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What is a semen analysis?

Why the semen analysis is done?

How To Prepare for the semen analysis?

How a semen analysis is done?

Sperm Evaluation and Testing

Treating abnormal sperm

What do the semen analysis tests measure?

Finding a Laboratory for Semen Analysis

Limits of Semen Analysis

Frequent ejaculation improves sperm quality

Obese Men Have Less Semen, More Sperm Abnormalities

Additional tests for a man with an abnormal semen analysis sperm count report

What is a semen analysis?
A semen analysis measures the amount of semen a man produces and determines the number and quality of sperm in the semen sample.

A semen analysis is usually one of the first tests done to help determine whether a man has a problem fathering a child (infertility). A problem with the semen or sperm affects more than one-third of the couples who are unable to have children (infertile).

Tests that may be done during a semen analysis include:

Volume. This is a measure of how much semen is present in one ejaculation.
Liquefaction time. Semen is a thick gel at the time of ejaculation and normally becomes liquid within 20 minutes after ejaculation. Liquefaction time is a measure of the time it takes for the semen to liquefy.
Sperm count. This is a count of the number of sperm present per milliliter (mL) of semen in one ejaculation.
Sperm morphology. This is a measure of the percentage of sperm that have a normal shape.
Sperm motility. This is a measure of the percentage of sperm that can move forward normally. The number of sperm that show normal forward movement in a certain amount of semen can also be measured (motile density).
pH. This is a measure of the acidity (low pH) or alkalinity (high pH) of the semen.
White blood cell count. White blood cells are not normally present in semen.
Fructose level. This is a measure of the amount of a sugar called fructose in the semen. The fructose provides energy for the sperm.

A semen analysis evaluates certain characteristics of a male's semen and the sperm contained in the semen. It may be done while investigating a couple's infertility or after a vasectomy to verify that the procedure was successful. It is also used in stud farming and farm animal breeding.

Semen analysis is a test to measure the amount and quality of a man's semen and sperm. Semen is the thick, white, sperm-containing fluid released during ejaculation.
The test is sometimes called a sperm count.
The semen analysis is the cornerstone of testing for male infertility problems. This test provides important information about the quality and quantity of the sperm. The semen sample is analyzed for volume, viscosity (thickness), pH and color of the ejaculate, sperm concentration, motility, morphology, and forward progression of the sperm. The sample is also examined for the presence of white or red blood cells which may indicate infection or inflammation. We perform both manual and computer assisted semen analyses (CASA). From this simple test, we can tell how many sperm are present, how many appear normal and how many are moving. A semen analysis does not assess sperm function. It dcoes not answer the question ˇ°ar the sperm good enough to conceiveˇ±. More sophisticated tests of sperm quality such as the Sperm Chromatin Structure Assay (SCSA) can better help asses the ˇ°healthˇ± of the sperm.

A semen analysis evaluates the seminal characteristics of the ejaculate, in order to assess whether there are any deficiencies that may impair fertilization and subsequent pregnancy. The various parameters tested are:

  • Semen volume
  • Sperm concentration
  • Sperm count
  • Percentage motile sperm
  • Grade of motility
  • Normal sperm morphology

These parameters allow us to detect if there are any problems with the reproductive system, so that you and your physician may isolate the problem and treat it efficiently and effectively

A semen analysis is a simple test that assesses the formation and maturity of sperm as well as how the sperm interact with the seminal fluid. To do semen analysis, a fresh semen sample (no more than a half hour old) is collected and then analyzed in a laboratory for a variety of different factors. Men who are uncomfortable with the idea of semen collection in a clinical setting may be able to provide their sample in the comfort of their home so long as they live close to their fertility clinic. Check with your fertility clinic first, though, as many prefer that the sample be provided on-site. Semen can also be collected using a special type of condom for those men that have troubles providing an "on demand" sample by themselves.

In order to ensure the best possible sample, and therefore get the most accurate results, it is necessary to:

ˇ¤Abstain from sex for two to four days prior to the day of testing
ˇ¤Use a clean, sterile container
ˇ¤Avoid spilling or leaking any of the collected semen
ˇ¤Avoid using a lubricant, which can kill sperm
ˇ¤Keep the sample at room temperature

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Why the semen analysis is done?
A semen analysis is done to determine whether:

¦µA man has a reproductive problem that is causing infertility.
¦µA vasectomy has been successful.
¦µThe reversal of a vasectomy has been successful.
Semen analysis is one of the first tests done to evaluate a man's fertility. It can help determine if a problem in sperm production or quality of the sperm is causing infertility. Approximately half of couples unable to have children have a male infertility problem.

The test may also be used after a vasectomy to make sure there are no sperm in the semen. This can confirm the success of the vasectomy.

The test may also be performed for the following condition:
¦µKlinefelter syndrome
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How To Prepare for the semen analysis?
You may be asked to avoid any sexual activity that results in ejaculation for 2 to 5 days before a semen analysis. This helps ensure that your sperm count will be at its highest, and it improves the reliability of the test. If possible, do not avoid sexual activity for more than 1 to 2 weeks before this test, because a long period of sexual inactivity can result in less active sperm.

You may be asked to avoid drinking alcohol for a few days before the test.
Be sure to tell your health professional about any medicines or herbal supplements you are taking.                                          Do not have any sexual activity that causes ejaculation for 2 - 3 days before the test.
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How a semen analysis is done?
You will need to produce a semen sample, usually by ejaculating into a clean sample cup. You can do this in a private room or in a bathroom at your health professional's office or clinic. If you live close to your health professional's office or clinic, you may be able to collect the semen sample at home and then transport it to the office or clinic for testing.

The most common way to collect semen is by masturbation, directing the semen into a clean sample cup. Do not use a lubricant.
You can collect a semen sample during sex by withdrawing your penis from your partner just before ejaculating (coitus interruptus). You then ejaculate into a clean sample cup. This method can be used after a vasectomy to test for the presence of sperm, but other methods will likely be recommended if you are testing for infertility.
You can also collect a semen sample during sex by using a condom. If you use a regular condom, you will need to wash it thoroughly before using it to remove any powder or lubricant on it that might kill sperm. You may also be given a special condom that does not contain any substance that kills sperm (spermicide). After you have ejaculated, carefully remove the condom from your penis. Tie a knot in the open end of the condom and place it in a container that can be sealed in case the condom leaks or breaks.
If you collect the semen sample at home, the sample must be received at the laboratory or clinic within 1 hour. Keep the sample out of direct sunlight and do not allow it to get cold or hot. If it is a cold day, carry the semen sample container against your body to keep it as close to body temperature as possible. Do not refrigerate the semen sample.

