Updated: Oct 16, 2019
So your Dr has suggested a semen analysis...
Many guys will find this very confronting, but it's one of the most important steps in finding out why you haven't been able to conceive as quickly as you had hoped. There are two main ingredients to making a baby - Sperm and Eggs. Then, of course, they have to meet and fertilise and the resulting embryo needs to be able to grow and develop and implant etc etc etc.... but if you don't have the right ingredients, then spending more months 'trying' is kind of a waste of time.
1 in 20 men in Australia experience some sort of infertility. Male factor infertility affects approximately 50% of infertile couples and it's the biggest single factor affecting a couple's chance of conceiving, after a woman's age.
There is no easy and convenient way to ensure that there are eggs there, or to know EXACTLY when they're ready... we can make some fairly educated guesses (a topic for another blog), but we can never be entirely, convincingly, absolutely sure..
But with sperm it's much easier - a simple, non-invasive semen analysis can tell us quickly and easily, the volume of the ejaculate, how many sperm are present (concentration), how quickly they are swimming (motility), and if it's in a relatively straight line (progressive motility) and how 'normal' their shapes are (morphology).
We can't tell by looking at them if they're going to be able to fertilise an egg.... but we can see that they are there, and that there are 'enough'.
So what does a semen analysis analyse?
Firstly, the andrologist looks at the volume of the ejaculate - usually somewhere between 2 - 4mls. The WHO say that a normal sample is between 1.5 - 7.6mls (but I have seen up to 12mls!!!)
Next they take a small droplet of the ejaculate and assess it under the microscope using a special counting chamber.
Using a chamber like this one pictured (Makler chamber) scientists can count a number of different things.
An experienced andrologist (sperm scientist) can count 4 aspects of the sperm sample at once using a special counter by clicking on one of 4 buttons depending on what they see:
1. Rapid forward progression (progressive motility)
2. Forward progression (progressive motility)
3. Movement - but not forward progression
4. No movement
The WHO say that there should be more than 15 million sperm per ml in total. The total motility should be more than 40% (sum of 1,2 and 3 above) and the progressive motility (sum of 1 and 2 above) should be more than 32%
Finally, the scientist needs to assess the morphology or shape of the individual sperm.
This can be a confronting one as it is quite normal for MOST of the sperm to be abnormally shaped - a result of 90% abnormal forms is not unusual
Once the scientist has assessed all of these parameters (volume, concentration, motility and morphology) they can then calculate the total amount of sperm in the ejaculate that are likely to be able to fertilise an egg (normally shaped and with forward progression).
Anti-sperm antibodies is another parameter that is worth having tested. Semen is an Antigenic compound - which means that it can promote an immune response.... especially in the man who made it. There is a naturally occurring barrier between the testes and the rest of the body so the mans blood stream never actually comes into contact with the sperm, but if he should have any kind of damage to the testes, he can damage that barrier and then his body can form anti-sperm antibodies. Then, when the sperm are joined with the rest of the contents of the semen, the man's body recognises it as antigenic and tries to attack it by sending out loads of antibodies which cause the sperm to all coagulate or stick together. This makes it virtually impossible for them to swim and/or fertilise an egg.
(Sperm actually only make up about 5% of the entire ejaculate - the rest is seminal fluid that comes from other glands along the way).
Anti-sperm antibody test is performed on the semen sample at the same time as a routine semen analysis.
A semen analysis can be done at 2 different kinds of labs - either a pathology lab or an andrology lab. Andrology labs specialise in analysing sperm - it's all they do, so you are much better off having this test done at an andrology lab if you are able.
The results of a semen analysis can vary greatly depending on how the sample was collected and how soon after ejaculation it was assessed. Some lubricants can affect results.
Andrology labs will require you to make an appointment just to make sure that they have a scientist ready to assess the sample within the appropriate time frame to ensure accurate results. Temperature and time will also have a detrimental affect, so producing the sample on-site, or making sure that it is delivered to the lab at the pre-arranged time is really important.
Volume, Concentration and Motility can all be assessed by a computer in some labs, but the morphology assessment is done by a scientist looking down a microscope and documenting what they see - so if you want the most accurate result, you are much better off having this done by an experienced sperm scientist.
At the end of this blog I have included some links to semen analysis request forms for the andrology labs in Melbourne: (in no particular order - please choose the one closest to you and ask your GP to complete the form for you)
The results of the semen analysis can be confronting - but the reality is that you only need some sperm to fertilise one egg in order to make a baby. In couples where the semen parameters are particularly 'bad' (low concentration, low motility, high abnormal forms), couples can still conceive naturally, but the woman's age also needs to be taken into account. If she is still young, the preference might be to continue trying naturally for a bit longer and hope you hit the jackpot, but if she is over 35 or if the couple want to have more than one child, then they may be moved more quickly to ART (assisted reproductive technology)
Semen parameters can be heavily influenced by the man's health - a bout of flu or a high temperature can completely wipe out sperm production and it can take up to 3 months before sperm are seen again in the ejaculate. There are also a number of supplements and some lifestyle changes that have been proven to impact sperm quality - if you have had a semen analysis and would like to talk through the results and have some guidance making decisions for next steps - please get in touch!
Melbourne IVF: clinics in Mt Waverley, East Melbourne, Box Hill and Werribee
you can read more about their male fertility testing here: https://www.mivf.com.au/fertility-treatment/male-infertility-tests
Monash IVF: Clinics in Richmond and Clayton, but appear to be using Australian Clinical Labs for semen analyses
(I have tried to call them a number of times to get details for their request forms, but so far not been able to get through to anyone who can help me).
You can read more about their male fertility testing here:
Andrology Lab - Women's and Children's hospital: Carlton