Definition

Sperm analysis is a test used to assess male fertility. Sperm are cells contained within semen, which are released upon ejaculation after reaching climax or orgasm. In men, the primary function of sperm cells is to fertilize a woman’s egg, leading to pregnancy.

For successful fertilization, sperm must exhibit both sufficient quantity and optimal quality. Sperm quantity and quality are assessed based on:

• The number of sperm cells present in a single ejaculation
• The shape of sperm cells
• The motility or speed of sperm movement
• The size of sperm cells

If any of these components are compromised, sperm quality may suffer, potentially hindering the sperm's ability to fertilize the egg. This can impact male fertility. Poor sperm quantity or quality can interfere with the fertilization process, thereby preventing pregnancy. Among couples who face infertility, male infertility accounts for approximately one-third of cases. In fact, 40-50% of unsuccessful pregnancies in married couples are attributed to male infertility factors.

Sperm analysis is thus essential for detecting potential sperm issues early on, enabling timely intervention that may reduce the risk of irreversible infertility in men. The test evaluates sperm count, morphology, size, and motility.

Indications

A doctor may suggest a sperm analysis test if you experience any of the following:

• The absence of pregnancy within a year of marriage, despite regular, unprotected sexual intercourse.

• Post-vasectomy assessment, following a male contraceptive procedure designed to prevent pregnancy. A vasectomy involves surgically severing the tube connecting the testicles to the penis, so that sperm do not enter the semen.

Sperm analysis aids doctors in identifying male factors contributing to infertility. It is also useful for verifying the effectiveness of a vasectomy. In these cases, sperm analysis is typically repeated monthly over three months to confirm the absence of sperm in the semen, indicating successful vasectomy.

Contraindications

Sperm analysis is a generally safe procedure with no known contraindications or certain conditions that would prevent an individual from undergoing the test.

Preparations Before the Test

Certain guidelines should be followed to ensure accurate sperm analysis results. The preparation steps include:

• Abstaining from sexual activity or masturbation for 2-5 days prior to the test, to maximize sperm count for analysis.

• Avoiding alcohol and smoking before the test.

• Informing your doctor if you are using any medications or hormonal treatments, such as testosterone supplements, as these may influence sperm production.

• Ensuring that you are in good health, without stress or strain, before the examination.

Test Procedure

A sperm analysis test involves the collection of a sperm sample and its analysis in a laboratory. Sample collection may be done at home. Here are the methods for collecting sperm samples:

• The doctor provides a sterile container or specialized condom to collect the sperm sample, preventing contamination.

• Sperm collection methods include:

  • Masturbation: This is the preferred method for obtaining a clean sperm sample.

  • Sexual intercourse using a condom: Sperm may also be collected during intercourse with a special condom provided for this purpose.

  • Alternative methods: These include interrupted intercourse or ejaculation induced by an electrical device.

After collecting a semen sample, it should be transported to a healthcare facility within 30-60 minutes. In the lab, a microscopic test is performed to evaluate sperm components, including quantity, shape, size, and motility.

Normal and Abnormal Values

Normal values for sperm analysis observed under the microscope are based on WHO (World Health Organization) guidelines:

In addition to microscopic analysis, semen is also visually examined. Here are some components of sperm that are visually assessed, namely:

Volume

Normal semen volume per ejaculation ranges from 1.5 to 7.6 mL. Semen contains sperm cells and other components such as sugar, protein and vitamins as a food source for sperm cells. Semen volume is considered abnormal if the volume in one ejaculation is less than 1.5 mL, it may suggest a blockage in the vessels or ducts from the testicles to the penis and may indicate low sperm count.

pH

Normal semen pH is 7.2 - 7.8. A pH above 8 indicates alkalinity, often due to infection, while a pH below 7 signals acidity, which can harm sperm viability. Acidic or alkaline semen can affect the life of sperm cells, making sperm unable to survive for a long time.

Liquefaction Time

Semen initially appears thick and should liquefy within 15-30 minutes when they enter the vagina. Failure to do so can hinder sperm movement and affect fertility.

Color

Typical semen color is grayish-white. Reddish semen may indicate blood, while a yellowish color can result from infections, liver issues, or medication effects.

Results and Recommendations (Further Testing)

If semen analysis falls within normal values for all components, sperm is generally healthy, indicating no fertility issues in the male partner and a high likelihood of pregnancy. Abnormal findings in sperm count, morphology, size, or motility suggest unhealthy sperm and a low chance of pregnancy.

In these cases, the doctor might recommend additional tests, such as blood and urine tests, ultrasound, or cancer markers, to further explore the causes of poor sperm health. Contributing factors to low sperm quality include:

• Genetics
• Obesity
• Infections
• Cancer
• Alcohol use
• Smoking
• Drug use

Consult the Right Doctor

If a couple has not achieved pregnancy after a year of regular, unprotected intercourse, they should consider visiting a healthcare facility for further guidance. An obstetrician or andrologist can help identify any factors impacting fertility.

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