Who Can Benefit From Semen Analysis and What Can They Learn?
The name is deceptively simple: semen analysis. It's more or less what it sounds like, a noninvasive procedure that measures a slew of qualities unique to an individual's spermatozoa.
But what a semen analysis measures and exactly how that information is applied to a man's situation is where the nuance begins.
"The semen analysis serves as a baseline assessment of a man starting fertility [evaluation] and whether a pregnancy is most likely through natural means or through advanced reproductive treatment like in vitro fertilization," said Russel Williams, M.D., a Houston-area reproductive urologist with the Y Factor, a multi-location urological wellness and fertility practice. "It can give an assessment of the presence of infection in a prostate. You can also get information as to whether there might be an obstruction of the ejaculatory ducts."
Not a single-purpose analysis
While semen analysis is most commonly requested for men experiencing infertility concerns, the test is applicable for other urological and genital health issues. Williams mentioned the analysis may be conducted to confirm the presence, or absence, of spermatozoa in the semen. A lack of sperm in a sample indicates azoospermia, which is typically an obstacle in infertility cases but sometimes exactly what patients (and their doctors) wish to see in their semen sample.
"Some men will get a semen analysis three months after a vasectomy to make sure that the vasectomy worked and that there is no sperm in the semen sample," said Dorette Noorhasan, M.D., a reproductive endocrinologist and a co-founder of CCRM Dallas-Fort Worth, a specialty fertility clinic. "Additionally, men considering fertility preservation will have a semen analysis prior to freezing the sample."
Semen analysis parameters
"The important parameters from a semen analysis are the volume, the sperm count, the sperm motility or swimming ability, the sperm shape or morphology, the presence of inflammatory cells like white blood cells or red blood cells, and whether the semen agglutinates, which means sticks together," Noorhasan explained. "More advanced semen tests will also look at the sperm DNA quality."
In other words, any trait spermatozoa might possess, a semen analysis gauges. Noorhasan unpacked the ins and outs of the relatively simple procedure for both the patient and the healthcare provider. The process starts with making an appointment and then practicing sexual abstinence for anywhere from two to five days prior to it.
"The sample is produced in a cup and will typically sit in the cup for 30 minutes to liquefy before it can be analyzed," she said. "We will measure the volume of the sample. A good sample has a volume of 1.2 milliliters or more. The sample is then placed under the microscope, where the sperm is counted and motility assessed. Ideally, a good concentration is 18 million per milliliter or more. We want to see that 43 percent or more of the sperm are moving. The count of the sperm is important. Morphology is important because there are enzymes in the sperm head that are used to fertilize the egg."
All of these qualities are important in determining a person's fertility.
At-home semen testing
It's natural to question whether such a straightforward health procedure requires a visit to a doctor's office. Home testing does have its upside, but there are downsides, too.
"The at-home semen analysis testing continues to improve," Williams said. "The one factor of semen evaluation most affected by at-home testing is the motility. The most accurate semen analysis is still in the laboratory under a microscope with analysis of the sample 30 minutes after it is produced."
Noorhasan explained that another inevitable drawback of at-home testing can be inconsistency. The parameters of a semen sample can be normal one day but abnormal another day. While the transitory nature of the human body can't be changed, a particularly concerned man who's averse to the doctor's office may opt for multiple at-home tests.
Any fear of an in-office test, however, should be laid to rest, according to Williams, who outlined the pros and cons of a semen analysis.
"There is no significant drawback to producing a semen analysis except for the inconvenience of producing a specimen," he said. "The benefit of producing a semen analysis is that both you and your doctor can develop a greater in-depth understanding of the testicles, the genital ducts, the prostate, the bladder neck and the urethra. If the semen analysis is abnormal, suggesting decreased testicular function, then the doctor would be alerted to perform additional hormone and testicular ultrasound testing."
Whether you're trying for a baby, actively trying not to have a baby or concerned by genital aches or pains, a semen analysis is a simple test, and all direct contact with your penis is limited to your own hands. If discretion is especially important to you, an at-home test may be preferable. But if the answer is anything less than ideal, you won't have a doctor to speak with at the exact moment when you have the most questions.