So your sperm count came back (ab)normal…
What next?! That’s the question many guys are faced with once they receive their initial semen analysis. First, we almost never diagnose male factor infertility from one semen analysis. Your doctor will almost always have you do a repeat sample, and make sure that you have the right number of days of abstinence (2-7), didn’t miss the cup, and weren’t suffering from the flu or any other ailment when you gave the initial sample. If the second comes back abnormal, then a referral to a urologist (like a gynecologist for men) may be warranted, especially one who specializes in fertility.
So what do all those numbers mean? The first thing your doctor looks at is the volume of the sample. If it’s unusually low – that can skew the results. A normal ejaculate volume is >2mL, which sounds like a lot, but is actually a very small amount. The second thing we look at is the sperm count. A normal sperm concentration (count) is greater than 20 million sperm/mL. Again sounds like plenty, but it takes millions of sperm competing to fertilize one egg. The reason for that is many of these millions of sperm are abnormal and not appropriate for fertilization of an egg. That brings us to our next parameter, which is sperm morphology. Morphology is the description of the shapes of the sperm. A normal shaped sperm has an oval head with a long tail. An abnormally shaped sperm may have a double tail or large head. The percentage of normally shaped sperm that is described as “normal” depends on the laboratory where you had your analysis done, but fertility centers generally use a system called Kruger morphology. Appropriate Kruger morphology for fertility purposes is generally >4% normal morphology, but you should discuss this further with your doctor as again this can differ from lab to lab. Another assessment of sperm is the motility. At least 50% of the sample should have motile sperm that are living and ready to swim to the egg. A total motile count may also be reported, which is a calculation based on sperm motility, concentration and volume.
Other parameters that you may see on the report include progression, vitality and anti-sperm antibodies and a calculation of total motile sperm count after a “wash” or IUI prep. These may be lab specific so discuss further with your doctor. Having an abnormal semen analysis doesn’t mean you will never be able to have a baby, but it does mean that you may need some intervention such as IUI or IVF. That’s why it’s so important for your doctor to have the results of all of your fertility testing to look at the big picture and determine an individualized treatment plan for you and your partner
For further information on male infertility and how it impacts your chances of conception, please contact us. We are here to help.
Stephanie M. Thompson, MD is a Reproductive Endocrinologist and Infertility specialist at The Institute for Reproductive Medicine and Science (IRMS). She is an attending physician in the Department of Obstetrics and Gynecology at Cooperman Barnabas Medical Center, and Board Certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility.