Abnormal semen Introduction

Abnormal semen analysis at a glance

A semen analysis microscopically looks at a man’s semen checking for abnormalities.

A semen analysis can come back abnormal if the semen volume, sperm count, sperm morphology (shape) or sperm motility (ability to move) do not meet medical standards.

An abnormal semen analysis may indicate a possible male factor contributing to a couple’s infertility, which can be a sole or contributing factor in about two-thirds of all infertility cases.

Depending on the possible etiology (causes) of a man’s abnormal semen analysis, there may be lifestyle changes and treatment options that can help.

What is an abnormal semen analysis?

A semen analysis is a microscopic examination of a man’s semen to analyze the sperm shape, count and ability to move. Additionally, the semen volume is assessed. If a man’s semen falls below the normal parameters in any of those areas, it is considered an abnormal semen analysis. This does not necessarily mean a man is infertile, but it could take longer for him to achieve a pregnancy or have difficulty achieving a pregnancy by natural means.

A man with an abnormal semen analysis might need to see a urologist to discuss treatment options. Abnormal semen analyses are most often caused by lifestyle factors, other medical conditions, blockage to the passage of sperm, or genetic conditions affecting sperm production.

Some people use the words semen and sperm interchangeable, but they are different. Semen is the fluid emitted from the penis during ejaculation. Sperm cells are one component of the semen. They are made in the testicles and fertilize a woman’s egg. The semen provides a supportive environment for the sperm to carry out their function.

Conducting a laboratory semen analysis

The semen sample is collected by a man masturbating and ejaculating into a special container or by using a special condom to collect semen during intercourse. The sample is then sent to a lab to look for abnormalities. Since this is a time sensitive test, it is usually recommended that the sample be collected at the facility performing the analysis.

If the first test comes back normal, most doctors will not recommend doing an additional test. However, if the first test comes back abnormal, frequently a doctor will request repeated semen analyses to be completed to ensure accurate results. It is common for there to be some variability in a man’s semen analysis between different samples.

The urologist may also recommend additional testing after an abnormal semen analysis including a physical exam, blood work, genetic testing, testicular biopsy or imaging.

Testing at home

Home semen tests are growing in popularity but they only test for sperm count. This is not a full picture of a male’s fertility because it only considers one possible cause of an abnormal semen sample. If a man is concerned about his fertility, it is best to get a lab test done by a medical professional for a comprehensive evaluation of the semen sample provided.

Characteristics of semen, sperm count, sperm motility & sperm morphology

Semen is normally translucent or whitish-gray in color. Semen that is greenish, yellowish, brownish or reddish can be a sign of an abnormality. Other characteristics that could suggest an abnormality is if it is too thick, too watery or carries a foul odor.

Other areas that are evaluated during a semen analysis include the following.

Semen volume (concentration).Low volume can indicate a possible blockage, an inadequately collected sample, retrograde ejaculation (semen going into the bladder instead out of the tip of the penis), and dysfunction in the seminal vesicles or prostate. According to the World Health Organization (WHO), ≥1.5 milliliters is a normal volume for semen in each ejaculation.

Sperm count. WHO defines normal sperm count to be ≥ 15 million per each milliliter of semen ejaculated. The technical term for low sperm count is oligospermia.

Sperm morphology (size and shape). Sperm morphology includes an assessment of the head size, the midpiece appearance and the structure of the tail. The head shape is important because it can affect the sperm’s ability to penetrate the outer surface of a woman’s egg in order to fertilize it. According to WHO, ≥ 4 percent of sperm should be of normal shape.

Sperm motility (movement).Lab technicians look at two aspects in the semen sample when it comes to motility. The first is the activity of the sperm, looking for at least 40 percent of the sperm to be active to be considered normal. The second area being monitored is the quality of the movement.

Causes for abnormal semen analysis

There are many causes behind an abnormal semen analysis, and some of these are covered in the lifestyle changes section below. Other reasons include:

Having certain past or present infections.

Having experienced trauma to the testicles.

Using testosterone.

Being exposed to toxins.

Having a vasectomy or major abdominal or pelvic surgery.

Previously or currently having an undescended testicle(s).

Having certain medical conditions including tumors and chronic illnesses such as sickle cell disease.

Taking certain medications or undergoing medical treatments such as radiation to treat cancer.

Treatment options after an abnormal semen analysis

After a man learns that his semen sample is abnormal, it is time to see a urologist who specializes in male fertility. The doctor will be looking for a clear cause of the abnormality in the sperm sample and look for a way to correct or work around the cause. One of the first areas the urologist will consider is the man’s lifestyle and possible changes he may need to make.

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Treatments by a urologist

Of course, making lifestyle changes can be a slow process. Men often need medical treatment in addition to lifestyle changes. Following are ways our urologists can treat abnormal semen analysis issues.

Medications. This may include therapies to help correct any hormonal abnormalities. Additionally, men on testosterone therapy for low testosterone may need to switch to alternative medications to optimize sperm production. Men with ejaculatory or erection issues sometimes benefit from medical therapy. If there is any evidence of an infection, antibiotics may be given.

Surgeries. The following surgeries are the three most common to either increase a man’s semen production or to allow for retrieval of sperm for in vitro fertilization (IVF). On top of these operations, the surgeons at Urology Associates try to identify any reversible cause and treat it to improve the man’s fertility prospects. This leads to a variety of surgeries to remove a blockage, if present, depending on the location.

Surgery to treat varicocele. Varicoceles are an enlargement of the veins within the scrotum. They can lead to abnormal semen parameters. Surgery is usually completed using microscopic techniques to treat the affected veins.

Vasectomy reversal. Vasectomy reversal is a surgery to undo a vasectomy and reconnect the tube that carries sperm from a testicle into the semen. The success rate for a vasectomy reversal ranges from 40 to 90 percent. Factors for success include the length of time since the vasectomy, physical exam findings prior to the reversal, the female partner’s age, and the surgeon’s experience and training. Six to eight weeks after surgery the surgeon will want to complete a semen analysis to confirm the semen is normal.

Sperm retrieval. At times when an obstruction cannot be repaired with surgery or if sperm production is significantly affected, a urologist will need to remove the sperm directly from the testicle or epididymis using a sperm retrieval technique. Sperm retrieval surgeries performed at Urology Associates include testicular sperm aspiration (TESA), percutaneous epididymal sperm aspiration (PESA), testicular sperm extraction (TESE; this also includes microsurgical TESE) and microsurgical epididymal sperm aspiration (MESA). Once the sperm is collected, a fertility specialist can use it to achieve pregnancy through artificial reproductive technologies including IVF, possibly with intracytoplasmic sperm injection (ICSI). IVF is a process that involves the fertilization of an egg in a lab setting before transferring the embryo to the woman’s womb. ICSI uses the IVF process but goes further by microscopically injecting the sperm into the egg to boost chances of successful fertilization.