As part of your annual checkup, you may often undergo blood tests and scans from time to time. Similarly, when you plan to undergo any fertility treatment, the most basic test often suggested by your clinician is semen analysis. It is a simple test for the male partner, wherein the semen sample is produced by ejaculation into a sterile container. Producing the sample is the easy part, however the confusion begins later when you are handed a very ‘scientific’ looking report. We have been asked many times to explain the semen analysis report and hence, we will try and solve most of your doubts regarding how to read a semen analysis report.
Some of the aspects, we will be covering in this article
Sample Semen analysis reports
Let’s begin with Abstinence – this is the gap between your last semen output either via ejaculation or intercourse. WHO recommends having an abstinence of 2-5 days before producing a sample for fertility treatment. Shorter or longer abstinence can cause variance in your semen parameters. If your abstinence is too long, it would be a good idea to dispose one semen sample via masturbation and then arriving at the clinic for your test between 2-5 days. (After abstinence)
What we look for, in any semen sample given for analysis:
Most laboratory offering fertility treatment will follow the WHO reference range for analyzing your semen sample. There are four critical parameters which will allow the clinic to take a decision regarding the course of your fertility treatment. Looking at the values the clinician may advise you to go for IUI, Conventional IVF or ICSI.
These parameters are:
WHO guidelines (2010)
|Sperm concentration||>15 million/ml|
|Total sperm count||>39 million|
|Sperm motility (A+B)||>32%|
Volume: The amount of semen per ejaculate is measured in mL and is referred as Semen Volume. WHO takes 1.5 mL as the lower reference range for volume. Anything above 1.5mL is considered Normal. Volume also gives an indication of total sperms present in the entire ejaculate.
Concentration: The count of sperm (in million) present per mL is referred as Concentration. According to WHO the lower reference range of concentration is 15milllion/mL, anything above 15million per mL is considered Normal. It is not necessary that your semen sample will always have this count and it could be either higher or lower. However, concentration is a good indicator of type of treatment to be offered, along with knowledge of motility of the sample.
Total concentration/Ejaculate: This is a term used for the total number of sperms present in the ejaculate. Total concentration in Ejaculate = Volume * Number of sperms per mL
Sperms when observed under the microscope are constantly on the move, this is referred to as the Motility. The speed or motility of the sperm, in natural conception plays a vital role in reaching the egg and thus is a vital parameter to check during semen analysis when seeking fertility treatment. As per WHO, this motility is classified in 3 categories; 1) A+B or Fast moving, 2) C or twitching and 3) D or non-motile/stationary.
According to the guidelines, A+B motility sperms should be at least 32% of the sample to be considered as normal.
Your sample may not always be above 32% and that is alright, based on this parameter along with count and morphology your embryologist and clinician will devise a treatment plan for you.
Morphology:This is one of the most important, but very often ignored parameter. The appearance of the sperm is known as Morphology. Each sperm has a head, mid piece and tail. Based on their appearance the sperms are checked for deformities in head, mid piece and tail. 100 sperms are checked and analyzed for defects and a percentage is recorded. According to WHO 4% is normal that is if 4 sperms are normal (Have no defect) in 100 sperms you have normal morphology. Surprisingly if morphology is done well, finding 4 normal sperms in 100 sperms (i.e 4%) is not a common occurrence. So, do not stress if your sperm morphology is below 4%, there are techniques and ways to work around it.
Apart from these parameters, the IVF clinic will assess the viscosity and pH of your sample. Viscosity, is nothing but the consistency of the sample. As per protocol, each semen sample after collection is left untouched at room temperature for 20 minutes allowing it to liquefy. Usually, the sample liquefies in 20 minutes and can then be used for analysis. The time taken for the sample to liquefy may vary and is referred to as the liquefaction time. Samples taking longer than 20 minutes to liquefy are termed as viscous samples. Extreme Viscosity in sample could imply presence of any underlying infection. Infection is further confirmed by the presence of puss cells in the sample. Your clinican may prescribe antibiotics to treat the infection.
Semen is alkaline in nature and it is important to check the PH of the sample. pH alteration is a rare phenomenon, but an acidic pH indicates blockage of seminal vesicles, while an extremely high basic pH might indicate presence of infection.
After being armed with the basic principle behind semen analysis, you are now ready to take on more scientific nomenclature. The nomenclature is made based on the WHO guidelines and it takes alterations in different parameters like count, motility, morphology into account.
|Less than 15 million/ml sperms||Oligozoospermia|
|A+B motility less than 32%||Asthenozoospermia|
|Less than 4% morphology||Teratozoospermia|
|No sperms seen in sample||Azoospermia|
|Count above 15 million, motility above 32%, volume above 1.5 mL and morphology above 4%|
If you find any of the above or combination of terms mentioned in the report then you know which parameter of your semen sample is below the normal parameter.
