Semen Analysis/Seminogram/Spermiogram/Sperm count

Semen analysis is usually the first test your fertility specialist will request, that is a basic analysis of a man’s semen. It is an essential test for evaluating whether there is a male factor contributing to infertility. Semen analysis is an effective and non- invasive test, and measures whether your semen sample is normal (capable of causing a termed pregnancy). It includes a determination of colour, viscosity (consistency), volume, liquefaction, pH, sperm count or sperm numbers, motility, morphology, grade of progression (evaluates the quality of the movement), type and number of non-sperm cells (i.e. white blood cells, red blood cells). World Health Organization recommends at least two consecutive semen analyses be performed (diagnosis).

How is this test done? And how to prepare yourself for the test?

For the most accurate test results, do not ejaculate for 2 to 7 days. Share with the laboratory all medicines, herbs, vitamins, and supplements you are taking. This includes medicines that do not need a prescription and any illegal drugs you may use. Do not use KY jelly/Vaseline during masturbation it negatively affects sperm quality.

The most common and reliable way is to masturbate and ejaculate into a sterile container in a private room at your healthcare provider’s office. You can also collect the sample at home through intercourse by ejaculating into a male factor special condom that has no additives or lubricants. During transportation semen sample must be kept at body temperature and delivered to the laboratory within 30 min after production.

Other methods may be used to collect the sample such as vacuum device fitted around the penis to increase blood flow, resulting in ejaculation. If you are suffering from a spinal cord injury, a vibrator may be used to bring about ejaculation. Semen can vary in quality, so you may need to provide two samples within a week or two.

Testing semen macroscopic parameters

Appearance, semen volume, pH, colour, odour, viscosity and liquefaction. Routine semen analysis includes all the above macroscopic parameters which are compared against WHO’s established reference range for a normal semen sample. 

Testing semen microscopic parameters
Sperm Morphology, Size and Shape of sperm head, midpiece and tail

Sperm morphology refers to the size, shape and positioning of different sperm sections, which if abnormal can decrease fertility, making it challenging to fertilize the woman’s egg (oocyte). We closely examine the sperm cells for normal size and shape of the head, mid piece, tail or for any other abnormalities. Other sperm defects include bent tail, coiled-tail, stump-tail and not having the tail attached at the correct position.

Some couples will need to use either IUI, IVF or ICSI treatment to improve their chances of becoming parents based on the sperm morphology results.

Sperm Count, Sperm concentration

Sperm count also known as sperm concentration measures the numbers of sperm cells per ml of semen (16 million sperm up to 250 million per millilitre indicates normal concentration). Total sperm count is obtained by multiplying the sperm count per ml (concentration) by total semen volume. As per WHO 2021, 39 million sperm per ejaculate or more is considered normal.

Low sperm count (less than 16 million/ml or less than 39 million per ejaculate) condition is considered oligozoospermia and sample with zero sperm is considered azoospermia. Cryptozoospermia is the condition where a semen sample contains less than or equal 1, 000,000 spermatozoa per millilitre. Spermatozoa can be detected in an ejaculate only after centrifugation and inspection of the pellet.

Sperm Viability/Live dead Test/ Necrozoospermia

Viability test determines whether non-motile sperm are alive or dead. Sperm viability (vitality) should be assessed if a low percentage (40%) of sperm are progressively motile. The percentage of live spermatozoa is determined by identifying sperm with an intact cell membrane. This is done by using a dye exclusion method (eosin-nigrosin), where dye enters a non-vital (dead) cell due to the damaged plasma membrane. Viable cells will appear unstained (membrane integrity).

Centrifugation in Severe Oligo and Azoospermia

This is a standard protocol in our laboratory. If fewer to no sperm cells are observed after examining the semen several times, sample is centrifuged at high speeds to concentrate the content. Semen sample sediment is then meticulously examined several times. Because there are so few sperm in the ejaculate, they are incredibly difficult to find and very easy to miss. When there is a miniscule amount of sperm in the ejaculate, the chances of sperm reaching and fertilizing an egg and leading to pregnancy are slim.

Evaluation of Seminal Fructose and Citric Acid Levels

If little to no sperm are found during semen analysis, an additional test for fructose in the semen may be needed. The absence of fructose may indicate either the vas deferens are obstructed at or before the ejaculatory ducts, or the seminal vesicles are absent. A blockage may be the result of infection, including sexually transmitted disease, injury, or previous surgery that could have scarred the delicate tubules of the epididymis or obstructed the vas deferens. Congenital absence of the vas deferens is often found in patients with cystic fibrosis.

Post-Ejaculatory Urinalysis

Post ejaculation urinalysis is a test performed to check for the presence of spermatozoa in the urine which is caused by a condition called retrograde ejaculation. In retrograde ejaculation, the semen flows back into the bladder instead of flowing out through the urinary meatus during ejaculation. This results in absence of semen (aspermia) or no apparent ejaculation during sexual intercourse.

Retrograde ejaculation is one of the causes of male infertility and a post ejaculation urinalysis can easily diagnose this condition. Specific techniques are used to recover sperm from urine before they are damaged. Such sperm can still be used for IUI, IVF or freezing for future use.

Antisperm Antibody Test

Sperm antibodies, bound to spermatozoa are found in over half of men’s seminal fluid and/or serum post vasectomy. During this procedure, the blood-testis barrier is broken, and sperm antigens are presented to the immune system. Antibody Antisperm test helps to determine whether there is an immunologic factor contributing to infertility.

