Men and women are about equally likely to suffer from infertility (1). Therefore, it is crucial that male fertility is investigated proactively, especially as getting a test is quick, non-invasive and it can reveal undiagnosed health issues with the help of your doctor.
Semen analysis is an important part of male infertility diagnosis, which also involves considering your medical history and can require a physical examination.
When is it particularly important to get tested?
Couples who have an immediate pregnancy plan, should think about ensuring they know the status of their reproductive health before trying to have a baby. If you are in this category, it is recommended to consult with your reproductive health specialist or a GP. It especially important to get tested after a year of actively trying to naturally conceive, that is, if you do not need to seek assisted conception immediately if you are a same sex couple.
In some specific cases, you will need to request a semen analysis, for instance if you suffer or have suffered from:
- Mumps as a child
- Surgery for non-migrated / undescended testicles
- Testicular torsion
- Erection or ejaculation difficulties
- Surgery in the scrotum, for example due to scrotal hernia
- Infection of the scrotum or prostate
- If you have taken certain long term prescribed medication or you participate in recreational drug use
However, semen analysis is not limited to men who want to have a baby in the short term, and you can learn more from a semen analysis than fertility indicators.
There are several reasons that can encourage a person with sperm to get tested at any time:
- Wanting to get ahead potential future fertility issues: global sperm count has been declining by more than 1% a year since the 1970s (2) and infertility is affecting 48.5 million couples worldwide (3).
- Wanting to know more about your general health: even if you do not plan to have a baby, you can have a semen analysis. Male reproductive health assessment can contribute to early detection of potential chronic illness, disease and cancer (4) and there is evidence that reduced semen quality is related to shorter life expectancy (5,6,7).
Male fertility examination is a quick and straightforward process, another reason to get tested proactively and regularly.
Do I know if I have any sperm or not?
In the majority of cases, symptoms of infertility are not obvious and tests are necessary to find out if a patient has sperm or not.
More than 90% of semen is made up of accessory glands secretions, which dilute the sperm. That’s why a change in the sperm quantity is not noticeable in the amount of semen ejaculated, even though there are no or few sperm present, like after a vasectomy for instance.
Most of the male patients diagnosed with infertility declare no difficulties with intercourse, erections and ejaculation. The quantity and appearance of the ejaculated semen generally appears normal to the naked eye.
That’s why getting an assessment proactively is so important.
Which factors should a good sperm analysis test?
A semen analysis should test:
- Volume of semen
- Quantity of sperm (concentration and/or total number of spermatozoa)
- Motility: how efficiently and how fast sperm move
- Morphology: what they look like
A good semen analysis is not a direct test of fertility. It provides guidance to the chance of having a baby and can be a starting point of further investigation; achieving a pregnancy remains possible even in those with severe deficits.
If abnormalities are detected by the test, a good facility would suggest to look further, more laboratory or simple blood tests, and a physical examination may be needed to help in diagnosing the problem.
Testing should be done by a specialised laboratory that uses methods recommended by the World Health Organisation (WHO).
Should I always test my sperm twice?
Sperm quality is impacted by our lifestyle, general and mental health, and environment. It is not constant. That’s why evaluation of a single semen sample is not sufficient to characterise a man’s semen quality, let alone his fertility!
If you are taking a test to know more about your health, even if your first semen analysis results are not abnormal, then in practice, you may not be required to take a second test for the moment.
However, if infertility or low reproductive health is suspected, a minimum of two semen analyses, at least six weeks apart, will be required to properly assess the semen quality. Sperm production can be variable in the majority of men; therefore, it is essential that picture of sperm production is created.
How long before a sperm test can/should I ejaculate?
Studies have shown that repeat and frequent ejaculation leads to the release of competent sperm that have not been retained stored in the testes for too long.
To ensure the semen analysis results can be assessed against existing data and reports relating sperm function or pregnancy, the semen sample should be collected after a minimum of 2 days and a maximum of 7 days of sexual abstinence. This ensures that advice can be given on chances of pregnancy, further testing/investigation or type of assisted conception, if that is needed.
If repeat analyses are required, the number of days since last ejaculation should be as constant as possible at each visit.
- Fertility and infertility: Definition and epidemiology, Elodie Vander Borght, Christine Wyns. 2018
- Temporal trends in sperm count: a systematic review and meta-regression analysis, H Levine et al. 2017
- National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys, Maya N. Mascarenhas et al. 2012
- Male fertility: a window on the health of this generation and the next, Barratt, C.L., Anderson, R.A. and De Jonge, C. 2019
- Semen quality, infertility and mortality in the USA, Eisenberg M.L. et al. 2014
- Relationship between semen production and medical comorbidity, Eisenberg M.L. 2015
- Semen Quality as a Predictor of Subsequent Morbidity: A Danish Cohort Study of 4,712 Men With Long-Term Follow-up, Latif T. et al. 2017