Semen analysis is not a test for fertility. The patient cannot be considered fertile based only on normal semen analysis. It was shown that 30% of all patients with normal semen analysis have abnormal sperm function.
Semen sample should be collected after a minimum of 48 hours and up to 5 days of sexual abstinence (not having sexual intercourse or not ejaculating semen by masturbation).Abstinence lesser than 2 days and more than 5 days will give wrong results and creates unnecessary anxiety which needs repeat semen analysis.
Semen sample should be obtained by masturbation and ejaculated into a sterile container provided by us. Never use jelly, lubricant, saliva or condom for collecting the semen sample as they can harm the sperm quality.
Please inform if the sample is incomplete either due to collection difficulty or spillage of the first ejaculate (sperm rich fraction of semen sample) during collection. It should be informed as it gives wrong results. If so, repeat analysis needs to be done after 2-5 days of abstinence.
Please speak to the doctor, if there is difficulty in collecting semen sample.
Sample should ideally be collected at our centre or may be collected at home, provided you bring the semen sample within 30min.
For home collection, lab should be informed prior and time of semen collection should be noted. While transporting, the sample should be kept as close to the body temperature as possible (in the pocket or in a bag). Semen sample should not be exposed to too cold or too hot temperatures as they can alter the sperm quality.
Always first wash your hands and penis with water and dry it with tissue before semen collection to avoid bacterial contamination.
Sample should not be collected soon during or after flu or high fever.
Avoid stressful activity or long driving before semen collection.
Blood tests to check viral infections (HIV, HbsAg and HCV) are mandatory prior to giving semen sample for semen analysis.
Semen analysis is done between 9am to 2 pm (Monday – Saturday). Report can be collected on the same day or during your next visit.
Patients should be strongly recommended to collect samples within clinic area. If intercourse is the only way to collect sample, special nonreactive condoms are available for purchase at pharmacy.
Typically two to three semen analyses are obtained over a 3 month period prior to making any final conclusion regarding baseline sperm quality or quantity. However, if the first semen analysis is normal, the repeat test is not required.
Recent febrile illness or exposure to gonadotoxic agents may affect spermatogenesis for up to 3months, therefore semen analysis has to be postponed.
In testing the semen, macroscopically, we look at certain physical characteristics like volume or quantity of the ejaculate, pH, viscosity and time taken to liquefy.
Microscopic examination helps us to measure the count or the concentration, motility of the sperm (forward), morphological characteristics of the sperm (size and shape) & concentration of white blood cells.
This basic analysis guides the clinician to proceed further and manage accordingly. If any of the parameters are below normal range in a semen sample it may prevent the fertilization of an egg from occurring but more likely these deficiencies may simply reduce the probability of pregnancy.
Normal ejaculate volume is between 2 and 6 ml. 65%of the volume is from seminal vesicles, 30-35% is from the prostate and only 5% from the vasa. Low volume is associated with absence or decrease of seminal vesicle component of ejaculate (absence of SV, complete or partial obstruction of ejaculatory ducts) or retrograde ejaculation.
Normal semen pH is 7.2-8.0. Prostatic secretion is acidic while seminal vesicle fluid is alkaline. Acidic ejaculate (pH<7.2) may be associated with blockage of seminal vesicles. Infection is usually associated with alkaline ejaculate (pH >8.0).
Liquefaction:The semen is initially in liquefied state but quickly coagulate by the action of protein kinase secreted by the seminal vesicles. Proteolytic enzymes from the Prostate liquefy coagulum in 20-25 minutes. Abnormal liquefaction may be caused by prostatic abnormalities, e.g. prostatitis. Increased viscosity may affect sperm motility.
Concentration: Concentration: evaluated in Mackler or Cell-VU chambers. Azoospermic specimen contains no sperm, oligospermic specimen reveals concentration of less than 15x106/ ml and Normospermia specimen contains more than 15x106/ ml.
Motility and forward progression (sperm movement): Normally >40% of sperm in the specimen are motile. Forward progression describes how fast the motile sperm are moving.
Morphology (Shape of spermatozoa): Sperm are classified into normal-oval shaped and tapered. The predictive value of sperm morphology in determining pregnancy rates is low. Morphology has higher predictive value in determining rates of pregnancy in IVF program.Men with fewer than 4% normal forms usually fail to fertilize without micromanipulation.
Viscosity(or thickness of the sperm fluid). Low or moderate viscosity is considered normal. Highly viscous sample is seen in prostate infection.
Leukocytes(pus cells) – these are white blood cells, which are signs of inflammation or infection. A small number of leukocytes can be normal, while more than one million leukocytes per ml is considered abnormal.
It is usually suggested that a repeat semen analysisshould be performed only if the result of the first analysis is abnormal. The optimal time for the second sample is at least 2 months after the initial sample because the cycle of sperm formation takes about 60-72 days. However, this delay may cause anxiety and the timing of the second sample should take into consideration the preferences of the man.
If azoospermia or severe oligozoospermia is reported in the initial semen analysis, a repeat test should be undertaken within 2-4 weeks. Centrifugation of the semen sample should be done and the pallet should be checked to see any sperm are present.
Low sperm count or quality is found to be the only cause of infertility in about 20% of couples, and is a contributory factor in a further 25% of couples.
It is estimated that in between 30% and 50% of men with poor semen quality no cause for this will be identified.
In fact semen parameters are abnormal in 1/3rd of normal fertile men.
The most important point to keep in mind is that the amount of semen you have in your ejaculate naturally goes up and down. Parameters of the semen analyses vary day-to-day, week-to-week, and year-to-year. We ask all of our patients to get at least two or three semen analyses if the initial sample has abnormal results.