A Step-by-Step Guide to Checking Your Sperm and Understanding the Results
Getting a diagnosis of infertility can be overwhelming. It usually starts with what’s often casually referred to as a sperm test. Here we’re going to take you through that process step-by-step, explaining all the basics so that you can then take action by attacking any areas that need improvement.
Getting Tested
First, if you haven’t already, make an appointment at a fertility clinic. There’s likely one near you where you can schedule a Semen Analysis (you shouldn’t need a referral or prescription), or you can ask your general practitioner for a recommendation. This is by far the most accurate way to get an overview of your situation, although there are also some home tests on the market that we’ll cover at the end of this section.
First, a quick distinction between “sperm” (or “spermatozoa”, which is plural) and “semen”, which are often mistakenly used as synonyms. Semen is the familiar pale fluid, or ejaculate. It carries microscopic sperm (male reproductive cells – those little heads with long tails), along with fluids from the prostate, seminal vesicles, and other glands. This fluid is full of proteins, sugars, vitamins, and minerals, each of which plays an important role in helping the sperm reach the egg. You might think of it this way: semen contains sperm, but sperm doesn’t contain semen.
A Semen Analysis is done to measure not only the viability of your sperm, but also the quality of your semen, which plays a role in the sperm’s ability to accomplish its mission. A “normal” sperm count is generally considered to be anywhere from 15 million sperm to over 200 million sperm per milliliter (mL) of semen, and a typical ejaculation contains 1.5 to 5.0 milliliters of semen. That means a literal sperm “count” in the normal range is between 22.5 million and 1 billion sperm per ejaculation.
We don’t need to revisit 9th-grade biology class here, but it’s good to have at least a general idea of the main parts of the male reproductive system involved in semen production:
a. Sperm and testosterone are made in the testicles (or “testes”).
b. Sperm then moves from the testicles into a tube hugging the back of each: the epididymis.
c. The epididymis then delivers sperm into another tube called the vas deferens, where it’s stored (the vas deferens links the epididymis and the urethra, the tube through which urine and semen exit the body).
d. Meanwhile the seminal vesicles, a pair of glands behind the bladder, are producing other ingredients of semen.
e. And in the prostate, another gland circling the end of the bladder, as well as the urethra, an alkaline is being produced as another ingredient of semen. The prostate also helps propel semen from the penis.
Semen Parameters
A traditional Semen Analysis will measure 3 basic markers (a doctor may refer to these as “semen parameters”):
a. Sperm Count/Concentration: the number of sperm per milliliter of semen. Note again that this isn’t a literal count of sperm, but a measure of how concentrated the sperm is in the semen. The amount of semen (called Semen Volume) is a separate measurement that ultimately determines the actual number of spermatozoa.
b. Sperm Motility: the sperm’s ability to swim toward the egg (i.e. its motion). You might think of this as your sperm’s physical fitness. It is generally referred to as Total Percent Motility (TPM) and is expressed as a percentage of total sperm showing good motility (a TPM of 60% means that 60 out of 100 sperm move well).
c. Sperm Morphology: the sperm’s shape or appearance, expressed as a percentage of total sperm appearing normal (a morphology of 4% means that 4 out of 100 sperm have a normal shape). While “abnormal” looking sperm can still fertilize an egg, they’re not nearly as good at it as “normal” looking sperm.
The first of these parameters are often combined into a single parameter called Total Motile Count (TMC). This is calculated by multiplying Semen Volume, Sperm Concentration, and Total Percent Motility. For example, a Semen Volume of 1.5mL, with a Sperm Concentration of 22 million/mL (sometimes expressed as 22 x 10⁶/mL) and a Total Percent Motility of 70% (sometimes expressed as .70) gives you a Total Motile Count of 23.10 million (1.5 x 22,000,000 x .70).
A normal TMC is generally considered to be above 20 million, although along with morphology there will be other parameters measured in your semen analysis, and you’ll ideally want those in the normal range as well. TMC, however, is a key number to focus on.
But it doesn’t tell the whole story. You might get back results showing a TMC in the acceptable range and still have difficulty conceiving. Increasingly, research is showing that an additional parameter may be at least as important, and maybe even more, than TMC or morphology: the quality of the DNA within the sperm.
