How to Interpret Sperm Analysis Test Results

When some fertility test results come back, you may be even more confused than you were before. If your partner’s semen analysis comes back with some results askew, he may be too embarrassed to ask what the results mean.

Semen samples can vary from month to month, or even day to day. That’s because it takes about 72 days for sperm to develop. Unlike eggs, which are present from your embryonic days, sperm are replenished all the time.

Because men are constantly producing new sperm, one “bad” semen analysis should be followed up with another in a month or so to see if the problem was a temporary one. An illness, injury, or medication or drug used a few months before may make one sample not so superior, but checking again a month later may show an improvement.

Making too few sperm

Sometimes a semen analysis shows a very low number of sperm, less than 15 million/ml, a condition called oligospermia. While 15 million sperm may sound excessive — why isn’t one or two million enough? — large numbers of sperm are needed in the ejaculate because many sperm are abnormal even in a good sperm sample, and it’s a long way to the ovulated egg, so many don’t make it all the way.

There are many causes of oligospermia, ranging from varicoceles to lifestyle issues. Other causes may be

• Hormone imbalances, which can be checked by a simple blood test
• Chromosomal abnormalities such as a congenital deletion of part of the Y chromosome
• History of lymphoma or testicular cancer or chemotherapy
• Diabetes
• Sickle cell disease
• Kidney disease
• Liver disease

You can get pregnant without fertility treatments if your partner has oligospermia, but your chances of pregnancy are higher if you do one of the following:

• Intrauterine insemination (IUI): The sperm are concentrated and “washed” so that the best sperm are used for insemination.
• In vitro fertilization (IVF): This treatment allows fertilization to take place in the lab, where a high concentration of sperm can be put in with the egg. If the sperm are especially abnormal, the lab may need to utilize intracytoplasmic sperm injection (ICSI), the insertion of a sperm directly into an egg. The procedure is done by an embryologist under a high-powered microscope.

When there’s no sperm in sight

If no sperm are seen, it’s called azoospermia. About 1 percent of males have azoospermia. If your partner has azoospermia, you won’t be able to get pregnant conventionally. Different factors can cause azoospermia; either the production of the sperm or the delivery of the sperm can be at fault. Sperm production problems can be caused by the following:

• Sertoli cell only syndrome: In this condition, the germ cells that produce sperm in the testes are absent. There is no way for a person with this syndrome to father a child.
• Anabolic steroids: Their use may cause irreversible shutdown of the sperm production.
• Abnormal hormone levels: Low levels of LH, FSH, or testosterone can cause low sperm production. This problem can be treated with hormone injections, pills, or transdermal patches.

If the problem is obstruction, in general, the sperm production is normal, and the sperm simply can’t get to the ejaculatory duct. In these cases, your partner will need a surgical procedure to extract the sperm from the testicle (discussed in the nearby sidebar “If you need a sperm aspiration”). This procedure must be done in conjunction with IVF because the sperm need to be injected directly into the egg. Obstructive problems include the following:

• Absence of the vas deferens, the tube that delivers sperm to the ejaculatory duct and the prostate
• Previous vasectomy
• Previous infection that causes scarring and obstruction of the epididymis
• Obstruction from prior surgery

Mechanical problems with getting the sperm where they need to be include the following:

• Retrograde ejaculation, in which the majority of the sperm go into the bladder
• Spinal cord injury that prevents ejaculation
• Previous injury from trauma
• Previous injury from surgery, such as hernia surgery
• A disease such as diabetes

Considering the sperm’s shape and movement

After checking how many sperm are available, the andrologist will look at what shape the sperm are in and how they are moving — kind of like a test to see if they are “in condition” for conception. The terms you’ll see on the report are the morphology (shape) and the motility (how they swim).

Morphology

There are hundreds of papers written about the shape of sperm. The concern has to do with the ability of sperm to navigate the female reproductive tract to get to the egg in the fallopian tube at the correct time. There are many barriers to this; the cervix with its protective mucus is the primary obstacle. Putting sperm beyond the cervix through the use of intrauterine insemination is based upon the fact that the cervix keeps many sperm from entering the uterus. So while the cervix can act as a storage place for sperm, it can also prevent sperm from moving forward. The theory is that sperm need a specific shape to get through the cervical mucus (see the following figure).

Sperm with an abnormal shape may be filtered and not able to move forward. Both IUI and ICSI correct for this problem. But sperm have another issue. Once they reach the egg, they need to penetrate the shell of the egg. Sperm penetrate the shell by binding to the shell and releasing proteins that digest a pathway through the shell. If the sperm do not have these proteins, you could place a bazillion near the egg and they could not penetrate the shell.

In the early days of IVF, before ICSI, sperm and eggs were simply placed in a dish. Fertilization had to be done by normally functioning sperm and eggs. It became apparent that some men had sperm that were incapable of fertilizing an egg, but there was no highly reliable test to determine this before the IVF procedure. That meant that couples could go through IVF only to find out that they had no embryos. One school of thought suggested that the shape of the sperm may give an indication about the ability of the sperm to fertilize an egg. To that end, they developed a very detailed process for determining if a sperm had a shape that suggested that the sperm could fertilize the egg. Originally called the Kruger method, the term strict scrutiny is now used to identify that this detailed methodology is being used to determine the percentage of sperm with the desired shape. Labs vary in what they consider normal, but in general anything < 5 percent is abnormal, from > 4 percent to 14 percent may be an indication of a reduced fertility potential, and above 14 percent is normal.

Motility

In the sperm world, it’s swim or die. Sperm must traverse the female reproductive tract to get to the egg. Any reduction in motility reduces the number of sperm that even have a chance to get to the egg. Like morphology, a reduced motility may sometimes also indicate that the sperm lack the ability to penetrate the shell of the egg. Normal percentages for motility are > 40 percent motile and 32 percent forwardly motile. Sperm lose their motility if they remain in semen too long, and this is why andrology labs needs the specimen within an hour of collection. Also, cold conditions, such as a cold car seat in the winter, can artificially lower the motility. Another condition that can result in lower motility is the thickness of the semen (viscosity). After ejaculation, semen coagulates just as blood does. Over the next 30–45 minutes, it liquefies. Some men have conditions that create either super thick semen (increased viscosity) or failure to liquefy. Both of these may reduce the fertility potential for the man.