Semen Analysis Test Procedure, Parameters, and Interpretation | Importance for Male Fertility Evaluation

Semen analysis is a test of a man’s sperm and semen. Also known as a sperm count or male fertility test, its results show how many sperm are released, as well as how they’re shaped and how well they move.

Semen is the thick fluid that comes from men’s penis when they ejaculate during sexual activity. It carries sperm out of a man’s body so it can fertilize an egg and create an embryo (the first stage of pregnancy).

What is semen analysis?

Semen analysis, also known as a sperm count test, looks at the health and viability of a man’s sperm. Semen is the fluid that contains sperm (as well as other sugary and protein substances) that is released during ejaculation. A semen analysis measures three main factors of sperm health:

• The number of sperm
• The shape of the sperm
• The movement of sperm, also known as “sperm motility”

Why do I need a semen analysis?

You may need a semen analysis if:

• You and your partner have been trying to have a baby for at least 12 months without success.
• You recently had a vasectomy and need to make sure you don’t have sperm in your semen.

Preparation for the Semen Analysis Test

Your doctor will tell you what to do in preparation for semen analysis. It is very important to follow these instructions to obtain accurate results.

To get the best sample:

• Avoid ejaculation for 24 to 72 hours before the test.
• Avoid alcohol, caffeine, and drugs like cocaine and marijuana for two to five days before the test.
• Stop taking any herbal medications, such as St. John’s wort and echinacea, as directed by your health care provider.
• Avoid any hormonal medication as instructed by your health care provider.

How to Conduct Semen Sample

There are four main ways to collect a semen sample:

1. Masturbation
2. Sex with a Condom
3. Sex with withdrawal before ejaculation
4. Ejaculation stimulated by electricity

Two main factors are crucial to having a good test sample.
1. The semen must be kept at body temperature (37^oC).
2. The semen must be delivered to the testing center within 30 minutes of leaving the body.

Precautions for Semen Sample

1. Don’t use condoms, particularly with spermicide.
2. The specimen should be maintained at 37 °C during transport if brought from home and examined within 3 hours of collection.
3. A sterile container is needed, and the sample should be collected at room temperature of 37 °C.
4. Plastic containers are not recommended.
5. Avoid extreme temperatures.
6. The analysis should be done immediately when the semen is liquefied.
7. Should be examined within 4 hours,
8. The sample should be kept at 37 °C.
9. Wait till liquefaction is complete for the examination.
10. Drugs that may decrease the count are:
    1. Antineoplastic agents (nitrogen mustard, procarbazine, vincristine, and methotrexate).
11. Direct the patient to avoid alcohol intake for several days before the semen collection.
12. Instruct the patient to avoid sexual activity for 2 to 3 days before collecting the sample.
    1. Avoid prolonged abstinence because the quality of the sperm and their motility may be decreased.

What do the results mean?

• Volume is the amount of semen in your sample. The normal volume of semen is 2 ml to 3 ml. A low volume can cause infertility.
• Liquefaction: It should take 15 to 30 minutes before the semen liquefies. Although semen is initially thick, its ability to liquefy or become a watery consistency helps sperm to move. If the semen does not liquefy in 15 to 30 minutes, fertility could be affected.
• Sperm count is the number of sperm in the entire sample. A normal semen analysis should be between 20million/ml to over 200million/ml. A low count can make it difficult for your partner to get pregnant.
• Sperm movement (motility) tells you the percentage of sperm moving forward. The sperm must be able to move forward to fertilize an egg.A normal result, more than 50% of sperm must move normally an hour after ejaculation.
• Sperm shape (morphology) is the number of sperm that have a normal shape. Normal semen will have at least 50% normally shaped sperm. Abnormally shaped sperm may not be able to fertilize an egg.
• The pH describes the acidity of your semen. A pH level should be between 7.2 and 7.8 to achieve a normal result. Abnormal acidity can kill sperm or affect their ability to move.
• White blood cells (leukocytes) in sperm can be a sign that an infection is affecting your fertility. No any White Blood Cell in Normal Semen.
• Appearance should be whitish to gray and opalescent. Semen that has a reddish-brown tinge could indicate the presence of blood, while a yellow tinge could indicate jaundice or be a side effect of medication.

If the results of your semen analysis are not all normal, it does not mean that you are permanently infertile. But it does show that your sperm may be part of the problem you and your partner have getting pregnant.

Your provider may order more tests to help find the cause of the problem so it can be treated. There are many possible causes, including:

• Certain habits you can change, such as smoking
• A physical problem in the testicles, such as an enlarged vein (varicocele)
• Certain genetic disorders or other health conditions, including hormonal disorders, diabetes, and cystic fibrosis

Treatments for infertility depend on the cause. To help improve your chances of having a baby, your provider may refer you to a doctor who specializes in infertility.

Semen Analysis Test – Normal Values Chart:

Parameter	Description	Referance Ranges
Semen Volume	Total amount of fluid ejaculated	2ml to 3ml
Sperm Count	The total number of sperm in the measured volume of ejaculate	>= 20 million/ml
Total Sperm Number	Total number of sperm in the ejaculate	>= 39 million
Sperm Motility	Number of motile sperm compared to non-motile sperms and is reported as Percentage.	Total motility >= 40% motile sperms within 60 minutes of ejaculation. Progressive motility >= 32%
Sperm Viability Or Vitality	The number of sperms in the sample that are alive as a percentage of the total number of sperms	>= 58%
Sperm Morphology	Number of ideally shaped sperms as compared to imperfectly shaped sperms and reported as a percentage of the total number of sperms	>= 4%
White Blood Cells	A large number of WBC can be a sign of infection in the reproductive tract	< 1 million/ml
Semen pH	Measured to test if the semen is acidic or alkaline.	7.2 – 7.8
Sperm Antibodies	Normally done in specialised laboratories using methods approved by WHO	<= 50% motile sperm Showing antibody activity

What do abnormal results mean?

