August 18, 2020

Difficulty conceiving isn’t uncommon. About 10 out of 100 women in the United States have trouble becoming or staying pregnant.¹ For men, the statistics are similar. Approximately 9 percent of men in the United States have experienced infertility.² Fortunately, modern medical science has made great strides in helping women and couples conceive. Depending on the underlying issues for each individual or couple, a simple semen analysis may help shed light on the cause of a couple’s inability to conceive, and with a doctor’s guidance, may indicate the best course of action for improving their chances.

A Closer Look at Male Infertility

In one-third of infertile couples, the problem is with the male partner. For the other two-thirds, the problem lies either with the female partner, both partners, or is unable to be identified.² For males, studies have shown that fertility begins to decline around age 40. One such study found that over 12 months, conception was 30 percent less likely for males over age 40 when compared to men younger than 30.³   

There may be several factors to consider when assessing male infertility, one of which is sperm function. Multiple conditions relating to sperm function are encompassed in the term “male factor infertility.” Here are a few of the most common conditions:

• Low sperm concentration (oligospermia)
• Poor sperm motility (asthenospermia)
• Abnormal sperm morphology (teratospermia)

The fewer sperm that are present in semen, the lower the chances of a sperm and egg meeting and conception taking place. Low sperm concentration can be caused by several factors including smoking, drinking alcohol, taking certain medications, long-term sickness, childhood infections, chromosome problems, or low testosterone.⁴

Sperm motility refers to the sperm’s ability to move independently. This is different than mobility, which refers to the ability for an object or organism to be moved. If sperm have difficulty moving on their own, it stands to reason that they’ll have a tough time reaching an egg in the woman’s body.

Abnormal sperm morphology is when a sperm cell does not fully form or does not form normally. Abnormal sperm cells typically have head or tail defects. A head defect may affect the sperm’s ability to penetrate an egg, while a tail defect may affect the sperm’s ability to move effectively.

A semen analysis can reveal if any of these issues are present in a male partner’s sperm.

Semen Analysis

A semen analysis, or male fertility workup, is a fairly simple procedure that tests and analyzes a male’s semen for fertility issues, like those mentioned earlier. During a visit for a male fertility workup, a doctor will usually start by conducting a questionnaire with the male patient. The doctor will cover a lot of ground, so you or your partner should expect to answer a lot of questions, some of which may feel intrusive. Just remember that the doctor needs to know as much as possible about your or your partner’s lifestyle and medical history to make an accurate assessment.

Here are just a few of the topics your or your partner’s doctor may ask about before the semen analysis⁵:

• History of STDs (sexually transmitted diseases)
• Current sexual patterns and frequency
• Medications
• Lifestyle (alcohol consumption, tobacco use, recreational drug use, etc.)
• Surgical history
• Injuries to the groin

After the questionnaire there is a physical exam. During the physical exam, the doctor should check the male partner’s hormone and androgen levels, examine hair patterns on the genital area, examine the penis and scrotum for any physical abnormalities, and perform a prostate exam.⁵

Next, the doctor will request a semen sample. This can be provided in a few different ways. In most cases, the male patient goes into a private room at the doctor’s office and provides a sample by masturbating into a sterile cup. In other instances, the patient can create the sample in the privacy of his own home; however, the patient must return the sample to his doctor within half an hour. The sample must be kept as close to body temperature as possible during transport. Since the sample must be analyzed within one to two hours, samples made at home may not be ideal for getting the most accurate test results.⁶

The semen sample will be analyzed based on the following factors⁶:

• Sperm count
• Sperm motility
• Velocity (forward progression) of sperm
• Size and shape (morphology) of sperm
• Total semen volume
• The ability of the semen to liquify

What’s Normal?

As for sperm count, 40 million to 300 million per milliliter is considered normal. As for size and shape, at least 30 percent of the sperm should have normal morphology.⁵

Sperm should be both active (motile) and have a good quality of motion. In a normal sample, at least 50 percent of sperm cells will be active and the ones that are will have their motion rated on a scale of 1 to 4. A rating of 2 or higher is considered satisfactory.⁵

For semen volume, the normal range is between 2 milliliters and 5 milliliters. A low volume may indicate that the seminal vesicles are not making enough fluid, or that there may be a blockage.⁵

Normal semen coagulates after ejaculation and then liquefies within 20 minutes. Slow liquefication or inability to liquefy can signal a problem.⁵

Next Steps

Once the doctor gets the results of the semen analysis, they will discuss them with you and your partner, present the options available, and make recommendations on the next steps to take. Depending on the results, you and your partner may only need to make simple lifestyle changes. If more drastic changes are needed, or if alternatives to natural conception are discussed, you and your partner can work with your doctors to determine the best choice for your situation.