Example: The diagnosis in your report is OligoAsthenozoospermia this indicates low sperm count and motility. Similarly, Oligoasthenoteratozoospermia or OAT will be a sample with low count, motility and poor morphology.
Let us consider 2 semen analysis reports, as examples:
In this report, the volume is more than 1.5 ml, A+B motility is above 32, concentration is more than 15million sperms/ ml and the morphology is 4%. All these parameters pass the normal sperm parameters and hence, the diagnosis for this is report is Normozoospermia.
Also, reference value as per WHO is mentioned next to the test value in each category.
Now, let us look at example 2:
Here, parameters for volume, motility and concentration all pass the normal range. However, morphology is just 1% which indicates that the sample has poor morphology and this could be one of the factors for not conceiving naturally. The diagnosis is given as Teratozoospermia. Since, the morphology is poor this sample is ideal for ICSI – Intra cytoplasmic sperm injection wherein a good morphology sperm can be selected manually and injected in the egg.
Semen analysis report is one of the most crucial test in your fertility treatment. However, the course of treatment cannot be given without assessing the female counterpart and other blood reports. Discuss your report with your embryologist and clinician to work out a customized treatment plan, for you.
We hope this simple explanation of your report was helpful. Please comment with any other values, if indicated in your report and we would be happy to solve your doubts.
Frequently Asked questions (FAQ)
If I am unable to produce the sample at the clinic, can I collect the sample from home or a nearby hotel?
Yes, you may bring the sample from home if 1) you collect the sample in the sterile container provided by the clinic 2) you reach the clinic in 30-40 minutes post collection. Also, your clinic may require you to sign a form of consent declaring that the sample bought from home is your own.
Can I collect the sample in the sterile container provided by the pathology lab?
Containers provided by the pathology lab are sterile BUT meant for urine collection so it may be difficult for you to collect semen in them. Containers provided by fertility clinics are specifically designed for semen collection.
Do I need to come fasting for semen analysis, semen freezing, or semen wash?
Absolutely not, please follow your normal routine. In fact, have a good breakfast or lunch to maintain your energy levels.
Why are there variations between my semen analysis reports done at a pathology lab and a fertility lab?
Most pathology labs use glass slides to check the semen count. Fertility clinics use a special counting chamber called the Makler or Neubers chamber, specifically meant for checking the sperm count and motility, and it is therefore more accurate.
Can I collect my semen in a condom?
Commercial condoms have lubricants which are spermicidal. Therefore, it is not advisable to use them. There are special condoms available for the collection of semen samples and can be procured on request.
What should I do if I spill the sample?
Please inform the andrologist immediately. Do not collect the sample and put it in the container. The idea is to use sterile sample for your procedure to avoid infection.
How do you prevent samples from getting mixed up at the lab?
Each container is well-labelled and as a practice only one sample is handled at a time.
What do you do with the left-over sample after analysis?
The samples are discarded as per protocol.
How should the sample be collected?
The sample should ideally be collected by masturbation. If you suffer from penile erectile dysfunction or any other related problems, please inform the consultant.
Does medication, smoking, and alcohol affect the semen parameters?
Yes, they do influence the semen parameters. However, it is also something that varies between individuals, and a semen analysis is required to assess the severity in a case.
I did a semen analysis last month and repeated another analysis this month at the same clinic. There is a variation in my result. Is this normal?
It is normal to see a slight variation between tests.
Is there a report for semen analysis or freezing that should be given to us?
Reports are made for all ART procedures and as patients, please ask your clinic for written reports of the same.
Do I need to have a full bladder while collecting the sample?
There are no restrictions on the bladder.
I took 40 minutes to collect the sample. Will that impact the count?
The time you take to collect the sample is irrelevant; the time is noted at the collection of the sample.
Can I be asked to produce another sample on the same day?
It is uncommon, but you may be asked to collect an additional sample if the andrologist feels that:
- The count is inadequate in comparison to your previous tests.
- You have spilled the sample.
If my sample has a good count of sperms but the sperms have no motility, does it mean they are all dead?
Immotile does not necessary mean dead. Sperms can have no motility but they may still be viable to induce pregnancy. There are tests available to determine the difference.
My semen analysis report mentions high debris and pus cells. What does this mean?
Both these conditions are temporary and are most often a sign of underlying infection. Discuss with your clinician they will most likely start you on a round of Antibiotics.