Since semen samples may vary from day to day, 2 or 3 different samples may be evaluated within a 3-month period for accurate testing.

A semen analysis to test the effectiveness of a vasectomy is usually done 6 weeks after the vasectomy.

Sample collection may involve masturbation and collecting the sperm into a sterile container. It may also be collected during intercourse by using a special condom supplied by your health care provider.

A laboratory specialist must look at the sample within 2 hours of the collection. The earlier the sample is analyzed, the more reliable the results. The laboratory specialist will look at the sample to determine the following details:
¦µFluid coagulation (thickening into a solid) and liquefaction
¦µFluid thickness, acidity, and sugar content
¦µResistance to flow (viscosity)
¦µSperm movement or motility
¦µNumber and structure of the sperm
¦µVolume of semen

A semen analysis is used to determine whether a man might be infertileˇŞunable to get a woman pregnant. The semen analysis has many parts and test a lot of aspects of the semen and sperm. A semen analysis to determine fertility should be performed on a minimum of two samples at least seven days apart over a period of two to three months because some conditions can affect sperm levels.

The semen analysis also can be used to count sperm after a man has a vasectomy. If there are still a lot of sperm present in the semen, the man and his partner will have to take precautions so that his partner will not become pregnant. He will have to return for one or more sperm counts until the sperm are cleared from his sample(s).

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Additional tests for a man with an abnormal semen analysis sperm count report
For the man with a poor semen sample, additional tests which may be recommended include specialized sperm tests; blood tests; and testis biopsy.

Antisperm Antibodies Test
The role of antisperm antibodies in causing male infertility is controversial, since no one is sure how common or how serious this problem is. However, some men (or their wives) will possess antibodies against the sperm, which immobilize or kill them and prevent them from swimming up towards the egg. The presence of these antibodies can be tested in the blood of both partners, in the cervical mucus, and in the seminal fluid. However, there is little correlation between circulating antibodies (in the blood) and sperm-bound antibodies (in the semen).

There are many methods of performing this test, which can be quite difficult to standardize, as a result of which there is a lot of variability between the result reports of different laboratories. The older methods of testing used agglutination methods on slides and in test tubes.

Perhaps, the best method available today is one such uses immunobeads, which allow determination of the location of the antibodies on the sperm surface. If they are present on the sperm head they can interfere with the sperm's ability to penetrate the egg; if they are present on the tail they can retard sperm motility. Of course, if the test is negative, this is reassuring; the problem really arises when the test is positive! What this signifies and what to do about it are highly vexatious issues in medicine today, and doctors are even more confused about this aspect than the patients.

Semen Culture Test
In the semen culture test, the semen sample is tested for the presence of bacteria, and , if present, their sensitivity to antibiotics is determined. Interpreting this test can also be problematic! It is normal to find some bacterial in normal semen samples - and the question which must be answered is : are these bacteria disease- causing or not?

Tests which assess the sperm's ability " to perform" include the following sperm function tests.

Postcoital Test (PCT)
The postcoital test is the easiest test of sperm function, since it is performed in vivo. It is done when the wife is in the " fertile" period, during which time the cervical mucus is profuse and clear. The gynecologist examines a small sample of the cervical mucus, under the microscope, a few hours after intercourse. ( This can be embarrassing and awkward for the patient, but it is not painful at all). Finding 5-10 motile sperm per high power microscopic field means that the test is normal. A normal test implies normal sperm function and can be very reassuring.

An abnormal test needs to be repeated and, if the problem is persistent, one needs to determine if the defect lies in the sperm or in the mucus, by cross-testing with the husband's sperm, donor sperm, wife's mucus and donor mucus.

Bovine Cervical Mucus Test
The bovine cervical mucus test is another form of testing for the ability of the sperm to penetrate and swim through cervical mucus, with the difference that in this case, the mucus used is that of a cow (since this is commercially available abroad in a test kit.) The sperm are placed in a column of cervical mucus and how far the sperm can swim forward through the column in a given amount of time is checked with the help of a microscope.

Sperm Viability or Sperm Survival Test
This is a simple test, which provides information on the functional potential of the sperm. The sperm are washed using the same method which is used for IVF (either a Percoll spin or sperm swim up) and the washed sperm are then kept in a culture medium in the laboratory incubator for 24 hours. After 24 hours, the sperm are checked under the microscope. If the sperm are still swimming actively, this means that they have the ability to "survive" in vitro for this period- and this is reassuring. If, however, none of the sperm are alive after 24 hours, this suggest that they may be functionally incompetent.

Sperm Penetration Assay (SPA, Hamster Assay)
Since the basic function of a sperm is to fertilize an egg, scientists were very excited when they found that normal sperm could penetrate a denuded (zona-free) hamster egg. A zona-free hamster egg is obtained from hamsters egg. A zona-free hamster egg is obtained from hamsters and the covering (the zone) removed by using special chemicals. The egg are then incubated with the sperm in an incubator in the laboratory. After 24 hours, the eggs are checked to ascertain how many sperm have been able to penetrate the egg. The result gives a penetration score, which gives an index of the sperm's fertilizing potential. This is a very delicate technique and is not available in India. In any case, nowadays scientists the world over are quite disenchanted with the test, since the correlation between IVF results (the ability to fertilize human eggs) and the SPA (the ability to penetrate zona-free hamster eggs) is quite poor.

Testing for acrosomal status
HOS test - hypo-osmotic swelling test-which tests for the integrity of the sperm membrane
CASA - computer-assisted sperm analysis
Hemizona assay
Electron microscopy of sperm
A test which has recently become very fashionable is the Sperm Chromatin Structure Assay (SCSA) and the sperm DNA Fragmentation assay. These test the integrity of the DNA in the sperm nucleus, and thus the ability of the sperm to fertilise the egg. While they seem very attractive, the major problem with these tests is that they provide information which is applicable only to groups of patients. Thus, we know that men with a higher degree of DNA fragmentation have a higher chance of being infertile. However, they do not provide any information for the individual patient, which means their utility in clinical practise is very limited.

The aforementioned tests are highly sophisticated and are not easily available. Another drawback is that these tests are often not standardized adequately, so that interpreting their results can be quite difficult. This is why we do not do any of these tests in our own practise, because we feel they do not provide any clinically useful information.

