Male Infertility Testing
Infertility testing in males is used to diagnose problems and provide solutions that will produce optimal sperm counts and sperm quality, as well as semen fluid quality. This evaluation may include semen analysis and a consultation, if necessary. The information acquired is also for determining necessary treatments of the female partner that can compensate for non-correctable male fertility issues. Significant medical issues that are contributing to infertility can be ruled out early in a couple’s evaluation by performing a semen analysis as the initial step.
A semen analysis assesses the quality and specific characteristics of both a man’s sperm and semen. A semen analysis is done to determine whether:
Tests performed on a semen sample may include:
- Volume – The amount of semen released at one time
- Liquefaction time – The length of time required for semen to go from a gel to a liquid; normal range is about 20 minutes
- Sperm count – Quantity of sperm found in semen in millions per milliliter
- Sperm morphology – Calculated percentage of normal-shaped sperm
- Sperm motility – Calculated percentage measuring the amount of sperm which appear to move normally; or the number in a specified quantity of semen which have normal movement
- pH – Measures if the semen’s pH is too low (acidity) or too high (alkalinity)
- White blood cells – Should not normally be found in semen samples, and may signify inflammation or infection
- Fructose level – Fructose is present in semen to energize the sperm; this test determines the amount present in semen
Restrictions Prior to Testing
In order to achieve the most accurate results, sperm concentration needs to be at peak level; therefore, patients may be instructed to restrict sexual activity for a period before testing. Patients should refrain from ejaculation for 2-3 days before the scheduled collection of the semen sample. At the same time, it is not recommended to abstain from sexual relations for more than a period of one week before testing because a long period of sexual inactivity can lead to a greater number of inactive sperm.
Please inform Dr. Buch of any prescription or over-the-counter medications, as well as any supplements that you are taking since some of these may interfere with testing results.
How Testing Is Performed
A semen sample is typically captured via ejaculation into a designated clean, non-toxic plastic sample cup. The patient has the convenience and privacy to use a designated semen collection room with a locking door at our office. However, patients living close to the medical office are encouraged to obtain the sample in the comfort of their own home and deliver it to the medical office within one hour. Care must be taken to keep the sample between room and body temperature after it is obtained, and until the time it is delivered to our lab.
If a patient chooses to collect a sample in the privacy of his own home, he has two options in the ways he can do this. First, a sample may be obtained through masturbation and ejaculating into the designated sample cup. It is recommended that the patient has clean hands and does not use any lubricants for the most accurate test results.
A second way that a sample can be collected at home is through sexual intercourse using a non-lubricated condom. Lubricated condoms cannot be used as they have spermicide on both the inside and outside. However, a water-soluble lubricant may be used on the outside of the non-lubricated condom once the condom is positioned over the top of the penis. As soon as climax is achieved, the penis is withdrawn, keeping the condom in place. The condom is held in place at the base of the penis, and a clean, dry towel is used to wipe the lubricant and body fluids off the condom surface. The penis is then positioned over the top of the container, and clean scissors are used to carefully snip the tip of the condom while it remains over the penis, in order to allow the ejaculate to drip into the sample container. The lid of the container is then closed for sample transport.
Any samples obtained outside of the clinic must be delivered to the medical provider within one hour. Care must be taken to keep the sample between room and body temperature after it is obtained until the time it is delivered to our lab. Semen samples can vary over time, so this testing procedure may be repeated at 3-4 week intervals, up to 3 times, in order to establish an accurate fertility profile. A semen analysis is also required to document the effectiveness of a vasectomy. This is normally done 3 months after the vasectomy and repeated one month later to confirm achievement of sterility.
What Will I Feel
Providing a sample for semen analysis does not result in discomfort for the patient; however, some people may be a little embarrassed at the collection process. In some cases, masturbation may be against religious beliefs. If this is the case, a patient should discuss alternate methods of collection with Dr. Buch.
Are There Any Risks
There are no medical risks involved with obtaining a semen analysis.
Semen Analysis Results
Semen analysis is used to measure the quantity of semen, and to determine specifics regarding the quality of the sperm found in the semen. Results are generally available in about a day. Labs set their own normal ranges, so guidelines may vary.
