Infertility, or the inability to reproduce, can be major cause for concern among couples and result in emotional and mental stress. The trauma related to medical treatment and the improbability about outcomes can be difficult to deal with. Manipal Ankur, a joint venture between Ankur Healthcare Pvt Ltd and Manipal Hospitals, helps childless couples by assessing shortcomings and ensuring maximum chances of having a child through in-vitro fertilization and reproductive medicine.


The following article gives a bird’s eye view on fertility assessment and male fertility.

How is fertility in men assessed?

In order to understand why pregnancy doesn’t occur, we need to examine only the four critical areas, which are needed to make a baby – eggs, sperm, fallopian tubes, and the uterus. The tests, which often seem endless, will actually fall into examining one of these four areas. In 40% of cases, the problem will be with the male, in 40% with the female, and in 10% both partners will have a problem. In some cases, about 10%, no cause can be identified (unexplained infertility) even after exhaustive testing.

Remember that the couple must be seen together and the first test, which should be done, is a semen analysis. Sadly, sometimes the wife will have undergone innumerable tests (sometimes repeatedly!) and the husband’s semen analysis (where the problem lies) has not been done even once.

What is semen analysis?

Semen analysis, also known as the sperm count test, analyzes the health of a man’s sperm and male fertility. Semen is the fluid containing sperm that is released during male ejaculation. A semen analysis measures three major factors of sperm health:

Number of sperm
Shape of sperm
Mobility of sperm

In order to get a good idea of your sperm’s health, doctors will often conduct two sperm analyses and average their numbers to get the most accurate reading.

Why undergo semen analysis?

A sperm analysis is often recommended when couples are having problems getting pregnant. The test will help a doctor determine if a man is sub fertile. The analysis will also help determine if low sperm count or sperm dysfunction (mobility and shape) is the reason behind sub fertility.

What are the characteristics of a normal sperm?

– A smooth, oval shaped head that is 5-6 micrometers long and 2.5-3.5 micrometers around (less than the size of a needle point)
– A well defined cap (acrosome) that covers 40% to 70% of the sperm head
– No visible defect of neck, midpiece, or tail
– No fluid droplets in the sperm head those are bigger than one-half of the sperm head size

How to prepare for semen analysis

Your doctor will let you know what you should do in preparation for the semen analysis. Following these instructions is very important if you are seeking accurate results.

To get the best sample:

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, hormone medications
Discuss any medications you’re taking with your doctor.

How is a semen analysis test conducted?

There are three main ways to collect a semen sample. They are:

Sex with withdrawal before ejaculation
Ejaculation stimulated by vibratory stimulation

Masturbation is considered the best way to get a clean sample.

Do not collect semen in a condom as most condoms have spermicidal material that will kill sperms.
Do not use a lubricant (soap, saliva, jelly, oil) to collect the semen sample.
Always use the container provided by the laboratory.

Getting a good sample

Two main factors are crucial to having a good testing sample. First, the semen must be kept at body temperature. If it gets too warm or too cold, the results will be inaccurate. Second, the semen must be delivered to the testing facility within one to two hours of leaving the body.

Test interference

Some factors can negatively affect the test, including:

Semen coming into contact with spermicide, an agent that can damage sperm
Taking the test when you’re ill or stressed
Sample becoming contaminated
There are no known risks associated with a sperm analysis

What are the minimum values needed?

Volume: Greater than 1.5 ml
Sperm count: 15 million
Movement: More than 40 percent of sperm move normally
Sperm shape: More than 4 percent of sperm are shaped normally

A single test abnormality does not necessarily mean that a problem exists and the test may need to be repeated, to confirm that it is a persistent problem.

What do abnormal results mean?

Abnormal sperm / slow moving sperm will have trouble reaching and penetrating eggs, making conception difficult.
Main abnormalities are Mobility and Shape.

An updated way of determining sperm shape is called the Kruger’s Strict Morphology Method. It is a useful system that helps doctors determine if a sperm is normally shaped or not.

Many patients have asked if abnormally shaped sperm mean they are likely to have children with genetic abnormalities. Abnormality in sperm only means the sperm capacity to produce a baby is less but will not produce defects in a baby.

Abnormal results could indicate the following:

Hormonal imbalance
Gene defects

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

Hormone testing
Urinalysis after ejaculation
Doppler evaluation of the testis for varicocele
Advanced sperm analysis – DNA fragmentation assessment
Taking a tissue sample from your testicles
Genetic tests

With today’s advanced reproductive technology, we can always find a solution, no matter what the problem – remember that unless you can intelligently identify the problem, you cannot find a solution!