The ultimate sperm function test is IVF, since this directly assesses whether or not the husbands" sperm can fertilize the wife's eggs. The best way to perform this test is to culture some of the eggs with the husband's sperm and the others with donor sperm of proven fertility, at the same time. If the donor sperm can fertilize the eggs, and the husband's sperm fail to do so, then the diagnosis of sperm inability to fertilize the egg is confirmed. However, even this test is not infallible, since it has been shown that about 5% of sperm samples which fail to fertilize an egg in the first IVF attempt, can do so in a second attempt at IVF. In any case, it is obviously not practicable or feasible to use IVF as a test for sperm function in clinical practice.
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Sperm Evaluation and Testing
Zero Sperm Counts & Genetic Links
What has become evident at our Centers over the last several years is that our ability to diagnose and successfully treat severe male infertility problems has surpassed our ability to understand the basic causes of these problems. In the recent past, it was considered that nearly 20% of men with extremely low or "zero" sperm counts had no known medical reason for their fertility problems. Most recently, major advances in molecular biology and genetics have provided the "reasons" for severe infertility (very low or zero sperm counts) in many men whose fertility problems were previously poorly understood. We now know that 20-30% of men with such low (under 10 million/ml) or zero sperm counts have a now identifiable genetic cause for their problem. While we are now able to assist many, many men previously thought to be "hopelessly" infertile achieve pregnancy, it remains very important to not only treat these men, but to provide such couples with genetic information related to the problem causing the low or zero count. This is important because many of these genetic characteristics may potentially be passed along to children conceived with the help of modern male infertility treatments. Genetic disorders that would previously not have been able to be "passed along" due to the male's infertility are now being retained in the "gene pool" as a result of new procedures that overcome most of these previously untreatable male conditions.

Congenital Absence of the Vas Deferens
Congenital absence of the vas deferens (CAVD) is a syndrome in which a portion or all of the reproductive ducts (including the epididymis, vas and seminal vesicles) are missing. This causes an obstruction to the passage of sperm. These sperm, which are being produced normally in the testicle become "trapped" in the testicle for lack of a pathway to the ejaculate. CAVD may be associated with several diseases, including cystic fibrosis (CF) and malformations of the kidneys (renal malformations). 65% of men with CAVD will have a detectable genetic mutation in one of the cystic fibrosis genes, and 15% will have a missing or misplaced kidney. This does not imply that the man has or will develop cystic fibrosis but it means that he could be a carrier of the gene. If his spouse is also a carrier, this means that there is a 25% chance of a child born to them having cystic fibrosis. It is a standard treatment policy in our Centers that all couples in which the man has CAVD undergo cystic fibrosis carrier testing of both the man and his spouse/partner. Once the genetic testing is completed (testing takes about 10 days), an in vitro fertilization cycle may be planned for the wife, and a "MESA" (microsurgical epididymal sperm aspiration) procedure planned for the man to obtain viable sperm. These sperm may then be gently, microsurgically inserted inside the eggs of the wife (ICSI) that have been obtained from an aspiration carried out through the vagina. The resulting embryos may then be placed into the uterus of the female to establish a pregnancy. Success rates remain very high with this technique, even in men with "zero" sperm counts.

Y Chromosome Microdeletions
The human genome consists of 23 pairs or 46 chromosomes. There are 44 autosomes and two sex chromosomes. The sex chromosomes are called "X" and "Y". Each genetically normal human has two sex chromosomes. A woman has "X" and "X" (2X) and a man has one "X" and one "Y". The reproductive gametes (eggs and sperm) get one or the other of each partner's sex chromosomes. Because women have 2 "X" chromosomes, each of her eggs will have an "X" sex chromosome. Because men have one "X" and one "Y" chromosome, half of their sperm will carry the "X" chromosome and half will carry the "Y" chromosome. It can therefore be soon that men are responsible for sex determination. If an "X" egg is fertilized by an "X" sperm, an "XX" female will result. If an "X" egg is fertilized by a "Y" sperm, an "XY" male will result.

If the "Y" chromosome from the sperm that fertilizes the "X" egg carries a small mutation or deletion affecting sperm production in part of it's genetic make-up, a male child resulting from a pregnancy may have the same sperm production problem. We have found that 10-13% of men with an absent, or "zero" sperm count will have a mutation or deletion on the "Y" chromosome. We have also detected "Y" chromosome microdeletions in men with low, but not zero counts. We offer a very sophisticated blood analysis (test) to determine if these genetic conditions are present before undertaking therapy that will lead to pregnancy.

Klinefelter's Syndrome
Klinefelter's Syndrome is a genetic disorder characterized by infertility, abnormal male breast tissue development (gynecomastia) and small, firm testes. It is the most common cause of azoospermia (no sperm production). Klinefelter's Syndrome is caused by an abnormal number of sex chromosomes. Whereas a normal male genetic make-up includes one "X" chromosome and one "Y" chromosome, in patients with Klinefelter's Syndrome, an extra "X" chromosome is present, resulting in three (XXY) sex chromosomes. Thought at one time to be hopelessly infertile, it has been found that these men can have small amounts of sperm production occuring within the testicle. Our Center has successfully recovered sperm in men with this disorder who have gone on to father normal, healthy children. It is important that all men with very low or absent sperm counts be tested for Klinefelter's Syndrome before offering IVF and ICSI.

One of the biggest concerns of couples involved in an infertility work up relates to the status of the male partner's sperm evaluation. While the thorough evaluation of sperm and sperm function should be given high priority in any infertility evaluation, we have found from our web page interactions with patients that often times the couple are told very little related to test results in this area. Or, in other cases, we hear of couples being told about "high numbers" of "abnormal" sperm, or "low" numbers of "good" sperm with little additional information about what those results mean to their chances for conception. Other very concerned couples have sent us copies of original semen analysis reports, having been told of "problems". On review, many of these reports have been printed with very out of date data related to what "normal" fertility test results should be in a fertile man. While there is no substitute for the evaluation of semen and sperm testing results by a highly trained and specialized professional, the truth is that many modern laboratories and even some very well qualified physicians have not kept totally abreast of our changing understanding of sperm function, and our new and evolving views of "fertile" sperm test results.

In our laboratory, we arrived at our "normal" values for sperm test results by closely watching the fertility course of the many, many patients that we have tested and followed over the years. If 60% of our male patients with sperm counts of 20 million/ml (considered "low" by many laboratories) are able to produce pregnancies without medical assistance, should a count of 20 million be considered "infertile"? In the 40% of men unable to produce a pregnancy with a count of 20 million/ml, they may indeed have a fertility problem. The point is that there are no absolutes in the area of sperm evaluation. This is true between different laboratories, and even within the same laboratory.