Every sperm carries DNA. Its quality is determined by the absence of mutations, extra or missing copies of chromosomes, or, most importantly, physical breaks in the strands of DNA. Broken DNA strands result in fragmentation of chromosomes, and when analyzing sperm, this is generally what determines “DNA quality”.
Factors such as infections, smoking, pollutants, and age can cause DNA fragmentation, which often decreases chance of fertilization or implantation (the embryo successfully “sticking”, resulting in a pregnancy), as well as an increased risk of birth defects, genetic diseases, or “unexplained” miscarriages.
Understanding DNA Tests
A DNA Fragmentation Test (DFT) measures the percentage of breaks present in sperm DNA. Note that this is a separate test from a Semen Analysis and can be expensive (check to see if your insurance covers it). There are several varieties of the test, but one of the most common is called an SCSA (Sperm Chromatin Structure Assay), which involves treating sperm with a chemical dye that turns broken sperm DNA red, and normal sperm DNA green. This gives you a DNA Fragmentation Index (DFI), which is expressed as the percentage of fragmented DNA. Typically, a DFI of 25% (25% “bad” sperm) is considered “Fair”. Anything more than that increases risk, and the lower the number, the better (for example, a DFI of 7.2% is considered “Excellent”).
Your fertility specialist will generally recommend a DNA Fragmentation Test after an unsuccessful IVF treatment, a miscarriage, or a year of trying to conceive. If you’re reading this, you may be in one of those categories (or close to it), so if you’ve got the budget for it, a DNA Fragmentation Test can give you more important data. If the price tag is too steep, however, the steps outlined in this book are designed to improve all the above parameters by taking every step in your control. Regardless of whether you decide to get a DFT or not, your doctor should at least be able to answer your questions about DNA fragmentation and recommend the test if your infertility remains “idiopathic” (without a known cause).
One last note on DNA: yet another test can be helpful at this point. While a DFT shows breaks (fragmentation) in the DNA chain, a SpermQT (Sperm Quality Test) is often done earlier in a fertility journey and can give you an idea whether your genes have any damage from lifestyle or environmental factors like stress, toxins, alcohol, smoking, etc. The results of a SpermQT are less specific than a DFT, categorizing its results as Excellent, Normal, or Abnormal. Because these categories measure factors at least somewhat within your control, I recommend getting a SpermQT if you can. These can be pricey too, but the steps you’re going to take over the next chapters should lead to an improvement in your SpermQT, and it will be useful to track what helps what, and what doesn’t.
Can I Home Test Instead?
Semen Analysis kits are available on Amazon and pharmacies, enabling you to test at home. Some are better than others, so do your research (Reddit is a reasonably good source for anecdotal infertility information). At best, however, a home test will provide what’s called a Motile Sperm Concentration (MSC), a combined measure of sperm count and sperm motility. You likely won’t get separate numbers for these two markers, and you won’t get other important markers like sperm morphology. Also, you definitely won’t get any information about your DNA. So, when you consider that a Semen Analysis (of the basic parameters that make up Total Motile Count) costs about $100, and the better home tests cost about the same, it makes more sense just to schedule an appointment.
Some kits sell “refills”, so that you can re-test whenever you like. If you’re someone who likes to track your steps, or your calories, or other performance markers, or if you live in the middle of nowhere and have some disposable income, this might make sense to give you a general idea of how your markers are trending over time. But keep in mind that it takes 10 weeks to create mature sperm, so it’s mostly pointless to test more often than that, and if you’re following this program with the determined goal of having a child, you’re going to want more detail than a home test can provide.
Blood Tests
Blood tests are generally affordable, and I strongly recommend getting one at the same time as your Semen Analysis. You’ll likely be asked to test in the morning, since that’s when most men have their highest blood levels of testosterone. For fertility, what you’re most interested in seeing are your hormone levels, including Testosterone, Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), and Prolactin. Imbalances in these can impact sperm count and quality, as well as compromising libido and erections. As with your semen analysis, your results will include a “normal” range. With blood tests, however, these ranges are not as helpful if you’re trying to conceive, since “normal” may be defined for all men of all ages in all situations. You’ll want to ask your doctor how your results apply to your specific situation.
