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Male Infertility: Is Semen Analysis Enough?

When a couple suspects infertility they each go through some initial testing in a search for more information. Women usually start with a blood test assessing the hormone levels, and men undergo a semen analysis. But just what is a semen analysis, what does it assess and if there are issues, what comes next? Is a semen analysis enough to confirm male factor infertility? Let’s find out.


What is Semen?

First a little basic biology. Semen is a thick white liquid released during ejaculation. The semen carries the sperm into the female’s vagina and beyond for fertilization of the egg. The semen analysis tests sperm count, movement and shape ensuring that the sperm is able to fertilize the egg.


The Semen Analysis

For the semen analysis the male partner must provide a sample of their semen. The sample requires the male partner ejaculate via masturbation into a sample cup or the doctor provides a special condom to wear during intercourse. (Note: a regular condom contains certain chemicals and is not for this purpose.)

It’s essential that you submit your sample within 30 minutes of ejaculation. The earlier the test takes place the more reliable the assessment. The lab evaluates the sample for:


  • Chemical or pH makeup of the semen such as acidity and sugar levels.
  • Volume of semen.
  • Thickness.
  • Ability of sperm to move around (viscosity).
  • Movement of sperm (motility).
  • Number of sperm (sperm count).
  • Structure of sperm (morphology).
  • White Blood Count indicates the presence of infection.
  • When you first ejaculate, the semen is thick and somewhat gelatinous, so it adheres to the cervix. Then it liquefies, enabling the sperm to swim to the target.


It’s important to note that a semen analysis, much like the initial blood test and ultrasound for the female partner, is only the first test. Should something appear abnormal in your test then the next steps find out the reason behind the abnormality.


What’s Next?

Normal results indicate, generally, there’s no issue with male factor fertility. Abnormal results may require further testing although that’s not always indicative of infertility. For example, sometimes semen analysis shows high acidity. This may be indicative of high white blood counts which suggests infection. Some infections affect fertility.

Because several variables impact sperm quality and viability, semen analysis alone isn’t always the best indicator of fertility. Your doctor may suggest genetic testing or tests of the endocrine gland should your results prove inconclusive. Or, if you indicate any health issues that may relate to infertility, your doctor usually investigates further.

Your doctor likely requires a second semen analysis if you believe something like an infection, medication, illicit drugs, cannabis or alcohol, confining athletic wear (such as bicycle shorts) or too many soaks in the hot tub caused the poor results.


Additional Testing for Male Infertility

If your diagnosis isn’t obvious after a semen analysis, then your doctor moves on to additional testing such as:


  • A Hormone Test: This test checks the level of testosterone and follicle stimulating hormone (FSH). If indicated a second hormone test checks the amount of additional hormones necessary to normal sperm production.
  • Seminal Fructose Test: A semen analysis based on the amount of fructose added to your semen by the seminal vesicles, a pair of glands located in your pelvic area and vital to normal semen production.
  • Post-ejaculate Urinalysis: A condition called retrograde ejaculation occurs when semen enters the bladder. Sometimes a blockage causes this.
  • Semen Leukocyte Analysis looks for the presence of white blood cells in the semen.
  • Anti-sperm Antibodies Test: This test identifies the presence of antibodies which may affect viability of sperm.
  • Ultrasound: An ultrasound detects the presence of varicoceles (enlarged veins) or other obstructions to the ducts of the scrotum, seminal vesicles, ejaculatory duct, or prostate.
  • Testicular Biopsy looks for blockages and other abnormalities affecting sperm production.
  • Vasography confirms normal duct structure.
  • Genetic Testing looks for gene mutations of the Y chromosome related to fertility. In men who don’t have a vas deferens (the duct that moves sperm from the testicles into the urethra) this test indicates the presence of cystic fibrosis.


Treatment Options

After your doctor confirms the diagnosis treatment may begin. There are several options for treatment of male factor infertility depending on the diagnosis. These may include:


  • Hormone treatment
  • Lifestyle changes
  • Treatment of underlying conditions
  • Extraction of sperm directly from the testicles for IVF, ICSI or IUI
  • Surgery correcting blockages, varicocele, vasectomy reversal or other conditions


Once treated, you may opt for assisted reproductive technology such as IVF for pregnancy. Of course, the treatment depends on the results and diagnosis of both partners.


Don’t Put Your Dreams on Hold

For more on tests for male fertility, or if you suspect male factor infertility, contact LA IVF today. Don’t wait for your dreams of growing your family to come true.

TEL: 310-286-2800 | FAX: 310-691-1116