It is our opinion that sperm test results should not be presented to patients by way of a five minute telephone conversation. Instead, we feel each couple is entitled to sit in consultation with their physician or nurse or Laboratory Director and be advised of the specific results, and how those results compare to the results of known fertile males tested in that laboratory. Couples should also ask and be told about how the "Normal" ranges for the individual laboratory were established. There are, of course, many more things to be elicited from the laboratory, but we feel this to be a good starting point

Sperm Counts
Laboratories performing sperm "counts", in general, vary in the details that they provide the physician requesting the "count". A general sperm count as part of a fertility evaluation should include the total density or count (20 million per ml or above), and the motile density (8 million per ml or higher). The motile density is perhaps the most important part of the semen analysis, as it reports the total number of sperm thought capable of progressing from the site of sperm deposition to the site of fertilization. This value is essential in both allowing a determination regarding whether or not a semen analysis is "normal", as well as in providing prognostic information should advanced reproductive medical assistance be required. (Numbers in italics are what "normal" values should be.)
Definitions of "abnormal" counts:
• Polyzoospermia: Excessively high sperm concentration.
• Oligozoospermia: Sperm count less than 20 million/ml
• Hypospermia: Semen volume < 1.5 ml
• Hyperspermia: Semen volume > 5.5 ml
• Aspermia: No semen volume
• Pyospermia: Leukocytes (germ fighter cells) present in semen
• Hematospermia: Red blood cells present in semen
• Asthenozoospermia: Sperm motility < 40%
• Teratozoospermia: > 40% of sperm seen are of abnormal form
• Necrozoospermia: Nonviable ("dead") sperm
• Oligoasthenozoospermia: Motile density < 8 million sperm/ml

Sperm Morphology (Shape and Appearance)
The evaluation of sperm size, shape and appearance characteristics should be assesed by carefully observing a stained sperm sample under the microscope. The addition of colored "dyes" (stains) to the sperm allow the observer to distinguish important normal landmarks (characteristics) as well as abnormal findings. Several methods of staining sperm are used, and the method employed should be one with which the examiner is comfortable and experienced.

Several different shapes or forms of human sperm have been identified and characterized. These forms fall into one of four main categories: normal forms, abnormal head, abnormal tail and immature germ cells (IGC).
Normal forms
Normal sperm have oval head shapes, an intact central or "mid" section, and an uncoiled, single tail.

Abnormal heads
Many different sperm head abnormalities may be seen. Large heads (macrocephalic), small heads (microcephalic) and an absence of identifiable head are all seen in evaluations. Tapering sperm heads, pyriform heads (teardrop shape) and duplicate or double heads have been seen. Overall (gross) abnormalities in appearance may be termed "amorphous" changes.

Abnormal tails
Coiling and bending of the tail are sometimes seen. Broken tails of less than half normal length should be categorized abnormal. Double, triple and quadruple tails are seen and are abnormal. Cytoplasmic droplets along the tail may indicate an immature sperm.

Immature germ cells (IGC's)
White blood cells (WBC's, germ fighters) in the semen should rarely be seen. It is very difficult to distinguish between an immature germ cell and a WBC. Because the presence of WBC's in the semen (pyospermia) can be a serious concern, if a report of "many IGC's" is delivered, it becomes very important to assure that these cells are not, instead, WBC's.

Sperm "Motility" (Movement)
Sperm motility studies identify the number of motile (moving) sperm seen in an ejaculate specimen. Here again, as in many other sperm studies, many laboratories use "normal" values that are out of date and inaccurate. Many labs will assess sperm motility upon receipt of the specimen, and again at hourly time intervals for four to twenty four hours. It is well known that sperm motility is a temperature dependent sperm function, so the handling and processing of specimens is critical. It is for this reason that we, except in very rare instances, require that specimens be evaluated only in a laboratory such as our own, where we are able to tightly control laboratory conditions. We have found the repeated testing of sperm over time for motility adds little to the evaluation of motility over the initial sperm motility assessment. Sperm are known not to survive well for extended periods of time in semen, and in nature, sperm very rapidly leave the semen to enter the cervical mucus. Many laboratories consider "normal" sperm motility to be 60% or greater. Our own studies, in agreement with many others have found men with 40% or greater sperm motility to be "normal".
Decreased sperm motility. If found to be present, exam should be repeated to assure that laboratory conditions did not cause the problem. Frequent causes: abnormal spermatogenesis (sperm manufacture), epididymal sperm maturation problems, transport abnormalities, varicocele. These conditions should all be looked for if sperm motility is repeatedly "low".

A total absence of moving sperm. It is vital, if sperm are seen, but are not moving, to carry out studies (vital stains) to see if the sperm seen are alive. It is possible to have sperm with normal reproductive genetics that are deficient in one or several of the factors necessary to produce motility. We have achieved several successful pregnancies emploting microinjection of healthy, non motile sperm directly into the egg (ICSI).
Chemical and Biochemical Semen Characteristics

Semen acid-base balance (pH)
The pH of semen is measured using a specially treated paper blot that changes color according to the pH of the specimen that it is exposed to. The pH of normal semen is slightly alkaline ranging from 7.2 to 7.8. Prostatic secretions are acidic while the secretions of the seminal vesicles are alkaline. Therefore, alterations in pH may reflect a dysfunction of one or both of these accessory glands. The pH of semen has not been generally found to have a major influence on a man's fertility potential.

Color and Turbidity
Semen is normally translucent or whitish-gray opalescent in color. Blood found in semen (hematospermia) can color the semen pink to bright red to brownish red. The presence of blood in semen is abnormal and should be reported. The presence of particles, nonliquified streaks of mucus or debris requires further evaluation.

Semen is normally produced as a coagulum. The specimen will ususally liquify within 30 minutes. The failure to liquify within one hour is abnormal. Excellent methods for correcting this problem in the laboratory are available. Viscosity
Nonliquefaction and excessive viscosity are two separate conditions. Viscosity is measured after complete liquefaction has occured. Viscosity is considered "normal" if the liquefied specimen can be poured from a graduated beaker drop by drop with no attaching agglutinum between drops. The role of hyper (excessive) viscosity is being studied, but it seems possible that htis condition may interfere with the ability of sperm to travel from the site of deposition into the cervix or uterus.
Computer Assisted Semen Analysis (CASA)
The use of computer asisted semen analysis has advanced the ability to study and understand sperm function as it relates to human infertility. The major advances have been in the ability to more accurately determine sperm concentration (counts) and motility (movement). Generally, sperm are "looked" at by a computerized digitizing tablet through a microscope. The computer has been "taught" by the laboratory personnel what sperm look like, and how they move. When the computer then "sees" a sperm under the microscope, it is able to draw a digitized picture of each individual sperm, including the speed and path this sperm takes while moving under the microscope. A great deal has been learned about the normal and abnormal "micro"characteristics of sperm employing this method. The method is, however, not foolproof. The computer is only as intelligent as it's programmer. Small changes in the computer program can alter the sperm calculations significantly. The computers must constantly be monitored and updated. In our laboratories, all grossly abnormal CASA assays are always verified by both a repeat analysis as well as with a "hands on" human second look opinion. We feel that any abnormal sperm count must be verified by a manual counting and assesment method.

