What you need to know about Semen Analysis

Liza and her friends were hanging out in a coffee shop, studying for next week’s major exams. Just when she was about to take a sip from her cup of coffee, she overheard the couple sitting next to their table talking. She was trying so hard not to listen, but their voices did not make it easier for her. They were talking about wanting to have baby. Based on what she heard, they’ve been trying for long but still, no baby.

“The doctor said I need to undergo semen analysis,” the man says and Liza’s interest increased at the mention of the test which is familiar yet vague to her. She has read about that once in her nursing books, but she didn’t really pay attention to it. Now, she wished she did. The couple continued talking about it, whether the man really had to participate in it while Liza ransacks her mind on what little she knew about the procedure. What’s it for again? And how is it done?

Semen Analysis: An Overview

Also known as a sperm count test, semen analysis is a procedure which analyzes the health and viability of a man’s sperm. Semen is the fluid containing sperm as well as other sugar and protein substances that’s released during male ejaculation. Basically, it measures how much semen a man produces as well as shows the number and quality of sperm in the semen sample. Specifically, this test measures three major factors of sperm health:

  • the number of sperm;
  • the shape of the sperm; and
  • the movement of the spermor “sperm motility.”

Doctors usually conduct two or three separate sperm analyses to get a good idea of sperm’s health. The American Association for Clinical Chemistry (AACC) states that the tests should be conducted at least seven days apart and over the course of two to three months.

It should also be noted that sperm counts can vary on a daily basis and taking an average of the sperm samples can give the most definite result.

Why it is done

This test is usually one of the first tests done to help find out if a man has a problem fathering a child or in other terms, infertility, since a problem with the semen or sperm affects more than one-third of couples who are infertile.

This procedure is typically done to find out if:

  • A man has a reproductive problem that is causing him to be infertile (to help determine if low sperm count or sperm dysfunction is the reason behind infertility).
  • A vasectomy has been successful (to make sure no sperm are in their semen).
  • The reversal of a vasectomy has been successful.

Other tests that may be done during sperm count

Tests that may be done during a semen analysis include:

  • Volume, which is a measure of how much semen is present in one ejaculation.
  • Liquefaction time. Semen is a thick gel at the time of ejaculation. It normally becomes liquid within 20 minutes after ejaculation. Liquefaction time is the time it takes for the semen to turn to liquid.
  • Sperm count, which counts the number of sperm present per milliliter (mL) of semen in one ejaculation.
  • Sperm morphology,which is a measure of the percentage of sperm that have a normal shape.
  • Sperm motility, which is a measure of the percentage of sperm that can move forward normally. The number of sperm that show normal forward movement in a certain amount of semen can also be measured. This is called motile density.
  • pH which is a measure of the acidity (low pH) or alkalinity (high pH) of the semen.
  • White blood cell count. White blood cells are not normally present in semen.
  • Fructose level, which is a measure of the amount of a sugar called fructose, which provides energy for the sperm, in the semen.

Preparation for the procedure:

To get the best sample, the patient should be advised to:

  • avoid ejaculation for 24 to 72 hours before the test
  • avoid alcohol, caffeine, and drugs such as cocaine and marijuana two to five days before the test
  • stop taking any herbal medications, such as St. John’s wort and Echinacea
  • avoid any hormone medications

How the procedure is done

SemenAnalysis_forwebThe patient will need to produce a semen sample, which is usually done by ejaculating into a clean sample cup. He can do this in a private room or in a bathroom at the doctor’s office or clinic. For patients who live close to the doctor’s office or clinic, they may be able to collect the semen sample at home then take it to the office or clinic for testing.

The four main ways to collect a semen sample are:

  • masturbation (considered the preferred way to get a clean sample)
  • sex with a condom
  • sex with withdrawal before ejaculation
  • ejaculation stimulated by electricity

To get a good testing sample, the semen must be kept at body temperature since if it gets too warm or too cold, the results will be inaccurate. Additionally, the semen must be delivered to the testing facility within 30 to 60 minutes of leaving the body.

A laboratory specialist then looks at the sample within 2 hours of the collection. The earlier the sample is analyzed, the more reliable the results. The following things will be evaluated:

  • How the semen thickens into a solid and turns to liquid
  • Fluid thickness, acidity, and sugar content
  • Resistance to flow (viscosity)
  • Movement of the sperm (motility)
  • Number and structure of the sperm
  • Volume of semen

Results

Results of a semen analysis are usually available within a day. Normal values may vary from lab to lab.Some laboratories use different measurements or may test different specimens.

Movement

For a normal result, more than 50 percent of sperm must move normally an hour after ejaculation. Sperm movement, or motility, is important to fertility because sperm must travel to fertilize an egg. An automated system analyzes the sperm for movement and rates them on a scale of 0 to 4. A score of 0 means the sperm are not moving, and a score of 3 or 4 represents good movement.

pH

A pH level should be between 7.2 and 7.8 to achieve a normal result. A pH level higher than 8.0 could indicate the donor has an infection. A result less than 7.0 could indicate the specimen is contaminated or that the man’s ejaculatory ducts are blocked.

Volume

The volume of sperm for a normal result should be greater than 2 millimeters. A low sperm volume could indicate a low amount of sperm to fertilize an egg. An excess fluid volume could also mean the amount of sperm present is diluted.

Liquefaction

It should take 15 to 30 minutes before semen liquefies. While semen is initially thick, its ability to liquefy, or turn to a watery consistency, helps sperm to move. If semen does not liquefy in 15 to 30 minutes, fertility could be affected.

Sperm Count

The sperm count in a normal semen analysis should be between 20 million to over 200 million. This result is also known as sperm density. If this number is low, conceiving can be more difficult.

Appearance

The appearance should be whitish to gray and opalescent. Semen that has a red-brown tint could indicate the presence of blood while a yellow tint could indicate jaundice or be a medication side effect.

Abnormal results

It is not completely clear how these values and other results from a semen analysis should be interpreted, but an abnormal result does not always mean there is a problem with a man’s ability to have children.

Abnormal results could indicate the following:

  • infertility
  • infection
  • hormonal imbalance
  • disease, such as diabetes
  • gene defects
  • exposure to radiation

If the results come back at abnormal levels, the doctor will probably suggest that the patient take additional tests. These tests include:

  • genetic tests
  • hormone testing
  • urinalysis after ejaculation
  • taking a tissue sample from your testicles
  • anti-sperm immune cells testing

Sources:

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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