7 common questions about the semen analysis
The importance of a semen analysis in the fertility workup
You may also be interested in reading about 6 lifestyle factors that impact male fertility.
Learn about sperm donation.
A semen analysis is a vital part of the fertility workup. As REIs, we recommend proceeding with one for all heterosexual couples that come to Markham Fertility Centre trying to conceive. Let’s dive into the importance of a semen analysis, what it means, why we need it, and what we are looking for in this test.
- What do you look for in a semen analysis?
- What is sperm morphology?
- Semen analysis standards
- An abnormal semen analysis
- Men and fertility: the importance of lifestyle
- The “cool thing” about sperm
- Supplements for abnormal sperm
What do you look for in a semen analysis?
The key elements of a semen analysis are:
- The volume of the semen
- The concentration of sperm. A sperm count of over 15 million sperm per milliliter is considered normal.
- The motility of sperm. Having 40% or more of the sperm moving is normal.
- The morphology of the sperm or the appearance of sperm
What is sperm morphology?
Sperm morphology basically describes the percentage of sperm that looks normal. Now this is really important: it is very normal to have lots of sperm that look abnormal! Depending on the scale or grading scheme used, it may be considered normal to have only 4% of all the sperm look normal.
The vast majority of sperm are going to have: defects of the neck, be bent, have two heads, broken tails, etc. A common question that comes up all the time is, “If I have abnormal morphology, does that mean that if my sperm fertilizes an egg, this baby is going to be abnormal as well?” And the answer is no. Sperm with abnormal morphology tend to not fertilize, ie. two-headed sperm tend not to fertilize an egg. So, if you are told that you have abnormal morphology, and then you do achieve a spontaneous pregnancy, which happens all the time, there is no need to worry about the health of the baby based on sperm morphology. Obviously, there are other factors like the age of the egg, and the health of the carrier of the baby but there is no need to worry that there will be issues with the baby.
Semen analysis standards
Markham Fertility Centre is a full-service clinic with an Andrology Department. There are other places where you can get semen analysis done, like Life Labs or Flow Labs but the testing of semen can vary a lot. Therefore, depending on where you go, clinics will have different standards or different “normal” values (although roughly similar). At the end of the report it may state: this is WHO 5th edition criteria for reference, etc. and so that’s why the numbers can vary a little bit based on where you’re getting the semen analysis done.
Overall, the biggest controversy is about morphology of the sperm and how to judge the appearance of the sperm. There are so many different criteria for looking at morphology of sperm which goes to show you that nobody really knows what’s the best way. For instance, the most strict criteria is called the Kruger strict criteria. You will only see 4% of sperm looking normal and that’s considered a normal semen analysis, but it’s actually not been shown to be very predictive of whether somebody will get pregnant or not. Other criteria, that are less strict, may say that 40% normal sperm is a normal semen analysis. It really depends on how you define “normal” and it varies a lot.
An abnormal semen analysis
It’s important to know that one semen analysis alone doesn’t tell you everything about whether or not you’ll be able to get pregnant or not. This is assuming that the semen analysis is slightly abnormal. Obviously, if you have a semen analysis that shows zero sperm or less than a million sperm, then that would be fairly predictive of fertility.
More commonly, we will see a semen analysis with maybe 12 million sperm and if the motility is 20 – 30% then that’s what would be considered an abnormal semen. And again, I always tell patients that one semen analysis does not predict your reproductive potential.
We always look at the big picture as well, like:
- How long has the couple been trying to conceive?
- The age of the female partner
- Any other related factors
We know that the semen analysis is highly variable. So even if you do absolutely nothing, you can come back a month to three months later and have completely different semen analysis report results. It could be worse. It could be better. It could be the same, but there’s a lot of variability in semen analysis results. This means that the sperm being produced at the time of intercourse could be very different from the semen analysis sample reported prior. And we’ll see this often, for instance, in men who do a semen analysis and then the couple might go into Intra uterine insemination IUI where you get a semen analysis each time an IUI is completed. So you might have four or five opportunities to look at the sperm. And you can really see the results go up and down quite a bit. It is also important to note that there’s rarely ever a specific thing that people can pinpoint and to say, “yes, this thing happened and therefore this is why my sperm looks that way”. For this reason, we rarely tell patients they MUST do In vitro fertilization (IVF) after one semen analysis. There are many factors and considerations that go into this decision!
Men and fertility: the importance of lifestyle
Read about 6 lifestyle factors that impact male fertility.
We talk a lot about lifestyle for women in fertility, but lifestyle is also really important for men.
Lifestyle factors include avoiding toxins like smoking, marijuana, vaping, cigars, and alcohol. We also know that elevated temperature of the scrotum, like when using hot tubs, saunas, and jacuzzis, can cause some abnormalities in sperm. Another big one that may not be so obvious but a lot of people will use in the wintertime is heated car seats(!) which are not great for the testicles and therefore not great for the sperm.
Exercise and maintaining a healthy BMI, and good nutrition are important to maximizing the quality of the sperm.
The “cool thing” about sperm
The really cool thing about sperm is that the testicle is constantly producing new sperm throughout a man’s life. If you make lifestyle changes you can see improvements in sperm parameters in three months! It takes on average approximately three months for men to have a whole new cohort of sperm. And the really interesting thing is that, when you see a man who quits smoking for example, three months later he can have a totally different semen analysis result.
Supplements for abnormal sperm
There are some supplements that men can take to improve the quality of abnormal sperm such as:
- Zinc
- Coenzyme Q10
- Selenium
- Packaged male fertility supplements from FloLabs Fertil Pro and Bird&Be
Although various prescription medicines have been studied to see if they improve sperm, the evidence is mixed. There is no specific medication made for improving sperm parameters.
FAQs
1. What does a semen analysis test measure?
A semen analysis evaluates several key factors including semen volume, sperm concentration, motility (movement), and morphology (shape). These parameters help assess male fertility and overall reproductive health.
2. What is considered a normal sperm count and motility?
A normal sperm count is typically over 15 million sperm per milliliter, while normal motility means at least 40% of sperm are moving. However, results may vary slightly depending on the laboratory standards used.
3. Does abnormal sperm morphology affect pregnancy or baby health?
Abnormal sperm morphology does not necessarily mean a baby will have health issues. Sperm with abnormal shapes are less likely to fertilize an egg, so if fertilization occurs, the risk is generally not increased due to morphology alone.
4. Can one abnormal semen analysis confirm infertility?
No, a single abnormal semen analysis does not confirm infertility. Results can vary significantly over time, and multiple tests along with other factors—such as partner age and overall health—are needed to assess fertility accurately.
5. Can lifestyle changes improve sperm quality?
Yes, lifestyle changes such as avoiding smoking, alcohol, and excessive heat exposure (like hot tubs or heated seats), along with maintaining a healthy diet and exercise routine, can improve sperm quality. Improvements may be seen within about three months.