Understanding Your Semen Analysis

If you catch the semen analysis report in your hand and confused on the various terms in it, this article will help you understand and analyze your report.

Though semen analysis is a major male fertility test in medical science, however, this test has been shown to be ineffective in reliably predicting the fertility status of men.

WHO, after studying the sample of 4500 fertile men from 14 countries in 4 continents, came up with a range for all sperm parameters that can be called Standard/Reference values. Sub-normal reading necessarily doesn’t mean infertile status. It needs a subjective analysis to study the numbers, hence no parameter should be read in isolation.

Preparing for Sperm Test

To avoid any inaccuracy resulting due to external factors, you must follow certain instructions to get the best sample.

  1. Avoid ejaculation for at least 3 days before the test. If you are asked for multiple tests, they should be conducted at least seven days apart and over the course of two to three months.
  2. Avoid drug such as cocaine and marijuana at least 10-15 days before the test.
  3. Discuss your medications with your Doctor, especially any hormone. Most often the Medical practitioners would not have any knowledge of herbal medicines, so it is better to stop them for a month before the test or at least seek an opinion from a herbal medicine expert.
  4. The cleanest way to get a sample is through masturbation in a sterile wide-mouthed container made of glass or plastic. Any loss of semen while collecting the sample should be reported to the technician as the volume is also a parameter in the report.
  5. Do not carry your sample from home. It is always preferable to give the sample in testing facility itself to avoid the interference in data from external factors of time delay, temperature etc.
  6. Amateur Lab technician often reports sperm precursor cells as puss cells. So it is advisable to go for a Computer-assisted sperm analysis from a reputed lab.

Each of this factor is extremely important as you certainly want to strike out the “mishandling of sample” factor in case there is an abnormal report.

When is a Semen Analysis Report Abnormal

Sperm test often requires a subjective analysis when certain parameters are below range and often interpreted differently by different doctors.

Three basic parameters together define the fertile ability of the sperm. There are other less important parameters of semen as well discussed below.

  1. Count: Number of sperm cells in the sample
  2. Morphology: Percentage of cells in normal shape
  3. Motility: Percentage of cells with the ability to swim

Physical Examination

  • Color: Semen is normally whitish-gray opalescent in color. Aged men may have yellowish tint. Presence of blood may make it red, or any infection of seminal vesicles, prostate, urethra produces a brownish or deep yellow color.
  • Liquefaction: Within a few minutes at room temperature, the semen usually begins to liquefy (become thinner), at which time a heterogeneous mixture of lumps will be seen in the fluid. As liquefaction continues, the semen becomes more homogeneous and quite watery in 15-20 minutes. Taking more than 60 minutes to liquefy signals a problem requiring further investigation.
  • Volume: The lower reference limit for semen volume is 1.5ml.
  • Viscosity: Viscosity is measured after complete liquefaction has occurred. Viscosity is considered “normal” if the liquefied specimen can be poured from a graduated beaker drop by drop with no attaching agglutinum between drops.

Sperm Count:

Sperm count per ejaculate (total volume of semen sample) and the sperm concentration (sperm count per ml) are the simplest measures of Man’s reproductive health.

WHO considers the range from 15 million to 150 million per ml as normal as long as total ejaculate sperm count is over 22 million. Some men with lower count per ml have higher volume to have normal total count.

The count is not an absolutely crucial factor in the test of fertility of a Man. Men with a count lower than 10 million/ml could make their partners naturally conceive and with a count, more than 40 million/ml could not due to issues in other sperm parameters.

A low sperm count is also called Oligospermia (ol-ih-go-SPUR-me-uh). A complete absence of sperm is called Azoospermia. Oligospermia can be treated with proven medical drugs and herbal Ayurvedic preparations. An extreme low count may need various assisted conception treatments like fertility medication, artificial insemination, in vitro fertilization and surrogacy.

Morphology:

Sperm morphology is the study of the size, shape, and appearance of the sperm cells.

A normal sperm has a head, midpiece and a tail. The head portion at the tip contains the DNA, the midpiece contains the mitochondria which supply the energy the tails need to move, and the tail executes the lashing movements that propel the sperm towards egg inside the uterus.

The morphology number on the semen analysis report gives what percent of the total sperm are normally shaped.

There are different scales for measuring morphology. WHO uses non-strict criteria to identify normal shape sperm and 30% or greater is considered normal. A more strict Kruger criterion rejects even a slightest defect in the sperm and 4% or greater is considered normal. And your semen analysis will likely be based on Kruger strict criteria.

Motility:

Motility is the percentage of moving sperm (forward or otherwise) in a sample and quality of movement is graded based on speed and direction traveled.

  • Grade A: (Straight moving)Sperm with progressive motility. These are the strongest and swim fast in a straight line. Sometimes it is also denoted motility IV.
  • Grade B: (Zig-zag moving): These also move forward but tend to travel in a curved or crooked motion. Sometimes also denoted motility III.
  • Grade c: (Vibrating) These have non-progressive motility because they do not move forward despite the fact that they move their tails. Sometimes also denoted motility II.
  • Grade d: (Non-motile)These are immotile and fail to move at all. Sometimes also denoted motility I.

For a normal result, total motility should be more than 50%, and 32% or more with forward progressive motility ( Grade A & B).

WHO also has a parameter of vitality, with a lower reference limit of 60% live sperms after an hour.

Semen PH:

This is a measure of acidity (low PH) or alkalinity (high PH) of the semen.

WHO defines the PH range of 7.2 to 8.0. Various independent research analysis find numbers that consistently lay outside this range up to 8.7 in fertile men.

The extensive research till now has not shown major impact of Ph on man’s fertility potential.

Fructose Level:

Human semen is naturally somewhat ‘sweet’ due to the presence of fructose. The normal fructose value is found to be 1200 to 4500 μg/ml. Fructose is the energy source for sperm motility.