Semen Analysis
The Fertility Center of California offers comprehensive semen analysis and testing in our laboratory:
Complete Semen Analysis-CSA
A CSA represents the most complete evaluation of ejaculated sperm. Typically 2 to 3 semen analyses are required to get a true baseline evaluation since sperm counts can vary significantly. Before testing, 2 to 5 days of abstinence is required.
Results of the semen analysis are a central component in male fertility testing. It is almost always the first fertility test ordered on a male and often times the only test needed. While it is useful, please note that the values of a normal semen analysis are only guidelines and are not a guarantee that significant male factor issues are not present.
The World Health Organization (WHO) has defined male infertility on the basis of concentration of sperm in semen. While concentration is useful, many other factors are measured and have clinical significance. Most male fertility specialists believe that the semen analysis is only a rudimentary test and that future testing will allow for much more in depth testing of sperm. A man is considered to be fertile by WHO criteria if he has at least 20 million sperm per ml. The average concentration of sperm for males in the U.S. was suggested to be 80 million per ml by at least one study in the U.S.
WHO Guidelines for a “normal” semen analysis
- Volume: 1.5 ml to 5.0 ml
- Concentration (number of sperm present per ml of the ejaculate): greater than 20 million/ml
- Motility (percentage of sperm moving): 50% or more
- Forward Progression (of the moving sperm the strength of their forward movement): 2+ or more
- Morphology (percentage of normally shaped sperm): 30% or more normal shapes (WHO criteria) or 14% or more (by Kruger strict criteria)
- Clumping: Minimal
- Presence of white or red blood cells: minimal
- No hyperviscosity (Thickening of seminal fluid)
- White blood cells less than 1x106/ml
Partial Semen Analysis-PSA
Typically utilized following vasectomy to verify complete absence of sperm and success of procedure.
Anti-Sperm Antibody Test-SpAb
Generally speaking, testing for antibodies on the surface of the sperm is the most clinically useful information while serum antibody testing is of less clinical value in the male patient. Causes of anti-sperm antibodies include injuries to the testicle, infection or surgical procedures, such as vasectomy.
Kruger Strict Sperm Morphology
This test looks at the sperm morphology or shape of the sperm (morphology – shape) in a much more in-depth and critical fashion than the routine WHO method. It’s believed to have clinical significance when deciding between IUI and IVF. It is important to recognize that an abnormally low number of ”normal sperm” is not associated with an increased rate of congenital malformations (birth defect).
This study is utilized when patients no longer ejaculate from the tip of their penis. In situations such as a spinal cord injury, using certain medications or following surgery, the ejaculate flows backwards (retrograde) into the bladder. Retrograde semen analysis involves harvesting the sperm from the bladder and then using sperm washing to prepare the sperm for artificial insemination (IUI) or IVF/ICSI.
A PEU is a diagnostic method for testing for retrograde ejaculation (when semen is ejaculated backwards) in order to determine the prevalence of sperm in a patient's urine after ejaculating. During this test a patient will ejaculate into a specimen cup and then provide a urine sample to evaluate for the presence of sperm. Catheterization is sometimes required if the patient is not able to completely empty his bladder.
A special stain is used to determine whether sperm is viable (alive) in the absence of sperm motility (movement).
When sperm is not seen in the ejaculate, the specimen is spun down in a centrifuge to look for the presence of even a few sperm. Any sperm found are potentially useful for IVF and can bring new hope for couples. Many labs do not offer this service, however high-speed centrifugation is performed on every specimen processed in our laboratory.
Sperm DNA Integrity Analysis (aka SCSA)
This test looks inside the sperm to see how well the DNA holds together after external forces are applied. If the DNA fragments easily, this is associated with recurrent miscarriages.
SPA tests whether a man’s sperm can penetrate a female egg. Penetration of the egg is required for fertilization to take place. This test is often ordered when low fertilization rates are encountered in IVF without other explanation.