Sperm Penetration Assays (SPA, "Hamster Tests")
There have been many attempts made to develop a Laboratory test that will accurately predict the ability of a human sperm to fertilize a human egg. Dr. Aitken and his group many years ago demonstrated a correlation between sperm movement characteristics and sperm fertilizing ability as evaluated by the zona pellucida-free hamster egg penetration test. In this test, the species specific barrier to penetration (not fertilization) is removed from the ova (eggs) of the hamster. These oocytes are then exposed to prepared sperm from the man being tested. There is some feeling that if a man's sperm are able to penetrate the hamster eggs in the laboratory, there is a higher likelihood that his sperm will ultimately be able to fertilize a human egg if so exposed. This test is not uniformly accepted, due to the high false negative (no penetration of the hamster egg, but wife gets pregnant anyway) rate and the sometimes seen false positive (penetrates the hamster egg but does not fertilize human eggs in vitro) rate of this test. Our experience has been that good performance in the hamster test can provide some limited reassurance of the likelihood that a man's sperm will be able to achieve fertilization if given the chance. If men fail the hamster test, we rely upon in vitro fertilization with ICSI. This protocol has provided us with excellent success rates in men whose sperm function remains questionable. It should be noted that most men that fail the hamster test, are able to achieve normal fertilization with ICSI. For a detailed explanation of the "hamster test" click here.

Post-Coital Testing
The postcoital test (also known as the Huhner test or the Sims-Huhner test) is a valuable office test that should be carried out in selected patients early in their infertility evaluation. While this is a very popular and widely used test, there are no widely accepted normal values for the interpretation of this test. Simply, the postcoital (after intercourse) test evaluates the women's cervical mucus at the time of ovulation and how the mucus interacts with her husband's sperm as ovulation is about to occur. The couple is instructed to avoid sexual intercourse for two days prior to the exam. When evidence of impending ovulation is detected (LH testing, hormone blood tests, ultrasound, etc.) the couple is instructed to have intercourse and then present to the office 6 to 10 hours later (standard test). At this time, a small drop of mucus is painlessly removed from the endo (inner) cervix, and this drop is examined under the microscope. A favorable result would find many sperm in thin watery mucus, with good forward, active motion through the mucus. If the initial test is good, a second delayed exam (18-24 hours after intercourse) may be required if infertility persists. If the initial test is poor, a repeat exam carried out 2-3 hours after intercourse may be needed. The timing of the postcoital exam is very important. If carried out too soon after intercourse, sperm that appear normal at that time may later die, giving a false sense of security. Patients should assure that the test timing is appropriate, and that they are not just being squeezed in to a busy schedule at a convenient time. A normal test largely excludes the cervix as a contributor to any fertility problem.

Normal (above) and abnormal (below)"post-coital" exams. Highly successful treatment is available for abnormal findings.

Sperm Washing and Freezing
Sperm "washing" techniques have been applied to treat a wide variety of sperm and semen disorders, as well as to prepare "normal" sperm for intrauterine insemination in the treatment of some female disorders. What is being "washed" in a sperm washing procedure are the various constituents of semen and the remainder of the ejaculate not deemed necessary to achieve fertilization of the egg. An ejaculate is not a sterile specimen and may contain both aerobic (oxygen dependednt) and anaerobic bacteria. In addition cellular debris from the vas deferens, the prostate, the seminal vesicles and thr urethra may be present. All of these components are "washed" from the specimen in the sperm wash procedure.

Antisperm Antibodies
Antisperm antibodies have been well documented in the scientific literature as having the potential to cause impairment of fertility in humans. Sperm antibodies are detectable in either the male or female partner in approximately 10% of infertile couples. While these antibodies may be present, they may not be ultimately implicated as the cause of the infertility, making the search for antibodies in infertile couples both important and frustrating for the physician.

Antibodies, in general, are biochemical "time-bombs" that develop in the immune systems of all normal human beings. They are there to protect us from foreign "invaders" (viruses, bacteria, foreign objects, etc.) that would otherwise have the potential to attack and harm vital parts of the body. A newborn infant is supplied with a temporary supply of vital antibodies from the mother. This supply may be initially be replenished and transmitted from breast milk from the mother. Ultimately, antibodies to harmful outsiders develop slowly and reliably over time as a growing human is exposed to more and more "coughs, clods and flu's" from the outside world. Vaccines are a way to trick the body into producing long term protective antibodies without the body having to first suffer the disease. Antibody protection can, on occasion, "short circuit". In these instances, the abnormal function of the antibodies can lead to a variety of diseases. Some common examles are certain forms of severe arthritis, lupus, diabetes, and in reproduction, premature menopause (ovarian failure) and antisperm antibodies.

What happens in many immunologic disorders is the immune system that is normally ONLY supposed to make antibodies to protect from harmful threats begins to see "normal" tissue as a threat. In the case of arthritis, the immune system mistakenly decides that a person's bone joints have become a threat and begins to attack the joints. This persistent immune attack leads to an eventual painful destruction of the involved joints. In the case of antisperm antibodies, either the man begins to see his own sperm as a foreign "threat" or his female partner, whose immune system is supposed to tolerate sperm as non-threatening, begins to lose this tolerance and produces a destructive antibody that may damage the sperm and make it incapable of performing it's egg penetration and fertilization duties.

Antisperm antibody testing is complex, as at least three different antibodies can have a damaging effect on sperm. Each of these antibodies must be specifically looked for in the investigation of the male and female. A new test, due for release to laboratories in early 2001 is able to determine biochemically if sperm have been damaged by any cause within the male reporiductive tract, making them incapable of fertilizing the egg. This new assay promises to make our ability to assess sperm function much more accurate. Initial use of this investigation assay has shown it to be nearly 100% accurate in determining is a sperm can fertilize an egg without help, either naturally or with in vitro fertilization, of if intervention in the fertility laboratory with ICSI will be required.

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Treating abnormal sperm
In general, it should be remembered that the predictive value (in terms of fertility) of the semen analysis is low. A man with an abnormal semen analysis with a history of proven fertility (prior pregnancy) without an intervening event associated with infertility has a better prognosis than a similar man without proven fertility.

When the cause for the semen abnormality can be identified, treatment directed specifically at this cause is the most direct and effective plan. In many cases, the cause for the semen abnormality will not be discovered. In this situation, treatment is directed at improving the sperm's ability to fertilize an egg. Even in extreme cases of male factor infertility, if any live sperm can be retrieved either by ejaculation, from the postejaculatory voided urine, or through surgical retrieval from the scrotal sac there are fertility options which have reasonable success. This section reviews these options.