- Normal Sperm Volume – Normal volume is between 1.5 and 5 ml for an ejaculation. Any amounts above or below this range may contribute to infertility issues.
- Normal Liquefaction Time – Liquefaction time of semen is generally under 60 minutes. If it is measured to be a longer time period, this may indicate the presence of infection.
- Normal sperm count – Normal sperm counts range from 20 to 150 million sperm per ml. None should be present if testing is being performed to confirm effective vasectomy. Substantially lower sperm counts may indicate infertility, but doesn’t verify that conception is impossible. Sometimes men with sperm counts less than1 million are still able to father children.
- Normal Sperm Morphology (shape and structure) – Normal sperm shape and structure should be a characteristic of a minimum of 30% of sperm, according to the World Health Organization (W.H.O.). Abnormalities in sperm may be noted when a sperm has two heads, two tails, too short of a tail, a very small head, or misshaped head (round, not oval). Abnormalities may cause sperm to be unable to move effectively or achieve penetration of an egg. Virtually all semen samples contain some abnormal sperm, but a higher concentration of these conditions may make conception more difficult.
The most accurate morphology assessment is called a “strict morphology,” in which the slightest surface defect causes the sperm to be labeled abnormal. Using a strict morphology, Dr. Buch and others merely require at least 4% of sperm to be “strictly normal.” In cases of less than 4% normal strict morphology, couples will encounter problems with the sperm’s ability to attach and penetrate the egg.
- Normal sperm motility – Normal sperm motility is that a minimum of 60% of sperm or at least 8 million sperm per ml show ability to move normally. Abnormalities may cause the sperm to not be effective at fertilization, as sperm must be able to navigate through the cervix to reach and penetrate the egg. The greater number of sperm that are not able to achieve this effectively, the greater the chance of infertility.
- Normal pH Level – Normal pH for semen is 7.2 - 8.0. If out of normal pH range, sperm mobility may be impacted, as well as ability to penetrate an egg. Inconsistencies may also kill sperm altogether.
- White Blood Cell Presence –No white blood cells should be found in semen samples, nor should any bacteria. The presence of either may indicate infection and may also impair sperm motility and egg penetration ability.
- Normal Fructose Levels – Fructose levels are normally 300 mg per 100 ml in a single semen sample. If fructose is absent from semen, this may indicate a problem with the function of or the lack of presence of seminal vesicles.
There are medical conditions that may cause a low or absent sperm count. Inform your provider of a history of any conditions such as orchitis, Klinefelter syndrome, any disease that is known to cause shrinking or atrophy of testicles, as noted with mumps, or if patient has had radiation treatment to testicles.
A sample that indicates an abnormal level of sperm, either too high or too low, may cause the provider to suggest additional testing. These tests may include blood levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, testosterone, or Estradiol (estrogen).
Effects on Testing
Factors that may affect accuracy of test results include:
- Medicines, male hormones (testosterone), female hormones (estrogen), cimetidine, sulfasalazine, and some chemotherapy medications
- Semen sample is allowed to get cold; will cause motility of sperm to be very low
- Exposure to radiation, chemicals like pesticides and spermicides, and prolonged heat exposure
- A partial semen sample, which is more likely to happen in collection methods other than manual masturbation
- Not ejaculating for several days may affect semen volume
Things to Think About
Consistently detecting sperm in his semen after a man has undergone a vasectomy clearly indicates that the surgery was unsuccessful. To prevent an unplanned pregnancy, couples should proceed only when using some other method of birth control. A low sperm count may exist in semen that is provided for sampling immediately following a vasectomy; but there should be no sperm count in any future samples.
A patient whose mother took a medication named diethylstilbestrol or DES while carrying him should be aware that he is at increased risk for infertility, including failure of testicles to descend into scrotum at birth.
Additional tests may be required to measure levels in a patient of male testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, or Estradiol.
Other testing that may be possibly recommended to diagnose fertility problems may include measures of sperm penetration, detection of antibodies harmful to sperm, or analysis after sexual intercourse (post coital test).