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Wednesday, July 26, 2006

Semen Analysis

by Serenity

Why would you be doing a Semen Analysis (SA)?

Since male factor accounts for about 35% of infertility, a RE’s office will administer a SA as one of the first tests they’ll do to diagnose you as a couple.
A SA measures the following:
Volume (measured in mL)
Liquefaction time
Sperm count (both the overall count and per mL)
Sperm motility (the percentage of sperm that are moving – these are your “swimmers”). Most clinics also measure how many sperm are moving forward, which is called the “forward motility” test.
Morphology (the percentage of sperm that have a normal shape).
The SA also measures the pH balance, number of white blood cells, and amount of fructose in the sample.

What you can expect

Giving a sample
Generally, clinics require that you to not ejaculate for 48 hours before the test, BUT also do not abstain for more than 72 hours. In layman’s terms: they want you to ejaculate once between 2 and 3 days before the SA, but then abstain until after the SA.
Obviously, this is not a painful process, but it can be embarrassing. I have heard stories where someone’s husband had to use a bathroom off the waiting area to produce his sample – the poor guy! In most clinics, especially the bigger ones, though, they have a room set up with magazines (and even movies) for you to do his thing. And in most cases they’ll let the wife go in with him if he so desires.
Some clinics also allow for the sample to be produced at home if you live close to your clinic. Once the sample is produced, though, you need to keep it warm and get it to the clinic within 1 hour, or some of the sperm begin to die off.

Generally you’ll get the results back within a couple of days of the SA, but it depends on your clinic. We got our SA results the following day.

Normal parameters of sperm are the following (*Based on World Heath Organization criteria, 1992. Table excerpted from Berger, G.S., Goldstein, M., and Fuerst, M. (1995). The Couple's Guide to Fertility. New York: Doubleday):

Normal Ranges for a Semen Analysis*
Liquify?: Yes – within one hour
pH: 7.5 to 8.1
% Motility: Greater than or equal to 50%
% of 3-4 + Forward Motile Sperm: Greater than or equal to 50%
Sperm Concentration: 20-200 million per mL
Total Sperm Count: Greater than or equal to 40 million
Total Motile Sperm: Greater than or equal to 20 million per mL
White Blood Cells: Less than or equal to 1 million per mL
% Normal Morphology: Greater than or equal to 30%

Problems that might arise

There aren’t many problems that will present themselves in terms of the collection process, unless you miss the cup or can't ejaculate.
If the results come back abnormal, your RE will suggest that you see a urologist, who can provide a further diagnosis. Additionally, at times, you can bypass sperm issues by trying IUI or even IVF with ICSI to get pregnant. I have also heard from my RE that there are other nifty high-tech sperm extraction procedures that can give you a chance of getting pregnant - even if your husband has a zero sperm count. At the same time, there will be men who will need to use donor insemination if this is your diagnoses.

Personal tips

Get one done as soon as possible! We didn’t get my husband’s SA done first because I had a lot of spotting and very irregular cycles; so we focused right away on diagnosing me. It wasn’t until we started thinking about treatments (3-4 months into the process) that my RE realized that he didn’t have a SA for my husband. I suppose I was trying to save him from the ‘embarrassment’ of doing one, but it ended up putting us back quite a few months, since his SA came back low.
Remember that counts wax and wane. My husband’s first SA came back pretty low – 20 million overall sperm, but 60% motility. The second one came back abysmally low – 4 million overall count and 20% motility. His third one was higher than the second, but lower than the first – 14 million overall sperm, and 50% motility. Chances are if you have a slightly low count one time, it might be normal another time. Or vice versa.

If the SA comes back abnormal, get thee to a urologist STAT! If there is a structural or hormonal problem, it can be treated. Your RE is NOT a male infertility specialist. For us – my husband had two varicoceles (varicose veins in the testicles) which needed to be surgically corrected. It took a couple of months to schedule the surgery, and since sperm take 90 days to be generated, it usually takes 3-6 months to see a result from that surgery. The sooner you see a specialist, the better.

Remember that there are some treatments for male factor. For us, our counts were so low we weren’t sure we were even a candidate for IUI – so we moved right on to IVF with ICSI. In the meantime, my husband got treatment for his varicoceles. It’s treatable, just takes a little time.
Keep a sense of humor about the collection part- the first one sucks, but it does get easier. I can’t tell you how many times we laugh about the rooms he’s been in for the process. Keeping a sense of humor about the whole thing really helps lighten it up and take the pressure off him a bit.


Lollipop Goldstein said...

I'd be curious to hear from guys who couldn't treat their male factor IF (how did you know it was the end of the line? When was the heads up?) as well as those who have tried some of these surgeries and not had them successful. What's your advice on next steps?

Bea said...

Not a guy, but partially in answer to the above question:

There is also a Sperm Chromatin Structure Assay (SCSA - I might have that wording ever so slightly wrong) that can be done as well. It measures the percentage of chromosomal damage in the genes carried by your sperm.

This is not part of a normal SA, and results can be abnormal whether or not your standard SA is ok.

Usually this is not a first-line test, although if going for more invasive/costly treatments (IVF) it might be a good idea to have it done upfront.

We are currently awaiting results for this test because of poor freeze/thaw embryo survival (only 30%) and having had two chemical pregnancies for three transfers (the other being negative, of course). Also, if you have recurrent implantation failure or early miscarriages, this is a good test to request. Basically do an SCSA if anything casts doubt on the genetic quality of your embryos.

If you have a high % of chromosomal damage, there is very little you can do to treat it. However, frequent (daily) ejaculation helps keep those sperm fresh, and TESA or other biopsy-type techniques can get a better quality of sperm.

IMPORTANT: some clinics infer that if you have over 30% damage, you should give up and use donor sperm. As always, things just aren't that clear-cut. You can still use your own sperm, but you have to be prepared for lower success rates.

Bea said...

My husband gets to bring his sample in with him the morning of. He's curious as to what he should put the cup in. paper bag, plastic? anyone have any ideas?