Callie Barnwell, Andrologist/Jr. Embryologist @ Carolina Conceptions

A semen analysis is an integral part of fertility testing. Many men report feeling embarrassed or awkward about submitting a sample to the lab for a semen analysis, but keep in mind that it is just a normal day at work for our lab staff!

Preparing for your semen analysis appointment

Call our office to schedule your semen analysis appointment on any weekday from 7:30-11:30am or 1-3pm.. Remember to bring a referral for the semen analysis from either your doctor or your partner’s doctor on appointment day.

Most men produce new sperm each day, however, it takes about 2.5-3 months for sperm to mature. During this time, factors such as exposure to extreme temperatures, toxins, diet, illness, fever, drug use, or certain medications may impact your semen quality.

For best results, you should abstain from ejaculation for at least 2 days but no more than 3 days prior to your appointment. A shorter abstinence period can result in a low semen volume and reduced sperm count. However, a longer abstinence period can result in a low motility score, as sperm begin to die after being stored in the reproductive tract for too long.

The best sample is collected by masturbation without the use of lubrication. In-office collection is the preferred method. Alternatively, you may choose to collect your sample at home. We have take-home collection kits available at our front desk that you can pick up at your convenience. The take-home kits contain instructions, a specimen cup, semen analysis questionnaire, and consent forms for you to fill out. Please make sure to label your specimen cup with your name, date of birth, and time of collection. Specimens should be kept at room or body temperature and should arrive at our office within an hour of collection time.

It is very important to collect the entire ejaculate in the provided sterile collection cup. The majority of the sperm are found in the beginning portion of the ejaculate. This is another reason that collection by masturbation is preferred. Collection through coitus interruptus could compromise the results as the first (sperm-rich) portion of the ejaculate is often missed. If you experience technical issues, there is a place on the semen analysis questionnaire to indicate what portion of the ejaculate was lost. If you have had a vasectomy or vasectomy reversal, this should also be noted for your andrologist.

What characteristics are we measuring in a semen analysis?

The semen analysis will include a report of the physical characteristics of semen (including color and viscosity), semen volume, sperm concentration, total sperm count, and sperm motility and progression. Sperm morphology may also be examined. Our lab uses guidelines and normal ranges set by The World Health Organization.

After dropping off the specimen with the andrologist, your sample will be placed in a 37C incubator to allow liquefaction. The andrologist will begin by measuring the volume of the semen sample. A normal semen volume is 1.5 milliliter or greater. While volume can be affected by factors such as frequency of ejaculation, collection problems, age, and certain medical conditions, a consistently low volume could be due to low testosterone levels or a blockage in the reproductive tract. Viscosity and color are also evaluated at this time. A normal sample is homogenous in appearance and should be a white to grey color.

Next, the andrologist will use a small aliquot of your sample to observe your swimmers under a microscope using a specialized cell counter called a Makler chamber. The andrologist will look for agglutination, which is when motile sperm stick to each other. If agglutination is present, your semen analysis will indicate the relative size and number of clumps. The concentration of round cells will also be indicated on the semen analysis report. Round cells are either white blood cells or immature germ cells.

Sperm concentration is the number of spermatozoa (sperm cells) per unit volume of semen (reported as millions per milliliter). Normally, sperm concentration is at 15 million/ml or above. Total sperm count indicates the total number of spermatozoa in your entire ejaculate. This value is calculated by multiplying your sperm concentration by your semen volume. A normal sample will have a total sperm count of 39 million or greater.

Sperm motility is a measure of how many sperm cells are moving versus not moving. A normal sample will have a motility of 40% or greater. The semen analysis report will also indicate the level of rapid progressive motility. Ideally sperm should be moving in a rapid, forward, and roughly linear fashion. Reporting rapid progressive motility is important for distinguishing between normal-moving sperm and those that are simply twitching in place or moving erratically.

If one of your values falls outside of the normal range, your overall semen analysis evaluation may be marked as subnormal. If two or more values fall outside the normal range, your overall evaluation may be reported as abnormal.

For abnormal results, we recommend repeating the semen analysis in two to three weeks. It is normal to have variation in your semen analysis results over time.

Sperm morphology

In addition to the semen analysis, we may assess sperm morphology if the sperm concentration is sufficient. Morphology refers to the shape of the spermatozoa. Normal sperm have a symmetric, oval head and a long tail.

The andrologist will assess morphology by smearing an aliquot of your sample on a slide. Once the smear has dried, the slide is fixed and stained and left to air dry. The slide is then examined under a microscope, and the andrologist will calculate the percentage of normally versus abnormally shaped sperm.

Here at Carolina Conceptions we use the strict Krueger morphology criteria which scores sperm with minor irregularities as abnormal. Under these guidelines, a score of 4% normal or less is considered an abnormal result. The morphology report may also indicate the primary head or tail defect present in the sample. In general, abnormally shaped sperm have lower fertilizing potential. For IVF patients, if your morphology score is ≤4%, your doctor may recommend using a procedure called ICSI (intracytoplasmic sperm injection).