In the chart below we’ll also give you some general minimums for men trying to conceive, but again, hormone levels can vary widely in various situations. These variations are often due to lifestyle, including habits, diseases, and illnesses. In most cases the changes you’re making for the next few months should help to correct at least some imbalances. So these hormones markers will be useful to track.
We won’t spend much time going into what each hormone does, because in each case it’s complex, but here’s a quick overview. When it comes to fertility, Testosterone plays a key role in sperm production, as well as sex drive. FSH helps stimulate sperm production in the testes, while LH helps boost testosterone levels. Prolactin tends to be more frequently discussed regarding female infertility (high levels can affect estrogen and progesterone production), but in men Prolactin helps regulate testosterone and maintains balance in those other hormones. If these hormones get out of balance, then low sperm count, poor sperm quality, reduced libido, or erectile dysfunction can result.
A Note on Testosterone
Not all testosterone is created equal. The last decade or so has seen a huge rise in men concerned about “Low-T”, and endless pills, patches, gels, and injections are being heavily marketed, often by medical professionals. These may be great solutions for aging men looking to maintain muscle mass and sex drive, but if you’re trying to conceive and considering testosterone replacement therapy (TRT), stop. First, you need to understand the difference between endogenous and exogenous testosterone.
Endogenous testosterone is a hormone naturally produced internally by the body and helps drive sperm production within the testes. Exogenous testosterone comes from an external source like injections, patches, gels, or pills, and signals to the body that it can reduce or even stop its own testosterone production. This consequently lowers LH and FSH levels, when can then lead to a drop in sperm count.
TRT can have such a powerful effect on your “fertility factory” that studies on it as an effective form of birth control have been done. In short, if you’re trying to conceive, you shouldn’t be coming anywhere near products containing exogenous testosterone, and most products marketed as testosterone boosters contain exogenous testosterone.
When we get to food and supplements shown to boost fertility, we’ll discuss some known to boost endogenous testosterone. For now, forget everything else and focus on optimizing your own T.
Understanding Your Initial Results
Along with your results, your analysis will also likely include average recommended ranges. For Semen Analysis and DNA Tests, I’ve included recommended minimums defined by the World Health Organization for the main parameters we’re targeting over the next months. If you’re reading this, your results are likely near or below those minimums in at least one area. That’s okay. We’ll check back again in 3 months.
For blood tests, as discussed above, generally acceptable ranges may be wider than what’s optimal for fertility, so we’ve included fertility-specific minimums. Those are less clear-cut than for Semen Analyses, but your doctor should be able to talk you through them.
SEMEN ANALYSIS
|
Parameter |
Recommended Result |
|
Sperm Count/Concentration |
more than 16 million/mL* |
|
Total Sperm Motility |
more than 42% |
|
Sperm Morphology |
more than 4% |
|
Semen Volume |
more than 1.4mL |
DNA TESTS
|
SpermQT |
Normal |
|
DNA Fragmentation Index |
less than 25% |
BLOOD TESTS
|
Testosterone |
more than 500ng/dL (nanograms per deciliter) |
|
FSH |
between 1.0 and 7.6 MIU/mL** |
|
LH |
between 1.0 and 8.0 IU/L** |
|
Prolactin |
less than 25 mcg/L (micrograms per liter) |
*Your results may be in cubic centiliters (cc). 1 cc = 1 milliliter (mL). And for reference, 1 teaspoon = approximately 5 mL (or 5 cc).
**IU and MIU = international units and milli-international units – a standardized measurement of the effect or biological activity of a substance
It may take a week to get your results back. Note down your results in the above categories and forget about them (at this point you may not have results for SpermQT or DNA Fragmentation). Good or bad, high or low, this is where you stand today, and losing sleep over suboptimal results won’t change anything. Following the steps in this guide, however (except for in more uncommon cases like azoospermia, or zero sperm), you’re almost certain to improve your fertility when you test again in 3 months.
