Male Fertility Testing: What to Expect During a Semen Analysis

The way in which male fertility is primarily tested is through a semen analysis. A semen analysis is a diagnostic tool that doctors use to evaluate the health of sperm. Sperm health is assessed in terms of the quantity and quality because a sufficient amount of sperm is required to be in excellent health in order to fertilize eggs. Typically, when a man has been having unprotected sex with a female partner and they are unable to build his family for up to a year, it could point to infertility. A fertility evaluation would be required to determine the exact cause of infertility if it is to be treated. So let us discuss what male fertility testing is and what one can expect from the process.

What Is a Semen Analysis?

Fertility for men is done using semen analysis which is a diagnostic tool that analyses sperm. Men produce fresh sperm regularly and the quantity and health produced is dependent on many factors. In order to conduct a semen analysis, a man will be required to masturbate and ejaculate in a sterile container to provide a sufficient sample that can be evaluated for fertility. 

With this sample, a lab can evaluate sperm parameters for health or anomalies. The lab will evaluate how much semen is in the sample, the number of sperm in the semen, how well sperm move, how well they are formed and if there are any anomalies in the chromosomes. All of these factors play a role in how effective sperm cells will be in fertilization. Let us talk about how each of these factors contribute to family building.  

Process

The process of doing a semen analysis begins with a fresh semen sample. This can be done at the medical facility or at home. If the sample is collected at home, a person should ensure that they submit it within 24 hours of collection, having kept it at room temperature. Let us look at how the different sperm parameters are evaluated, in the next section.    

Parameters Measured

Volume

The first parameter that is measured is the volume of semen in the sperm sample. The expected semen volume of one ejaculation ranges anywhere from 1.5 to 5 milliliters. Semen is also evaluated for acidity, sugar content, and its viscosity. Typically semen will contain some white blood cells, but when they are in high quantities, it is indicative of an infection. Which ideally would be diagnosed and appropriately treated. 

Count

Within a semen sample, it is expected that there will be about 20 to 150 million sperm. Considering the fact that sperm have a long journey to the fallopian tube from the vagina, the more sperm that could make that journey, the better the odds of successful fertilization. Measuring sperm concentration was a manual process done at a lab by a technician. The process is now computerized, making it more efficient. 

Motility

In order for sperm to fertilize an egg in the fallopian tube, they must be able to move well. Naturally, sperm can move independently and they can also move forward. When it comes to a sperm analysis, after the sperm are counted, their motility is evaluated in relation to the number of sperm. The higher the percentage of sperm moving as they should the better. 

Morphology

The sperm cell has three main components that make it function well, the head containing the chromosomes, the midsection containing the mitochondria that give energy to the sperm, and power the third part of the sperm, the tail that contains flagella for movement. Additionally there are enzymes on the head of the sperm that are used to penetrate the egg. When either of these aspects has an anomaly, the sperm is typically not able to reach the egg, or fertilize it. 

Therefore in a semen analysis, once the sperm are counted, and it is known which ones can actually move well, their structure is verified and it can then be determined which aspects of the sperm are preventing it from fertilizing an egg successfully. 

Other Diagnostic Tests for Male Infertility

Typically a semen analysis will provide sufficient information regarding what the cause of infertility is. However, there are times when semen parameters fall within the normal ranges, yet a person is unable to have children. When this is the case, the practice is to run additional tests for male infertility. Let us talk a bit about what they are and how they are are conducted:

Semen Culture

As mentioned, when many white blood cells are found in the semen, it indicates infection. Infections have a direct impact on sperm health, therefore they must be treated so that they do not become an obstruction to family building. In order to determine what the infection is and what type of medication would be required to treat it. In order to run tests, a semen culture is conducted by taking a small amount of the semen sample and placing specific bacteria on it to see if it will grow. An antibiotic course of treatment can be prescribed after further testing. 

Hormone Evaluation 

At the core of a person’s fertility is hormones. These are produced regularly and in specific quantities to maintain both primary and secondary sexual characteristics. Evaluating hormonal production is done using a blood sample. When the hormone levels are lower than normal, they result in poor sperm production and poor sperm health. As well, if hormone levels are higher than normal, they impact fertility.   

Hypoosomatic Solution Assay

This test evaluates the plasma in the head of the sperm. Sperm plasma contains chromosomes and the nucleus of the cell. Any anomalies could prevent the sperm from fertilizing the egg. This test also checks for other infections if the white blood cells are elevated.  

Sperm Aneuploidy by FISH (Fluorescent in-situ hybridization)

This test is done on the chromosomes where anomalies would be assessed. DNA anomalies could cause birth defects should a baby be conceived from such sperm. Additionally, when sperm with DNA anomalies fertilize an egg, it could prevent the embryo  from properly implanting itself into the uterine wall. When an embryo does not implant properly, it could lead to pregnancy loss, sometimes repeatedly.

Sperm Chromatin Integrity Test (SCIT)

Chromatin is a combination of RNA, DNA and protein in the chromosomes. The proper structure of these is essential in order for the chromosomes to bond correctly. When this is not the case, it leads to poor embryo formation.  

