Sperm Quality Analyzer
What is a semen
|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
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
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
- Semen volume
- Sperm count
- Grade of
- Normal sperm
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
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
from sex for two to four days prior to the day
a clean, sterile container
spilling or leaking any of the collected semen
using a lubricant, which can kill sperm
the sample at room temperature
|A semen analysis is done to determine
¦µA man has a
reproductive problem that is causing infertility.
¦µA vasectomy has
¦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
|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.
|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
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
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
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
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
(thickening into a solid) and liquefaction
acidity, and sugar content
¦µResistance to flow
¦µSperm movement or
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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for a man with an abnormal semen analysis sperm count
|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
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
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
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
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
Testing for acrosomal status
HOS test - hypo-osmotic swelling test-which tests for
the integrity of the sperm membrane
CASA - computer-assisted sperm analysis
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
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|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
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
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
• Hematospermia: Red blood cells present in semen
• Asthenozoospermia: Sperm motility < 40%
• Teratozoospermia: > 40% of sperm seen are of abnormal
• Necrozoospermia: Nonviable ("dead") sperm
• Oligoasthenozoospermia: Motile density < 8 million
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 sperm have oval head shapes, an intact central or
"mid" section, and an uncoiled, single tail.
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.
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
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
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
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.
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
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 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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|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
* (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
* (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
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
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
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
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
*contains molecules (called prostaglandins) that cause
painful contractions of the uterus if placed into the
*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
* 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
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
* (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
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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
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
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
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
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
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.
12.ANTI SPERM ANTIBODIES
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
Antibody levels may reported as a percentage or in
Less than 50% = Negative
Greater than 50% = Highly probable immunological
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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,
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
|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
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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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
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
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
"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.
"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
"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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