Male Fertility Testing: What to Expect During a Semen Analysis

Unlike female infertility, male infertility receives insufficient attention, yet it contributes to a large number of infertility cases worldwide. Male fertility testing is important for identifying potential issues with a man's ability to conceive. This testing is important for helping couples understand and address the causes of infertility, and ultimately improving their chances of having a child. Male fertility testing has proven to be a crucial step in a comprehensive infertility evaluation, providing valuable insights into sperm quality, quantity, and overall reproductive health.

What Is a Semen Analysis?

At its core, a semen analysis is a lab test that evaluates a man's sperm and seminal fluid. It’s designed to assess the overall health and viability of sperm. Fertility specialists look at several critical markers to determine fertility potential and sometimes to identify possible medical issues that need attention.

Semen Analysis Process

A semen analysis is typically done in a fertility clinic like Pacific Northwest Fertility. In many instances, you will be required to provide more than one sample for the clinic to get a comprehensive view of your sperm. This is because sperm counts typically change from day to day. 

To produce a semen sample during a semen analysis, you will be required to masturbate. You can choose to do this at home or the fertility clinic. If done at home, you must ensure the sample is stored in the right container and it must be returned to the clinic within the hour. 

Before you masturbate, your fertility clinic will offer you a sterile container for collecting the sample. Avoid touching the inside of the container as you may tamper with the sample. You also must ensure that your hands and penis are clean before you masturbate. 

What Does a Semen Analysis Measure?

A typical semen analysis covers a range of factors:

Semen Volume

First, the lab checks the amount of semen produced during ejaculation. Low volume (less than 1.5 milliliters) might suggest blockages, retrograde ejaculation, or hormonal imbalances.

Sperm Count

A healthy sperm count generally means at least 15 million sperm per milliliter. Less than that could mean reduced chances of fertilizing an egg. However, this doesn’t always mean it’s an infertility diagnosis.

Sperm Motility

Sperm movement matters a lot. The analysis looks at how well the sperm can swim. At least 40% of sperm should be motile and show progressive motility (moving forward in a straight line). This is especially important for the sperm to reach the egg.

Sperm Morphology (Shape and Structure)

Only a small percentage of sperm need to be well-shaped (with an oval head and long tail) to qualify as fertile. Odd shapes might have trouble penetrating an egg.

pH Levels and Liquefaction

Semen should liquefy within 15–30 minutes after ejaculation, and its pH should be slightly alkaline. Abnormalities here could signal infections or other reproductive tract issues.

White Blood Cells

Any white blood cells in semen might indicate an infection or inflammation that needs addressing.

Other Diagnostic Tests for Male Infertility

While a semen analysis is a great starting point, it's not the full picture. If something seems off or inconclusive, your doctor may suggest further testing. Other male fertility tests include.

Hormone Testing

Though testosterone gets all the attention, other hormones also come into play. FSH (follicle-stimulating hormone), LH (luteinizing hormone), and prolactin all help regulate sperm production. Bloodwork can reveal imbalances that might be impairing fertility. For example, low FSH can mean poor sperm production, while elevated prolactin might point to a pituitary issue.

Genetic Testing

If sperm count is extremely low or nonexistent (a condition called azoospermia), genetic causes could be in play. Chromosomal abnormalities like Klinefelter syndrome or microdeletions in the Y chromosome can interfere with sperm production. A simple blood test can help reveal these inherited conditions and guide treatment or counseling.

Mixed Antiglobulin Reaction (MAR) Test

Men have barriers that hide sperm from their body’s immune system so that the body doesn’t look at the sperm as dangerous. If the sperm is seen as dangerous, the body will produce a defense against it called anti-sperm antibodies. If these antibodies attach themselves to sperm, it may be unable to move.

The presence of these antibodies can be detected through the MAR test. If a high percentage of sperm are bound to antibodies, it can hinder their ability to fertilize an egg.

How to Prepare for a Semen Analysis

Preparation matters. A few small missteps can skew results and send you back to square one.

• Abstain from ejaculation for 2 to 5 days prior to the test. Too soon, and your sample might be low; too long, and sperm could lose vitality.
• Avoid alcohol, caffeine, and tobacco in the days leading up to the test. These can affect motility and morphology.
• No hot tubs or saunas. Heat is the enemy of sperm production.
• Let your doctor know about any medications or supplements you’re taking, as they can interfere with sperm health.
• Deliver the sample properly. If you're producing at home, make sure the container is sterile and the sample reaches the lab within an hour, and keep it close to body temperature.

Understanding Your Test Results

When the test is done, you’ll get a report full of numbers and terms that sound more like a chemistry class than a fertility check-up. Even though your healthcare provider will interpret it, you should still have a basic understanding of what the results could mean. 

For example, normal results don’t necessarily mean guaranteed fertility, and abnormal results don’t mean you can’t father a child. It’s all about context. Borderline or inconsistent values often warrant repeat testing. Sperm quality can fluctuate due to illness, stress, or lifestyle changes.

Don’t panic if the first report comes back with a few red flags. Plenty of men with less-than-perfect sperm parameters go on to become dads, sometimes with a little help from modern medicine.

Next Steps & Treatment Options

If your results indicate a potential problem, don’t lose heart. There are more solutions than ever, and treatments can be surprisingly effective. Lifestyle modifications are often step one. Quitting smoking, reducing alcohol, managing stress, and getting to a healthy weight can do wonders for sperm health.

Medications or hormone therapy may be prescribed if imbalances are detected. Surgical interventions (like varicocele repair or sperm retrieval procedures) can correct physical issues.

Assisted reproductive technologies (ART) like IUI (intrauterine insemination), IVF, or ICSI offer pathways to conception, even when sperm quality is severely compromised.

FAQs

How does IVF help with male infertility?

IVF can sidestep many sperm-related hurdles. Rather than requiring sperm to travel the entire reproductive tract, IVF allows fertilization to occur in a lab, where eggs and sperm are brought together under controlled conditions. Even when sperm count or motility is low, IVF can increase the odds of success.

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

ICSI (Intracytoplasmic Sperm Injection) takes IVF a step further. Instead of letting sperm and egg meet naturally in a petri dish, a single healthy-looking sperm is injected directly into an egg using microscopic instruments. This technique is particularly helpful when sperm can't penetrate the egg due to motility or structural issues. It's also used when sperm must be surgically extracted.

Who needs ICSI?

ICSI is typically recommended for:

• Men with very low sperm count or poor motility
• Cases of unexplained infertility after a failed IVF attempt
• Men who’ve had sperm retrieved surgically due to blockages or ejaculation issues
• Severe morphological abnormalities

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

Success depends on many variables, but IVF with ICSI boasts encouraging results. Fertilization rates can reach 70 to 80% per egg in ideal conditions. However, embryo quality, maternal age, and overall fertility health also play major roles in determining success rates for pregnancy and live birth.

Is there an increased risk of genetic issues with ICSI?

There is a slightly higher risk of transmitting genetic abnormalities through ICSI, particularly if the underlying fertility issue is genetic. That’s why preimplantation genetic testing (PGT) is often recommended before embryo transfer. It screens for chromosomal problems, reducing the risk of miscarriage or inherited disorders.