Investigating the Male Partner

Introduction

Producing a baby is always a team effort.  There should never be blame placed on either partner in this effort.  We find as a rough rule of thumb, one third of our cases show a problem for the female partner, one third for the male and the remainder a bit for each
If your female partner is under the age of 35 and you have been trying to conceive for one year, or is she is over 35 and you have been trying to conceive for six months, you and your partner should see a physician for a fertility “workup.”
Before starting a full “Workup” we will request one or two tests of his semen production.

Interpretation of Semen Analysis Results

Sperm Count:    Sperm count, or sperm concentration measures the concentration of sperm in a man's ejaculate, distinguished from total sperm count, which is the sperm count multiplied with volume. Over 15 million sperm per millilitre is considered normal, according to the World Health Organisation (WHO) in 2010. Older definitions state 20 million. A lower sperm count is considered oligozoospermia (few sperm). A vasectomy is considered successful if the sample is azoospermic (i.e. there are no sperm). We advocate obtaining a second semen analysis to verify the counts are not increasing (as can happen with re-canalization).
The average sperm count today is around 60 million per millilitre in the Western world, having decreased by 1-2% per year from a substantially higher number decades ago.

In our reports, this may be blank if the Total Sperm Count is very low. There will usually be a comment in "Appearance" such as "only 15 sperm seen"

Total sperm count:    Total sperm count, or total sperm number, is the total number of spermatozoa in the entire ejaculate. By WHO, lower reference limit (2.5th percentile) is 39 million per ejaculate.

Motility:    The motility of the sperm is evaluated. The World Health Organization quotes a value of 50% progressively motile and this must be measured within 60 minutes of collection. WHO also has a parameter of vitality, with a lower reference limit of 60% live spermatozoa. A more specified measure is motility grade, where the motility of sperm are divided into four different grades:
• Grade 4: Sperm with progressive motility. These are the strongest and swim fast in a straight line. Sometimes it is also denoted motility a.
• Grade 3: (non-linear motility): These also move forward but tend to travel in a curved or crooked motion. Sometimes also denoted motility b.
• Grade 2: These have non-progressive motility because they do not move forward despite the fact that they move their tails.
• Grade 1: These are immotile and fail to move at all.

Morphology:      The morphology of the sperm is also evaluated. With WHO criteria as described in 2010, a sample is normal if 4% or more of the observed sperm have normal morphology.
Abnormal Forms:    There seems to be no quality control in sperm the production process. Therefore, it is usual to find high numbers of abnormal sperm cells in any specimen. A finding of 86% abnormal forms is quite normal. As with motility, this will not normally be of importance unless there is also a low total count.

Volume:    The volume of the sample is measured. WebMD advises that volumes between 1.0 mL and 6.5 mL are normal; WHO regards 1.5 ml as the lower reference limit. Low volume may indicate partial or complete blockage of the seminal vesicles, or that the man was born without seminal vesicles. In clinical practice, a volume of less than 2 mL in the setting of infertility and absent sperm should prompt an evaluation for obstructive azoospermia. A caveat to this is to be sure it has been at least 48 hours since the last ejaculation to time of sample collection.

Round Cells: These cells suggest that there may be an infection and we would hope to find very few. This is usually reported as "<1million/ml".

To arrange an appointment for a semen analysis, telephone             
0845 6861540

http://www.channel4.com/programmes/the-great-sperm-race/4od#3057299

What If I Am Told That My Semen Analysis Result Is Not Good?

Semen analysis has been showing a gradual fall in Sperm Count over the last thirty or forty years. We do not know the cause. Some suggest that it is due to estrogen like chemicals from the plastics industry entering our drinking water.
Do not worry about one single poor result as we all have good days and bad days. A second test should be arranged to confirm the first.
What should I consider before arranging another test?
Was it an ideal sample? Were the instructions followed? Lack of time for the sperm to collect will result in a low count. Did it reach the laboratory in the specified time? Did it get cooled? Both of these will result in reduced motility.
What affects Sperm Production?
Temperature: Sperm are made in the testes which are in the scrotum. This is the body's way of keeping the testes slightly cooler than the rest of the body, which is best for making sperm. Tight clothing may keep the testes against the body and so warm them. We have no evidence to show that cold baths or showers help but avoiding long times in saunas and other hot places might be sensible.
Smoking: You should stop smoking for optimum fertility (if you smoke). We do not know how long it takes for an improvement to be seen.
Alcohol: More than 16 units per week (roughly 8 pints of normal strength beer or 16 small glasses of wine) may interfere with fertility.
Drugs and medicines: Most do not interfere with sperm production, but some may do. These include: sulfasalazine, nitrofurantoin, tetracyclines, cimetidine, colchicine, allopurinol, some chemotherapy drugs, cannabis, cocaine, and anabolic steroids. If you have a low sperm count, tell a doctor if you take any drugs or medicines regularly.
General Health: The body can be very good at shutting “unnecessary” processes to concentrate upon getting better. It is surprising how slight illness can affect sperm production.
To arrange an appointment for semen analysis, please telephone
O845 686 1540

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