* (1) excessive exposure to heat
Limit such exposure and recheck the semen analysis 3-5 months later to allow for a nonoverlapping cycle of spermatogenesis

* (2) substance abuse, toxin exposure, and medications
Discontinue these substances (only change medications in conjunction with the prescribing physician) and recheck the semen analysis 3-5 months later to allow for a nonoverlapping cycle of spermatogenesis.

* (3) radiation
The effects can be transient, but are often permanent when greater than 60 rads has been administered to the pelvic region.

* (4) surgery
Postoperative changes are rarely treatable with further surgery. One possible exception is an obstruction in the outflow tract from the testicle involving the epididymis, vas deferens or ejaculatory duct.

* (5) testicular failure
These causes for azoospermia and severe oligospermia are rarely correctable. If any live sperm can be retrieved assisted fertilization (such as ICSI) at the time of IVF has a good pregnancy success rate. Use of very poor quality semen for COH/IUI or standard microdroplet IVF rarely results in pregnancy.

* (6) antisperm antibodies
Usually treated with intrauterine inseminations (to avoid the cervical mucus) or In Vitro Fertilization, regardless of antibody type. Since this treatment does not change according to the site on the sperm that is attached to the antibodies simply determining whether the patient has an abnormal postcoital test appears to be the most direct, simple and cost effective test for these antibodies.

Antisperm antibody titers may be suppressed with steroids. These medications have potentially serious complications, appear to have an effect on antisperm antibody titers only after several months of administration, and the dosages of the medications for this indication have not been clearly established. Therefore, I have not tried to suppress the production of antibodies with steroids.

* (7) varicocele
Repair is not always recommended. Specific findings on semen analysis and/or exam suggest the utility of repair. The semen analysis of subfertile men with a varicocele may show increased numbers of abnormally shaped sperm, a decrease in sperm motility and/or a decrease in sperm concentration.

Repair of a clinically detectable varicocele appears to be indicated if a persistent abnormal semen analysis is detected, especially if characterized by the so called "stress pattern" that is associated with a varicocele (a decreased sperm count or an increased number of tapered forms with an increased number of amorphous or immature sperm)

Repair of subclinical varicoceles (varicoceles that can only be detected by special tests like ultrasonography, doppler studies or invasive venograms) have not been shown to result in improved fertility. Therefore, the repair of these subclinical varicoceles is highly controversial.

Repair of a varicocele detected in the presence of a normal semen analysis, normal testicular exam and "unexplained infertility" is also controversial, with no clear basis for the surgery. That is, the mere presence of a varicocele in the context of a couple suffering from infertility is not independently an indication for surgery.

Following varicocele repair there usually is little improvement in the shape of the sperm (morphology) yet there is improvement in the sperm counts and motility in up to 70% of patients. The improvement in fertility, the desired goal, is unpredictable and different reports suggest a wide range of outcomes.

Some urologists have suggested hormonal treatment of varicoceles with either Clomiphene citrate or hCG (which acts like LH on the Leydig cells of the testes, improving parameters like testosterone production) alone or following surgery. In general, the research in this area is lacking. Limiting hormonal management to patients with a solid basis for treatment (such as a documented serum FSH, LH or testosterone concentration deficiency) seems prudent at this time.

* (8) disorders of emission or ejaculation
Treatment with pharmacological agents attempt to optimize emission and bladder neck closure. Ephedrine sulfate, pseudoephedrine hydrochloride, phenylpropanolamine hydrochloride, and imipramine hydrochloride have been used to stimulate contraction of the bladder neck. These agents seem to work best with minor nonsurgical causes of bladder neck flacidity. Following such operations as childhood YV plasty the pharmocologic agents are rarely effective.If no specific cause for the abnormal sperm is identified, treatment options include intrauterine inseminations, controlled ovarian hyperstimulation, and IVF with ICSI. I typically recommend a progression through the available treatment options from less aggressive to more aggressive.

* (9) intrauterine insemination (IUI)
Intrauterine insemination (IUI) of sperm has been a widely accepted technique for improving fertility when there is a mild male factor.

The basis for placement of sperm within the uterine cavity or within cervical mucus is the rapid dropoff of the number of sperm as they "naturally" progress from the vaginal vault to the cervical mucus to the uterine cavity to the fallopian tubes (where fertilization normally occurs). Reportedly, when about 50-500 million sperm are placed within the vaginal vault during intercourse (where they normally live for less than 1-2 hours), only about 1 million sperm find their way to the "friendlier" cervical mucus (where they normally can live for days), only a few thousand sperm may eventually find their way to the top of the uterine cavity where the tubal openings are located, and only hundreds to thousands of sperm may enter the tube in search of a mature egg. The mechanism for this tremendous dropoff of sperm along the way to the tube is not fully understood. The theory supporting intrauterine insemination is that placing more than 1 million sperm (many men with decreased sperm counts will have greater than 1 million motile sperm per ejaculate) at the top of the uterine cavity near the opening of the tubes improves the ability of those sperm to enter the fallopian tubes in search of fertilizable eggs.

The success of procedures that attempt to optimize the sperm's natural fertilizing ability is limited by the inherent sperm quality. When equal numbers of motile sperm are separated from sperm initially with a normal semen analysis versus sperm initially with a poor semen analysis, there appears to be better function of the sperm from the normal sample.

Insemination of sperm can be into the cervix or into the uterus. Intracervical insemination is ideal if the couple's only apparent problem with fertility is the inability to complete intercourse. Otherwise, this is a technique with limited proven utility. The primary indication for intrauterine insemination without the addition of controlled ovarian hyperstimulation is an abnormal postcoital test. Intrauterine insemination requires that the sperm is "washed" free of the semen since semen

*contains molecules (called prostaglandins) that cause painful contractions of the uterus if placed into the uterine cavity,
*may contain bacteria, and
* may have oxygen reactive species of molecules that could interfere with fertilization.

Techniques to separate sperm from semen can partially determine the amount and quality of sperm inseminated. Many infertility specialists have suggested that 1 million motile sperm following the sperm separation procedure is the minimum amount of sperm associated with a reasonable chance of pregnancy success at intrauterine insemination. The basis of this suggestion is not clear from a review of the literature, however, my own personal experience is in general agreement.

In sperm with decreased motility, chemical agents similar to caffeine have been used to enhance motility. These agents include pentoxyfylline which when applied to sperm will often improve motility considerably. Many sophisticated sperm labs apply these agents to sperm.

