male infertility
In light of the above understanding, discussing male infertility will make more sense now. Since sperms fight through various barriers inside the vagina, naturally only thousands most effective, motile, and strong sperm cells reach the fallopian tube.
Unfortunately, the medical community has very less understanding of the sperm trajectory, staus, fertilization capability at each level of the female reproductive tract.
So nobody actually knows if 30 million or 50 million sperm count is sufficient. The motility and morphology factors are all theoretical which helps to make an educated guess to say that – this semen sample has a higher probability of getting the partner impregnated.
Few bullet points –
- A man with 8 million/ml sperm count with 80% motility successfully impregnated his wife in 6 months.
- Another man with 22 million/ml sperm count with 43% motility did not impregnate for 17 months before treatment started.
- Presence of fructose in the semen sample indicates its capacity to provide energy to sperm cells to traverse the path inside female oviduct.
- Sperm cells need a slightly alkaline environment to perform at the optimum – between 7 to 8 PH level.
- If the DNA fragmentation of sperm ( checked by the latest diagnostic test) is high, then it has a high correlation with miscarriage.
- Most importantly – neither of the parameters – sperm count, motility, morphology, Ph level, fructose level – are representative of fertilization potential.
The last bullet point says it all. If one sperm ultimately reaches the egg to fertilize, and its morphology is not normal, then also it may lead to miscarriage or deformed child.
So cut off mark for a semen analysis parameters is more of indicative than useful. If you are well higher than the required numbers, then there is probably nothing to worry. Even many untested parents take 8-9 months to get pregnant.
If you are borderline or just higher than that, the probability of impregnating your partner greatly decreases. With that said, it can happen in next month, or after 12 months or even worse. So boosting male fertility actually helps to increase your probability irrespective of what your doctor says if you are still trying after 12-14 months.