Fertility and sterility is one of the most difficult subjects to broach with men. It is simply personal. There is no other way of expressing this. For a couple trying to conceive, men are sometimes reluctant participants.
At Neo Fertility, we do our best to take care of men with the sensitivity they deserve.
Asking for a semen analysis from a man is one of the challenging interactions between the doctor and the couple.
At this moment, we would like to raise awareness on male infertility, specifically relating to performing and interpreting a semen analysis.
We would like to shed light on the different meanings of the findings after a semen analysis. Further, we would like share information on lifestyle choices that can affect male fertility.
MALE INFERTILITY
The male is solely responsible in about 20% of cases and a contributing factor in another 30% to 40% of all infertility cases.
Overall, the male factor substantially contributes to about 50% of all cases of infertility.
The initial evaluation includes a detailed sexual history and physical examination, then 2 separate semen analyses, separated by at least 4 to 6 weeks. Abstinence for at least three days is recommended before providing a sample, ideally collected at the laboratory or, if collected at home, kept at room temperature and delivered to the lab within an hour.
The semen is evaluated for volume, pH, leukocytes, and liquefaction.
The sperm is assessed for count, concentration, vitality, motility, progression, and morphology.
The purpose of evaluating the male suffering from infertility is:
- To determine the male factor contributing to the couple’s infertility.
- To identify the percentage of cases (about 20%) that can be normalized with treatment
- To determine if assisted reproductive technology (ART) is required.
- To identify the underlying pathology or associated medical comorbidities
- To determine if there are age, health, lifestyle, or genetic factors that could affect the outcome or success rate if ART is required
Either the W.H.O criteria (2010) for scoring sperm morphology or the Kruger–Tygerberg criteria should be used.
Below is a sample of a report. There may be variations between different
laboratories.
SEMEN ANALYSIS REPORT
Date:
File Number:
Partner 1:
ID:
D.O.B:
Collection Date:
Collection Method:
Partner 2:
ID:
D.O.B:
Collection Place:
Surgical Method:
SEMEN PARAMETERS | PATIENT’S RESULTS | NORMAL RANGES |
Abstinence (days) | 2-3days | |
Time of analysis (min post | <60min post production | |
Appearance | Translucent/Opaque | |
Coagulation (min) | <60min at 37°C/Complete | |
Liquefaction (min) | 20-30min at 37°C | |
Viscosity (min) | <50mm | |
Colour | Whitish-Grey | |
pH | >7.2 | |
Sperm volume (ml) | 1.5 – 5ml |
SEMEN PARAMETERS | PATIENT’S RESULTS | NORMAL RANGES |
Sperm agglutination | 0 agglutination/hpf | |
MAR | Negative (0%) | |
Non sperm cellular | <5/hpf | |
Semen culture | Negative | |
Sperm concentration | >15.0 x 10^6 /ml | |
Sperm motility (%) | >40% | |
Sperm viability (%) | >58% | |
Forward progression (SFP) | 2 – 2+ | |
Morphology (%N) | >4% |
- Normospermia: All semen parameters within the acceptable reference limits.
- Aspermia: No ejaculate at all.
- Azoospermia: No spermatozoa in the ejaculate
- Oligozoospermia: Sperm concentration <15 million/mL;
- Asthenozoospermia: <32% progressively motile spermatozoa.
- Teratozoospermia: <4% morphologically normal spermatozoa, therefore abnormal
- Oligo–Astheno–Teratozoospermia: Disturbance of all 3 parameters, also known as OAT Syndrome.
- Cryptozoospermia: Spermatozoa absent from fresh preparation but observed in a centrifuged pellet.
- Leukospermia: >1 million white blood cells/mL ejaculate
- Necrozoospermia: Complete when all the sperm are dead on a fresh semen sample; incomplete if 5%–45% are still viable.
OTHER TESTS
- Antisperm Antibodies (ASA):
These antibodies can form in men after testicular surgery or vasectomy, in prostatitis
- DNA Integrity Test:
Assesses the degree of sperm DNA fragmentation.
These tests should be done in those with:
- recurrent miscarriages.
- unexplained infertility >24months of trying to conceive.
RECREATIONAL DRUGS CAN AFFECT FERTILITY
ALCOHOL causes the following changes:
Decreases testosterone production
Increases the rate at which testosterone is cleared by your liver.
Increases the male oestrogen levels
ANABOLIC STEROIDS
MARIJUANA/CANNABIS
The active ingredient in cannabis is tetrahydrocannabinol (THC) decreases sperm production, reduces sperm motility and weaken s sexual drive. It interferes with testosterone production.
TOBACCO
Smoking has a negative effect on your sperm DNA by fragmenting DNA stands, reduce sperm production and reduce sperm motility.
METHAMPHETAMINE
Methamphetamines reduce sperm motility
OBESITY AND SPERM PARAMETERS
Men with obesity, a body mass index (BMI) >30kg/m2 are at an increased risk of oligospermia or azoospermia.
Obesity also affects semen quality, causes difficulty with natural conception and poor ART outcomes.
Weight loss reverses these changes, improving the overall reproductive profile.
SOME MEDICINES CAN AFFECT YOUR FERTILITY
Antidepressants, commonly Selective Serotonin, Reuptake Inhibitors (SSRI’s)
Chemotherapy, the duration of your treatment, and type of chemotherapy. In some instances fertility may return within 2 years.
Opioids, are narcotics used to reduce pain, but some are illegal drugs that lead to addiction.
Testosterone supplements to increase libido, usually given in Men’s Clinics to treat low libido and erectile dysfunction.
Ketoconazole, an anti–fungal medication, reduces testosterone production, thereby reducing sperm production.
5–alpha reductase medication to treat hair loss (alopecia) and benign prostatic hyperplasia (Propecia, Finasteride), they reduce libido and sperm production.
Flomax, Uromax. These cause decrease volume of ejaculation, in some cases , they
may inhibit ejaculation.
Anti–epilepsy medication, such as Carbamazepine, Valproate
Antiretrovirals primarily used in patients with HIV
Anti–biotics, minocycline
Blood pressure medication such as nifedipine, spironolactone, cause rectile
dysfunction
Cimetidine which is used to treat stomach ulcers and acid reflux
Colchicine used to treat gout,
Sulfasalazine is used to treat ulcerative colitis and rheumatoid arthritis.
Most of these drugs do not cause permanent damage, and the changes may be
reversible once the drug is stopped.
GETTING HELP
It is important to seek help from your doctor or a fertility specialist if you fail to conceive after 12 months of unprotected sexual intercourse.
It will be helpful to write down all the medical problems you have and the medication you take so that these can be incorporated in your overall assessment and management.
The most appropriate course of action can only be taken with your consent and participation in the process of trying to conceive.
We look forward to engaging with you and helping you conceive at Neo
Fertility.
