Semen Analysis - Everything about male infertility | Pus cells in semen analysis

Semen Analysis: A Deep Dive into Male Fertility Testing

Are you wondering if a semen analysis is in your future? This article provides a comprehensive overview of this essential male fertility test.

Why is semen analysis important?

For couples struggling to conceive, a semen analysis is a crucial step in diagnosing potential causes of infertility. The male partner's sperm health significantly impacts the likelihood of pregnancy.

What is sperm?

Sperm are the male reproductive cells produced in the testes. They travel through the male reproductive tract and are ejaculated in semen during orgasm. A healthy sperm count and quality are essential for fertilization.

Semen Analysis: A Closer Look

  • The Gold Standard:Semen analysis is the primary method for evaluating male fertility.
  • Beyond Cost:A low price tag doesn't guarantee accuracy. Skilled technicians and proper lab analysis are essential for reliable results.
  • Why Accuracy Matters:Inaccurate results can lead to confusion and unnecessary worry for both partners.

Choosing a Reliable Testing Facility

  • Specialized Labs:Opt for an andrology lab specializing in sperm testing for the most accurate semen analysis.
  • Technician Expertise: The lab technician's skill significantly influences the interpretation of your results.

Semen Sample Collection

  • Fresh Sample Required:A fresh semen sample, collected within 30 minutes of ejaculation, is necessary for testing.
  • Abstinence Period: Sexual abstinence for 3–4 days is recommended before sample collection.
  • Collection Methods:Masturbation is the preferred method, but alternative options are available for men facing challenges.
  • Sample Storage and Transport:Maintain room temperature and ensure a clean collection container to avoid compromising the test's validity.
  • Lubrication Guidelines: Only liquid paraffin is recommended as a lubricant during masturbation for semen analysis.
  • In-Clinic Option: Many fertility centers offer private rooms for semen sample collection.

What Happens After Ejaculation?

The laboratory performs a battery of tests to evaluate various semen parameters, including:

  • Liquefaction:Normally, semen thickens after ejaculation and liquefies within 30 minutes, allowing sperm motility. Abnormal viscosity may indicate an infection.
  • pH Level:Semen has an alkaline pH due to seminal vesicle secretions, which neutralize vaginal acidity and protect sperm. An acidic pH suggests problems with seminal vesicle function.
  • Fructose Presence: The seminal vesicles produce fructose, a sugar that fuels sperm motility. The absence of fructose indicates a blockage in the male reproductive tract.

Microscopic Examination: A Closer Look

Microscopic examination is a vital part of semen analysis. Here's what the lab technician observes:

  • Sperm Count: The number of sperm per milliliter (ml) is assessed. The new WHO criteria consider a count greater than 15 million/mL normal. Values below 10 million/ml are considered low, and less than 5 million/ml is very low. A complete absence of sperm is termed azoospermia.
  • Sperm Motility:Motility refers to a sperm's ability to move. The WHO classifies sperm motility from grade a (fast progressive) to grade d (immotile). Poor motility suggests potential issues with fertilization.
  • Sperm Morphology:Normal sperm have an oval head, mid-piece, and tail. An abnormally high percentage of misshapen sperm (teratozoospermia) can affect fertilization.
  • Sperm Agglutination:Clumping of sperm can hinder their movement and fertilization potential.
  • White Blood Cells: A few white blood cells are normal, but a high count may indicate a seminal infection. It's crucial to distinguish white blood cells from sperm precursor cells, as some labs misinterpret them, leading to unnecessary antibiotic treatment.Read more about this scam at

View a sampleSEMEN ANALYSIS REPORT by clicking here

Putting the Pieces Together: The Big Picture

The analysis considers total sperm count, motility, and normal morphology to determine the number of "good" sperm in the ejaculate. This provides a more accurate indication of fertility potential.

Additional Considerations

  • CASA (Computer-assisted Semen Analysis):While seemingly objective, CASA's reliability can vary due to technical variations across labs.
  • Normal Semen Analysis:A normal report is reassuring and may not require repeating. However, it doesn't guarantee fertility (even motile sperm may not fertilize an egg). In Vitro Fertilization (IVF) is the ultimate test of sperm function.
  • Overtreating Based on Results: Sadly, some men with normal reports undergo unnecessary treatments for "abnormalities," such as a few white blood cells or a normal sperm count.

Understanding Azoospermia (No Sperm in Semen)

About 10% of infertile men have azoospermia. We can classify the causes into three categories:

  • Pre-testicular: The pituitary gland fails to produce enough gonadotropins, hormones that stimulate sperm production in the testes (e.g., hypogonadotropic hypogonadism).
  • Testicular:Testicular damage prevents sperm production (e.g., Klinefelter's syndrome).
  • Post-testicular:Sperm production is normal, but an obstruction blocks their passage (obstructive azoospermia).

Semen Analysis Follow-Ups

  • Recheck for Azoospermia:Azoospermia requires careful sample centrifugation to identify any sperm.
  • FSH Blood Level Test: This helps differentiate between obstructive and non-obstructive azoospermia. High FSH suggests testicular failure, while normal levels may necessitate a testicular biopsy.
  • Aspermia: inability to ejaculate at all. Psychological factors, or retrograde ejaculation (semen ejaculates backward into the bladder), are common causes.

Factors Affecting Test Results

  • Incorrect collection technique
  • Contaminated container
  • Long delay between collection and testing.
  • Recent illness

When should I repeat the test?

An abnormal test may need to be repeated 3–4 times over 3-6 months to confirm the abnormality. Remember, sperm counts can vary naturally. Repeating the test at another laboratory is also advisable.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.