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Fertility Health
getting a semen analysis

When a guy is told he needs to get a semen analysis done, this news can leave him with many questions. Why do I need to get a semen analysis in the first place? What is the semen analysis procedure? And what happens if my semen analysis results are not normal? In this article, we address many concerns that men typically have before getting their semen analysis done.

Why do I need to get a semen analysis done?

1 out of every 8 couples will have trouble conceiving.  One-third of the time, it turns out there’s a problem with the man.  One-third of the time there’s a problem with the woman.  And one-third of the time, there are problems with both the man AND the woman.

Keep in mind, a couple with “normal” fertility, having regular sex without birth control, has about a 1 in 5 chance of conceiving each month.  So, it isn’t unusual for it to take 6 months or longer to conceive naturally.

Most couples should try on their own for a full year before consulting a doctor.  However, if the woman is in her late thirties or beyond, it’s probably best not to wait a full year, and instead, speak to a doctor after 6 months of trying.

In most couples having trouble conceiving, the first conversation is usually with the woman’s gynecologist. The GYN will usually ask the woman some basic questions ( e.g. “Are you getting your period regularly?”) and will usually send the male partner to get a semen analysis.

What is the semen analysis procedure?

Most guys aren’t thrilled at the prospect of doing a semen analysis, which is obviously a little awkward. But compared to the testing that might be needed for the woman (which can get pretty complicated)  it’s a relatively simple place to start.

So – what is the semen analysis procedure? The doctor’s office will give you a referral. If you can, avoid doing the test at one of the big commercial labs like Quest or LabCorp. Simply put, those labs are fine for blood tests, but a semen analysis takes specialized skills, and the results we get from Quest and LabCorp just aren’t very reliable.

So it’s best to do the test at a local ‘fertility lab’, which will usually be part of a fertility practice.

You should abstain from ejaculation for 2-3 days prior to the test. And although most guys would prefer to produce the specimen in the privacy of their home, that’s not the best idea. It’s actually much better to schedule an appointment with the fertility lab and produce the specimen there.  That arrangement produces MUCH more reliable results.  Most fertility labs will have a dedicated, private room and have helpful materials on hand. Quest and LabCorp usually direct patients to the bathroom down the hall!

If you have a normal semen analysis on the first try – you’re pretty much done with your testing.  However, if there are any abnormalities found on that first test (more about that below), you will probably be asked to do a second semen analysis. You should wait at least a couple of weeks before doing the second specimen.

guide to fertility health

What is a normal semen analysis?

A normal semen analysis can look somewhat different for every guy. First – remember that “semen” is comprised of “seminal fluid” plus “sperm.”  The seminal fluid is the “carrier fluid” and makes up about 98% of the ejaculate by volume.  The sperm are those little swimmers that actually fertilize the egg, and they make up only 2% of the volume.

What gets checked when they do a semen analysis? Well, there are 3 important features that we focus on.

First, is the sperm count, meaning how many sperm were actually in the ejaculated specimen?  We want that to be at least 30 million.  To figure that out we have to look at the total volume of the ejaculate (in cc’s) and the number of sperm per cc – and the semen analysis results will give us both of those numbers.  So, let’s say the volume was 2 cc’s and there were 20 million sperm per cc.  That would be 40 million sperm…which would be normal!

Next, we look at motility, which means ‘movement’.  The lab tech looks at the specimen under a microscope and determines what percentage of the sperm are ‘motile’, e.g.  wiggling their tails.  We want that to be at least 40%.

Finally, we look at morphology, which means the ‘shape’ of the individual sperm.  A normal sperm has to be shaped “perfectly”, e.g. an oval head, a long tail, etc.   But, when the body is making so many millions of sperm every day, many of them will end up with an abnormal shape.  Believe it or not, if the other two parameters (count and motility) are OK, then all you need are 4% normally shaped sperm – and your fertility will be normal.  You can have up to 96% of the sperm have an abnormal shape, and you will still have normal fertility.  This part of the semen analysis – “sperm morphology” – requires very skilled lab techs to perform it, and is the part that the commercial labs don’t do well.

Sperm and Men's Fertility

What if my semen analysis results are abnormal?

What happens next if the semen analysis results aren’t perfect? Well, that depends.

First, keep in mind that if there are slight abnormalities in one or more of the parameters (count, motility and/or morphology), that doesn’t mean that natural conception is impossible.  It could simply mean that instead of a 20% chance each month, you only have a 15% chance…and so, it may just take a little longer to achieve a pregnancy.  So – definitely keep trying!

There are several things you can do to improve the health of your sperm. Aside from diet and lifestyle changes, certain nutritional supplements can help support normal male fertility.

But if there are significant abnormalities on the semen analysis results, you should schedule an appointment with a urologist who specializes in male fertility.  Not every urologist does – so here again, a recommendation from your wife’s GYN might be helpful.


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