Semen analysis is a test that evaluates the quantity and quality of sperm in a man’s semen. Abnormal results can indicate potential fertility issues or other underlying health problems. Here are some possible interpretations of abnormal semen analysis results:

• Low sperm count: A low sperm count (also known as oligospermia) can make it difficult for a man to conceive a child with his partner. A count of less than 15 million sperm per milliliter of semen is considered low.
• Poor sperm motility: Sperm motility refers to the ability of the sperm to swim properly. Poor motility can make it difficult for the sperm to reach the egg and fertilize it.
• Abnormal sperm morphology: Sperm morphology refers to the size and shape of the sperm. Abnormal morphology can indicate that the sperm are not developing properly, which can affect their ability to fertilize an egg.
• High or low semen volume: Semen volume can vary, but extremely high or low volumes may indicate an underlying health problem.
• Presence of white blood cells: White blood cells in semen may indicate an infection or inflammation in the reproductive tract.
• Presence of sperm antibodies: Sperm antibodies are produced by the immune system and can interfere with sperm function and movement.

If your semen analysis results come back at abnormal levels, your doctor may suggest additional tests to help diagnose the underlying cause. Some of these tests include:

1. Blood tests to check for hormonal imbalances or infections
2. Genetic testing to check for inherited conditions that affect fertility
3. Ultrasound to check for abnormalities in the reproductive system
4. Post-ejaculatory urinalysis to check for retrograde ejaculation
5. Testicular biopsy to check for problems with sperm production or maturation
6. Antisperm antibody testing to check for immune system reactions to sperm
7. Semen culture to check for infections that may affect sperm quality
8. Transrectal ultrasound to check for blockages or abnormalities in the ejaculatory ducts.

Abnormal Results Chart:

Abnormalities	Descriptions
Aspermia	Absence of semen
Azoospermia	Absence of sperm in the semen
Hypospermia	Low semen volume
Hyperspermia	High semen volume
Oligozoospermia	Very low sperm count
Polyzoospermia	Abnormally high sperm count in the ejaculate
Asthenozoospermia	Poor sperm motility
Teratozoospermia	Sperms that have morphological defects
Necrozoospermia	All sperms in the ejaculate are dead
Leucospermia	A high level of white blood cell present in the semen
Hematospermia	Presence of red blood cells in the ejaculate

Factors that can influence a semen analysis report

1. Incorrect semen collection techniques, if the normal semen analysis report sample is not collected correctly or the container is not sterile.
2. The delay time between the supply of the sample and the analysis of the sample in the laboratory.
3. Too short an interval from the previous ejaculation.
4. Recent illness in the last 3 months (even the flu or fever can temporarily lower sperm count).
5. Physical damage to the testicles can lead to low sperm count or a man who has had radiation treatment to the testicles or has been exposed to certain medications has low sperm count. Failure of the testicles, obstruction of the ducts that carry semen can affect sperm count.

Frequent Asked questions (FAQs):

Q) What is semen?
Ans) Semen is the whitish-grey organic fluid that is secreted by the gonads of males. It carries sperm and fructose and other enzymes that help sperm survive to facilitate successful fertilization.

Q) How to expel sperm for the test?
Answer) Masturbation in the clinic is considered the best way to give a semen sample. In this way, the sample remains clean and uncontaminated. Electrical stimulators are also used to eject sperm for testing. There are other methods too.

Q) How to verify semen analysis?
Answer) Male fertility is diagnosed through a series of tests, the most important being the semen analysis test. After collection, the semen sample is sent to a laboratory where several factors are evaluated, such as semen volume, sperm count test, motility, and morphology.

Q) What to do before a sperm analysis test?
Answer) Before a sperm analysis test, the sample must be collected. Hands must be washed thoroughly before taking samples, and the man must refrain from using lubricants, saliva, or spermicide, which could affect sperm quality. A man can give a sample by masturbating at the clinic, or some labs can provide condoms for semen collection.

Q) How often should sperm count be checked after vasectomy?
Answer) Semen analysis to check sperm count should be done 3 months after a vasectomy to see if the procedure was successful.

Q) What is the best way to get pregnant with low sperm count and vitality?
Answer) I would recommend IVF treatment over IUI treatment as it has low sperm vitality.

Q) What is the cause of yellow colored semen? Do I need to have it checked?
Ans) Yes, it is best to consult a doctor to know the reason. Because yellowish semen may be due to sexually transmitted diseases, jaundice, the presence of very high white blood cells, infrequent ejaculation, in some cases there may be urine in the semen, and some dietary changes such as eating foods that contain dyes. yellows. it can also cause yellow semen.

Q) What is the cause of green colored semen?
Answer) A person suffering from a prostate infection may have green colored semen. Also, some sexually transmitted diseases like gonorrhea can cause green colored semen.

References:

1. Mayo Clinic. (2021). Semen analysis. https://www.mayoclinic.org/tests-procedures/semen-analysis/about/pac-20385033
2. Cleveland Clinic. (2021). Semen analysis. https://my.clevelandclinic.org/health/diagnostics/16898-semen-analysis
3. National Institutes of Health. (2021). Male infertility. https://www.nichd.nih.gov/health/topics/male-infertility

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