And how we work around it.
Infertility is complex partly because, unlike other medical issues, it is very much a team sport. If you’re a human, the reproductive equation will always have two components: female and male. Knowing exactly what you and your partner have to work with in both of those areas is crucial to determining the proper course of action to achieve your goals and conceive your very own bundle of joy!
The importance of the semen analysis (SA) as a component of the male factor diagnostic work-up cannot be overstated! An SA gives clinicians a valuable snapshot of the condition of a male patient’s sperm. This information is critical in determining which form of treatment will be most appropriate for a couple.
The Semen Analysis procedure aids clinicians in determining whether patients would be best served by undergoing IUI treatment as opposed to IVF treatment or vice versa. It also helps physicians decide whether traditional IVF is a viable option, if intracytoplasmic sperm injection (ICSI) is required, or whether a donor will be needed. All of these things help infertility medical professionals get your treatment right sooner rather than later, thus saving more of your hard earned cash.
During an SA, Andrologists take note of several details. Here’s an example of each metric we look at and the normal ranges (called reference ranges).
|Metric||Abnormal Range||Normal Range||Units|
|Viscosity||3-4||0||Grade Scale: 0-4|
|Concentration||< 15||> 20||Million/mL|
|Motility||< 39||> 40||%|
|Forward Progression||1-2||3-4||Grade Scale: 1-4|
|Morphology||< 14||> 15||% (Method used: Kruger Strict)|
Among the most important of these are Concentration, Motility, and Morphology.
Concentration is the measure of how many sperm are in the collected volume of seminal fluid, measured in millions of cells (sometimes hundreds of millions) per milliliter. Patients with fewer than 15 million sperm cells per milliliter of seminal fluid can be diagnosed with oligozoospermia (literally: few sperm). Oligozoospermia can be overcome in numerous ways. Mild cases may be suitable for IUI, moderate cases may be better suited to IVF, and severe cases may require ICSI. Even in cases where only a handful of sperm are present, with ICSI, Embryologists only require one sperm per egg retrieved in order to complete an IVF cycle.
Motility is the measure of what percentage of sperm are moving. Motility correlates to the viability of sperm. If it’s moving, it’s alive; and is therefore more likely to successfully fertilize an egg. Patients with fewer than 40% swimmers may be diagnosed with asthenozoospermia (literally: weak sperm). Asthenozoospermia usually lets us know to expect that fewer overall sperm will make it through a gradient during IUI and IVF procedures, and allow the clinic to plan in advance to work around any challenges that arise. Asthenozoospermia is typically overcome during all andrology procedures where a density gradient is used to “wash” sperm using the density of each cell and centrifugal force to separate out good, motile sperm for either IUI or IVF procedures.
Morphology is the measure of what percentage of sperm are normal shape. Morphology correlates to DNA fragmentation. The more normal a sperm cell looks, the more likely its DNA is intact and healthy. Making sure sperm with good DNA are the ones that fertilize the egg is very important in achieving successful fertilization, as well as embryo development and genetic normality of the embryo. Patients with fewer than 15% normal sperm may be diagnosed with teratozoospermia (literally: monster sperm). Harsh, right? If you have monster sperm, it can be overcome by selectively removing sperm with bad morphology prior to insemination (wash with density gradient) and/or by manual sperm selection done during ICSI.
Rarely, there are cases where no sperm are present in the ejaculate whatsoever. Patients with no sperm may be diagnosed with azoospermia (literally: no sperm). In these cases, retrograde ejaculation analyses may be performed to see if there is sperm present in urine post-ejaculation. Even in cases where there is neither sperm in ejaculate nor in post-ejaculate urine, there is also the option of surgical sperm extraction, where the epididymis (a duct behind the testes) or the testicles themselves can be directly accessed to search for viable sperm. Any viable sperm retrieved surgically can still be used in ICSI procedures to successfully fertilize eggs. In cases where no sperm can be surgically extracted, donor sperm will be recommended to the couple.
Given this, the value of the Semen Analysis is obvious. Narrowing down whether an IUI, Traditional IVF, or ICSI is the most viable option can save our patients money in the long run. For couples trying to conceive, a SA should be among the very first tests performed. And if the results are less than perfect, which they often are, keep in mind only one perfect sperm is needed to make a perfect baby.