The criteria for the timing of inseminations should be clearly established. The goal is to perform the insemination at about the time of ovulation. Ovulation occurs about 36 hours after the onset of the LH surge (signal from the brain to the ovaries to ovulate) in a natural cycle. Ovulation predictor kits detect LH in the urine after metabolism and excretion into the urine. The LH in the urine reacts with the test kit material which then changes color (pink or blue). The detection of high levels of LH in the urine correlates with the occurrence (not the onset) of the LH surge in the blood. Generally, ovulation occurs the day of or the day following the positive LH ovulation predictor kit result, but exact timing of ovulation with these kits is not possible. On occasion, ovulation may occur 2 days after the kit's detection of the LH surge.

I have normally recommended that the patient have an IUI the day of or the day following the positive kit result. If the patient cannot return to the office for an insemination until 2 days following the positive result, I will allow an IUI if the patient understands that there may be a somewhat decreased chance of success. The mature egg is most likely fertilizable for 24 hours following release from the ovary. If intercourse rather than IUI is planned, then the couple should have relations each day for 3-4 days starting the day of the positive kit result. I have not found there to be an improved success in pregnancy outcome when 2 rather than 1 IUI is performed per natural cycle. However, there are some reports in the literature claiming improvement of pregnancy rates with 2 rather than 1 IUI.

If ovulation is triggered using hCG then injection of this medication simulates the LH surge. If hCG is given when there is a mature egg present in an ovarian follicle then ovulation should occur about 36 hours later. With hCG triggered ovulation, some research suggests a higher pregnancy outcome when 2 IUIs are performed with the initial procedure at 18 hours and the second procedure at 42 hours. These findings have not been widely accepted.

Controlled ovarian hyperstimulation (COH) uses fertility medication to mature greater than one egg per month and may be useful in the treatment of male factor infertility. By maturing multiple eggs in a given month you increase the number of "targets" for available sperm. The use of menotropins with intrauterine insemination is a widely accepted approach of moderate level aggressiveness for mild to moderate male factor infertility. COH/IUI is also used for unexplained infertility and ovulatory dysfunctions resistant to or intolerant to clomiphene citrate.

The literature regarding the use of these techniques is not abundant, but does suggest

* for male factor infertility or couples with an abnormal postcoital test, menotropins with IUI increase the pregnancy rate up to 4 fold over no treatment, to a success rate of 10-15% per cycle for male factor and slightly higher for those with only an abnormal postcoital test;
* for unexplained infertility the per cycle success rates in one study are about 3% for IUI alone, 6% for menotropins alone, and 26% for menotropins with IUI;
* clomid, menotropins and IUI alone are relatively ineffective in the treatment of male factor or unexplained infertility
When the sperm quality is not adequate to recommend COH/IUI, or if this management has not resulted in pregnancy within a reasonable trial period (3-6 cycles with good apparent multiple egg development) then alternative treatment plans should be considered.
* (10) donor sperm:
The use of donor sperm is a major decision and absolutely must be discussed by both members of a couple and agreed upon prior to initiating treatment. Indeed, both members of the couple will sign the consent for the donor insemination.
* (11) ICSI:
The use of assisted fertilization techniques have evolved over the past decades from (a) making small nicks or incisions in the shell of the egg (zona pellucida) called zona drilling or partial zona dissection (PZD), to (b) inserting a small number of sperm under the shell of the egg but not within the plasma membrane (oolemma) of the egg called subzonal insertion (SUZI), to (c) inserting individual sperm under the plasma membrane of the egg directly into the contents (cytoplasm) of the egg called intracytoplasmic sperm injection (ICSI). ICSI has far greater success than the earlier techniques in terms of pregnancy. The only sperm requirement of ICSI is having as many alive (generally motile) sperm as there are eggs for injection.
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What do the semen analysis tests measure?
What the sample looks like - a yellowish colour may indicate the presence of leucocytes (pus cells), a brownish tinge may indicate the presence of blood.

As you would expect - how much there is of the sample. After two days abstinence there should be more than 2ml of semen.

When semen is produced (ejaculated) it coagulates on contact with the air, then, over a short period of time, it liquefies. Liquefaction should be complete at the time of testing (1 hour after ejaculation).

This is a measure of how fluid the sample is (for example, water has a low viscosity, treacle has a high viscosity. Semen should have a fairly watery consistency at the time of testing (1 hour after ejaculation).

A sample of semen is looked at under the microscope. The presence of motile sperm 'stuck' together is called agglutination and may indicate the presence of antibodies.

The pH of a substance is a measure of how acid or alkaline it is (pH 7.0 is neutral). The pH of semen increases with time but should not be less than 7.2 at 1hour.

This measures what percentage of sperm are moving and how well they are moving.
Motility will be graded "A, B, C, and D"
A = percentage of sperm which are actively progressively motile (they move forward quickly).
B = percentage of sperm which are slowly progressively motile (they move forward slowly).
C = percentage of sperm which are non progressively motile (they move but stay in the same place).
D = percentage of sperm which are nonmotile (they do not move at all).
At 1 hour 'A' sperm should be more than 25%, or 'A+B' sperm should be more than 50% of the total

Leucocytes, also known as white cells, or pus cells, may be normally present in the semen in small numbers (less than 1 million per ml) larger numbers may indicate the presence of infection, although this is not necessarily so.

The sperm count is a measure of the total number of sperm (spermatozoa) present. It is usually recorded in millions of sperm per ml of semen. A normal count is regarded as being greater than 20 million per ml.

The vitality of a sample is the percentage of sperm which are alive. Note that this is not the same as the percentage of sperm which are motile. Motile sperm are obviously alive, but non-motile sperm may or may not be dead. At 1 hour, more than 50% of the sperm should be alive.

Morphology estimation involves looking at the individual spermatozoa and saying what percentage of them are normal. It involves making stained preparations of the sample and examining them under the microscope. This is a time consuming procedure calling for both experience and expertise and involving visual examination and measurements. As such, it is too involved to describe fully here, though I do intend to add this information to the site soon.
Normal morphology levels should be given as in the region of greater than 14%.
I have seen web sites for various infertility clinics which give normal morphology as greater than 60%. These places cannot be using the strict criteria of the World Health Organisation, which is the recognised standard for male infertility testing.