DNA Fragmentation Test

It is an analysis of the sperm DNA integrity. A high level of DNA fragmentation in sperm cells may represent a cause of male infertility. Elevated levels of DNA fragmentation above the critical threshold can significantly compromise the possibility of a successful pregnancy. Information about sperm DNA integrity may help in the clinical diagnosis, management and treatment of male infertility and may be of prognostic value in assessing the outcome of assisted reproductive treatment.

Male Infertility Oxidative System (MiOXSYS) Test

MiOXSYS® is a rapid in vitro diagnostic semen test that accurately measures oxidative stress system in the semen. MiOXSYS’s® sORP represents an integrated measure of all oxidants and reductants, making it a more clinically meaningful measure when diagnosing idiopathic cases associated with high levels of oxidative stress. It reflects the oxidative relationship between the sperm cell and its environment.

Semen Culture

The test assesses semen samples for bacterial growth to diagnose infections or inflammatory conditions in the male reproductive system. 

Hormonal Testing

Sperm production is under the control of special hormones that come both from the pituitary gland (FSH, LH) and from the testicle (testosterone). If the blood levels of these hormones are abnormal, sperm production may be very low or absent. This type of problem is diagnosed with simple blood and saliva tests and, if present, may be correctable with medications. Male hormone screen tests levels of FSH, LH, Testosterone, SHBG, Free Androgen Index, DHEA Sulphate, Prolactin and Glucose.

Sperm washing is performed in a series of steps including centrifuging or spinning the semen sample to separate the best sperm from the remainder of the specimen.

Sperm washing is a laboratory process of separating healthy, motile sperm from the rest of the semen specimen (seminal plasma, dead or nonmotile sperm, enzymes, proteins, cryoprotectant….). It enhances the fertilizing capacity of the sperm and is recommended in cases of immunologic, male-factor, or unexplained infertility. Washed sperm cells are then concentrated in a medium or solution that nourishes and preserves them for fertilization of the egg.

Sperm washing is a reproductive option for an HIV-serodiscordant couple in which the man has HIV. Because the seminal fluid contains the highest concentration of HIV, washed sperm contains little, if any HIV. Sperm washing can also be used in the case of oligo-asthenozoospermia conditions to increase the numbers and motility of sperm for IUI or IVF.

We offer different sperm washing methods: the basic sperm wash technique using dilution and centrifugation; the Density Gradient Wash using density gradient centrifugation to isolate and purify the motile sperm; and Swim-up Wash using self-migration to obtain a sperm sample with a motility of at least 90%.

Individual sperm which fertilizes an egg is the sole determinant of child gender. If that sperm carries an “X” chromosome, it will result in a female. If it carries a “Y” chromosome, a male will be born. In certain situations, a couple will have a strong gender preference.

IMPORTANT:  Please understand that this technique is only a way to try to increase the odds of conceiving either a male or a female child.

Success Rates of Sex Selection

The Ericsson Method of sex selection produced a success rate of 70-72% for male sex selection, and 69-75% for female gender selection. To date no research has conclusively disproved the value of the technique, nor has any study proved conclusively that it consistently produces high success rates.

Of course, patients must also understand that there is no guarantee that any insemination using sex-selected sperm (or any semen sample, for that matter) will result in conception, or that if conception occurs, that the pregnancy will be carried to term.

You may want to consider freezing your sperm if:

1. You have a condition or are facing medical treatment such as radiotherapy or chemotherapy.These therapies can adversely affect sperm production and may cause sterility. Recovery of testicular function after therapy is variable and unpredictable; therefore, the only way to protect future fertility is through sperm cryopreservation.
2. If you are about to have a vasectomy we advise you to freeze and store your sperm in case you change your mind and wish to have (more) children in the future.
3. Before surgical procedures which may impair reproductive functions.
4. In cases of oligozoospermia (low sperm counts) or the quality of your sperm is deteriorating, multiple semen collections and pooling may be desirable for use in a single insemination.
5. To preserve sperm for deferred inseminations when an intimate partner is temporarily absent.
6. You have difficulty producing a sperm sample on demand (fertility treatment on the day).
7. You are exposed to high-risk occupational exposures: environmental toxins such as chemicals, pesticides, lead, and radiation.
8. You are at risk of injury, or death or you’re a member of the Armed Forces being deployed to a war zone.
9. You are a male transitioning to a female; you may want to preserve fertility before starting hormone therapy or have reconstructive surgery. Both treatments can lead to the partial or total loss of your fertility.

Sperm Supplements: Maximizing Male Fertility

Sperm supplements are vitamins, minerals, amino acids, anti-oxidants that support sperm development and health (for those diagnosed with low sperm quality). Many studies have shown a positive effect of supplements on male infertility. Few supplements have shown effectiveness in improving sperm health. These supplements can improve sperm quality in many ways: concentration, morphology, motility, and DNA integrity, thus increasing sperm fertilising capability.

Lifestyle Changes: improving male fertility through healthy diet and lifestyle.

Whether semen analyses are normal or not, there is good evidence that diet and lifestyle can have a major impact on a man’s fertility. Smoking lowers sperm count, motility, and morphology. Smoking also increases levels of oxidative stress in the semen and can lead to sperm DNA damage and genetically abnormal sperm. Alcohol and Drug Use impairs normal sperm. Avoid the use of any artificial lubricants, which can be toxic to sperm.

Excessive Heat harms sperm quantity and quality.  Eating a healthful diet can be beneficial for sperm function. Drinking enough water to stay well-hydrated is also important as well as enough sleep time.

Moderate and regular Exercise may be beneficial. Try to limit coffee or other caffeine-containing beverages to one serving per day. Environmental Hazards and Harmful Nutritional Supplements may affect fertility by impairing sperm production.

Products intended to build muscle mass are harmful to sperm production. With frequent sexual activity chances of becoming pregnant is much higher leading
up to and including ovulation.