When the topic of infertility comes up, people tend to think about women. But men suffer from fertility problems, too. According to Cleveland Clinic, “In at least half of all cases of infertility, a male factor is a major or contributing cause. This means that about 10% of all males in the United States who are attempting to conceive suffer from infertility.” Let's shed a little light on male fertility testing and the steps that may be taken to resolve any issues.
The first step after a man seeks help from a fertility specialist is a semen analysis. This can seem like a scary prospect, especially when you don’t know what to expect. Here’s a quick overview of the process and why it’s important.
When you get to the clinic on the day of the semen analysis, you’ll receive a collection cup with a lid and specific instructions for sterile collection.
Some clinics allow you to produce your sperm sample at home and bring it to the clinic within 60 minutes. If that sounds less stressful to you, be sure to ask your clinic if this is an option.
Once the lab has your sample, they examine it under a microscope. The main categories assessed are the size of the sample in milliliters (volume) , how many sperm are present per ml (Concentration), if the sperm appear to have a normal shape (Morphology), and how the sperm are swimming (Motility). The lab will come up with a total motile count Total Motile Count, which is approximately how many swimming sperm there are in the sample. Based on the results of your initial semen analysis, your fertility specialist can make personalized recommendations for you as you proceed through your treatment plan.
The following are a few typical recommendations to optimize your semen analysis results:
It’s best to have 2-5 days of abstinence (time without ejaculating) prior to doing a semen analysis. This is the optimal amount of time for your body to accumulate enough sperm for the best results possible.
It’s also advised to avoid saunas, steam rooms, and hot tubs because very hot temperatures can kill sperm.
Lastly, drugs and heavy alcohol intake can reduce sperm count. It’s recommended to avoid these substances to not only improve your general health, but also to help prevent unnecessary harm to your sperm.
If your semen analysis results come back and everything is within normal range, there’s usually no further assessment prior to proceeding with sperm collection for intrauterine insemination (IUI) or in vitro insemination (IVF). Typically, a semen analysis is repeated yearly while undergoing treatment to confirm that all categories remain within normal range.
Normal ranges for male sperm semen analysis.
While everyone hopes for a result devoid of issues, sometimes semen analyses come back with results that are lower than anticipated in one or more categories. Typically, the first recommendation will be to repeat the test after a few weeks. The second semen analysis will be used to confirm the results of the first. If issues are identified in the second collection, your doctor will discuss next steps.
If there’s a problem with the ability of the sperm to swim well or to swim at all, problems with their shape, or a very low sperm count, your fertility specialist will likely recommend something called ICSI. ICSI stands for Intracytoplasmic Sperm Injection. ICSI is a procedure used alongside an IVF cycle to help fertilize the eggs. For ICSI, the lab will pick the best looking sperm and inject one into each egg when creating embryos. This eliminates the need for the sperm to swim well enough to make it to the egg. Your doctor can discuss if ICSI is a good fit for you based on your semen analysis results.
Sometimes, very few sperm (or even no sperm) are found in the sperm sample. This can be caused by previous physical trauma, structural or genetic abnormalities, or other malfunctions of the male reproductive tract. In these cases, your fertility specialist will likely refer you to a urologist for further evaluation and more in-depth testing. For certain conditions, there are medications or procedures that the doctor may recommend to help treat the cause of the low sperm count.
Male factor infertility is an often overlooked part of the fertility journey, but is just as critical to the process as the female portion. Knowing and understanding the semen analysis and what to expect before and after can help to demystify the role it plays throughout the course of treatment.
Chertoff, Jane. 2018. “Normal Sperm Count: Understanding Your Semen Analysis.” Healthline. August 29, 2018.
“Male Infertility: Causes & Treatment.” n.d. Cleveland Clinic.