Since very early on in the growth of a foetus, the area which will develop into the testes (or the ovaries in the female) has been kept, as it were, shut away from the rest of the body. This is because sperm cells are different from the other body cells and would be recognised by the body as alien invaders, in much the same way as harmful bacteria or viruses are. Injury or trauma to this region can allow this barrier to be broken, and the body will begin making antibodies to its own sperm.
Antibody levels may reported as a percentage or in words, thus:
Less than 50% = Negative
Greater than 50% = Highly probable immunological infertility
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Finding a Laboratory for Semen Analysis
Expertise: Semen testing is a sophisticated and technical field. An improperly or incompletely performed semen analysis may miss significant problems. Unrecognized problems may significantly delay a man's treatment. Unlike many other lab tests, a semen analysis relies completely on the expertise of those performing it. Make sure that the lab has sophisticated protocols and well-trained, specialized technicians.
Timing: In order to get accurate test results, the specimen must be processed within one hour of collection. If not, the measurement of the movement of the sperm may be extremely inaccurate. With any lab you use, make sure that the analysis is performed on site and not shipped elsewhere for evaluation.
Thoroughness: As a semen analysis is being performed, certain findings may indicate the need for additional tests. Ideally, you should use a laboratory that has the capability to do complete initial testing as well as the flexibility to do the appropriate follow-up testing on the same specimen.
Comfort and convenience: In order to maximize your results, it is important that you are as relaxed and comfortable as possible. Ideally, the specimen should be collected at the laboratory itself.
If your physician has recommended that you have a semen analysis at our laboratory, these are most likely some of the reasons:
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Limits of Semen Analysis
Semen analysis can provide important information related to the function of the male reproductive system but, even when results are within normal limits, it does not ensure that a male is fertile.

A normal semen analysis result does not mean that all causes of male infertility have been ruled out. One reason for this is that there can be considerable differences between one semen analysis result and another in a single individual.

On the other hand, an abnormal result does not always mean that a couple cannot conceive a pregnancy. Men with suboptimal sperm counts have been known to father children. Also, infection, trauma, stress, febrile illness and medications can cause temporary subfertility.

For all of these reasons multiple specimens are recommended for a complete analysis of the semen.
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Frequent ejaculation improves sperm quality
PARIS: Men who want to become fathers should have sex or ejaculate daily in order to maximise sperm quality, scientists report.

Australian fertility specialist David Greening recruited 118 men whose sperm had a higher-than-normal level of DNA damage.

Before the test, 34% of the group's sperm was rated as damaged, meaning that it was classified as 'poor' in quality. For individuals, 15% to 98% of their sperm were classified as such.

The men were asked to ejaculate daily for seven days, but were not given any drugs or told to make any changes to lifestyle. After seven days, their sperm was examined again. The average of damaged sperm fell to 26%, placing it in the category of 'fair' in quality.

Greening presented his findings the European Society of Human Reproduction and Embryology in Amsterdam, The Netherlands on Tuesday.

80% saw improvement in sperm quality

About 80% of the men saw an increase in sperm quality, and many of them moved into the 'good' range from the 'poor' or 'fair' categories. However, about 20% saw a decline in sperm quality.

Men who donate or have their sperm collected are usually told to avoid ejaculation two to three days before collection. But this study may challenge this ingrained idea.

Greening, an obstetrician and endocrinologist at Sydney IVF, an Australian company that carries out assisted reproduction, said the improvements were "substantial and statistically highly significant."

Daily ejaculation not only boosted sperm quality for most of the men, it also helped sperm motility ¨C another big factor in successful fertilisation ¨C even though volumes of semen declined, he said.

Exposure to oxygen damages sperm cells

The research did not investigate whether the improvement in sperm quality led to better pregnancy rates. But previous work has shown that sperm that is less damaged and more mobile has a better chance of leading to a healthy baby.

"These results may mean that men player a greater role in fertility than previously suspected, and that ejaculatory frequency is important for improving sperm quality," said Greening. Why this is so is unclear.

Greening said he suspected that the longer sperm stays in the testicular ducts, the greater its exposure to rogue oxygen molecules that damage cells. His advice to couples would be to have sex, or to ejaculate, daily in the run-up to ovulation or to sperm donation for in-vitro fertilisation (IVF).

"The optimal number of days of ejaculation might be more or less seven days, but a week seems manageable and favourable," he said. "It seems safe to conclude that couples with relatively normal semen parameters should have sex daily for up to a week before ovulation date."
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Obese Men Have Less Semen, More Sperm Abnormalities
Obese men should consider losing weight if they want to have children, a scientist told the 24th annual conference of the European Society of Human Reproduction and Embryology July 9. Dr. A Ghiyath Shayeb, from the University of Aberdeen, Aberdeen, UK, said that his research had shown that men with a higher body mass index (BMI) had lower volumes of seminal fluid and a higher proportion of abnormal sperm.
Dr. Shayeb and colleagues looked at the results of seminal fluid analysis in 5316 men attending Aberdeen Fertility Centre with their partners for difficulties in conceiving. 2037 of these men had complete data on their BMIs. "We felt that it was possible that male overweight might contribute to fertility problems," he said, "particularly since it is a known risk factor for problems in conceiving among women."

The scientists divided the men into four groups according to their BMI, from being underweight to being considerably overweight. Taking into account other characteristics that could confound the analysis, such as smoking, alcohol intake, age, social deprivation, and the length of time of abstinence from sex prior to producing a semen sample for analysis, they looked for a relationship between BMI and semen quality. The analysis showed that the men in Group B, who had an optimal BMI (20-25, as classified by WHO), had higher levels of normal sperm than those in the other groups. They also had higher semen volume. There was no significant difference between the four BMI groups in sperm concentration or motility.

The researchers did not look at DNA damage in the sperm, preferring to look at the parameters of the routine semen analysis, which all men attending the fertility centre will have at least once. "Other studies have suggested an association between male obesity and increased DNA damage in the sperm, which can be associated with reduced fertility as well," said Dr. Shayeb.

"Our findings were quite independent of any other factors," he said, "and seem to suggest that men who are trying for a baby with their partners, should first try to achieve an ideal body weight. This is in addition to the benefit of a healthy BMI for their general well being.

"Adopting a healthy lifestyle, a balanced diet, and regular exercise will, in the vast majority of cases, lead to a normal BMI. We are pleased to be able to add improved semen quality to the long list of benefits that we know are the result of an optimal body weight."

The team intends to follow up their research by comparing male BMI in fertile and infertile couples to see if the poorer semen quality correlates with reduced fertility. "There has been a significant rise in the numbers of men with poorer semen parameters in the industrialised world," said Dr. Shayeb, "but this has not been reflected so far in male infertility. To compare male BMI in these two groups therefore seemed to us to be a logical next step."

Further research is also needed on exactly how obesity affects semen production, said Dr. Shayeb. "The mechanism for the relationship could be a number of things -- different hormone levels in obese men, simple overheating of the testicles caused by excessive fat in the area, or that the lifestyle and diet that leads to obesity could also lead to poorer semen quality. We just don't know the answer yet, but this is an important question that needs urgent attention."
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