Acrosome Stimulation Test

Acrosome is the enzyme that sperms use to penetrate the egg during fertilization. When the sperm head comes into contact with the egg surface a reaction takes place which opens up the sperm head. This reaction reveals the DNA bonding sites of the sperm to the DNA of the egg, allowing for the embryo to be created. This test is a simulation that checks if the acrosome reacts as it should.  

Hamster Egg Penetration Test

Sperm has to be able to move through cervical mucus to the fallopian tube in order to fertilize the egg. To test whether sperm are capable of this movement, they are mixed with hamster eggs to see how they move. Typically a successful hamster egg penetration indicates the ability of the sperm to navigate cervical mucus through to the fallopian tube.   

Anti-sperm Antibodies Test 

Our bodies produce antibodies whose role is to protect the body from infections. Sperm cells are delicate and therefore have barriers to protect them from being damaged by these antibodies. These protective barriers can sometimes become compromised which prevents sperm from fertilization. Humans naturally produce antibodies to protect them from infections.

Cervical Mucus Interaction

Sperm has to move through cervical mucus in order to reach the egg to fertilize it. In order to determine whether sperm are capable of moving through this mucus, cervical mucus is used. The patient’s sperm is put next to donor sperm and observations are made every 30 minutes comparing how well the two sperm fare. Ideally, the sperm should equally be able to navigate the mucus. 

Retrograde Semen Analysis

Sometimes during ejaculation, a man’s sperm may not always come through the penis. This can be observed if the man has had prior surgery to his reproductive organs, or an infection. Both sperm and urine leave the body through the same tube in the penis. When a person has retrograde semen, upon ejaculation, semen enters the bladder and can be found in a urine sample. 

Sperm Longevity

When sperm is healthy, it can remain alive for three to five hours after leaving the body. This test is done to see how long sperm remain alive. It is necessary for sperm to remain alive in order to be able to reach the fallopian tube to fertilize the egg. 

Transmission Electron Microscopy 

This test is conducted under an electron microscope which allows the subcellular level of the sperm to be examined for anomalies. Sometimes, defects that cannot be seen under the microscope can be seen under an electron microscope. This is particularly useful because as we have seen anomalies in sperm structure or DNA lead to embryo defects or pregnacy losses.

Kruger Morphology Test

This test is specifically geared for individuals who would undergo fertility treatments. The purpose is to assess the structure of sperm under strict criteria. The purpose is to check if the fertility treatments are likely to be successful in family building.  

Varicoceles

The veins that supply oxygen and nutrients to the testicles can sometimes swell, creating blockage, discomfort or even pain. When it comes to fertility, they can sometimes create a situation where sperm are not being produced and released effectively, leading to low sperm count and poor motility. As well, when the testicles are affected, it can create challenges in natural family building. 

How to Prepare for  a Semen Analysis

If you are scheduled for a semen analysis, it is recommended that you avoid caffeine, nicotine, recreational drugs, and sexual activity for several days prior to the test. This allows for an optimal quantity of sperm to be collected. Typically on the day one is scheduled to submit a sample, they will masturbate and ejaculate into a sterile cup or a condom that is specifically used in sperm sample collection. 

Understanding Your Test Results

Your fertility specialist will go over the results of your tests with you. Typically this involves explaining the test results and how they relate to your fertility. Additionally, if further testing is necessary, this will be addressed. As well, treatment options will be discussed as they pertain to improving your fertility or chances of having a child.

Treatment Options

Typically treatment options will include dietary and lifestyle changes, medications, or medical treatments. The benefits, side effects and risks, as well as the expected duration of treatment will be discussed at this point. However, it is important to note that each treatment option is determined based on an individual’s fertility challenges, in light of their family building goals. If you have further questions on fertility testing, contact our team of specialists at NCFMC. We are happy to assist you in realizing your family building goals.  

FAQs:

How does IVF (In Vitro Fertilization) help with male infertility?

IVF is used to assist men who are facing fertility challenges to build their families through a more direct approach to fertilization which bypasses some of the more common infertility parameters. 

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

ICSI (Intracytoplasmic Sperm Injection) is an improvement on regular IVF treatments where sperm is directly injected into the cytoplasm of the egg. 

Who needs ICSI?

People who have poor sperm parameters like poor motility, low sperm count, or severe sperm anomalies can benefit from ICSI treatment. People who have not had success in their IVF treatments or have had their sperm retrieved surgically could also benefit from this type of fertility protocol.  

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

IVF with ICSI has a 70 to 80 percent success rate in general. This however can be impacted by what the fertility diagnosis was initially, the quality of a person’s sperm, as well as the quality of the egg being fertilized. 

Is there an increased risk of genetic issues with ICSI?

There is a higher risk of genetic issues using ICSI, therefore pre-implantation genetic testing (PGT) is valuable in screening embryos for abnormalities prior to transferring them into the uterus.