20 July 2018

When do you need semen analysis and what is involved in the sperm test?

By the Editorial Comitee IVI Blog

As every couple going through the stressful experience of failure to conceive knows, the temptation to look for something or someone to ‘blame’ for their difficulties has to be resisted. Nevertheless, in these circumstances it is only natural and sensible for those affected to want to find out the cause or causes of their infertility. Sperm analysis is one of the steps that can be taken. For around 40% of couples who are having problems conceiving, the cause of their infertility is sperm-related. Female factor infertility accounts for another 40% of couples struggling to conceive, with the remaining 20% of cases being unexplained. Therefore for any couple undergoing difficulties, the cause of the issue is equally likely to lie with either partner. This is all the more reason to opt for sperm analysis to find out exactly what the situation is so that, hopefully, it can be remedied.

In this article we look at the circumstances around having a sperm count test, how the sperm analysis procedure works, and what the sperm analysis results may indicate for any types of treatment subsequently recommended.


When should you seek advice on having a sperm test?

The normal advice is to seek medical advice if you have not managed to conceive after one year of trying for a baby. However, depending on your age and that of your partner, you could be better advised to start the process after 6 months. When you reach the point where you have decided to seek assistance, it may be some comfort to know that currently approximately 15% of the world’s population have problems conceiving, and since half of these cases are due to sperm-related problems, you are obviously very far from being alone in your situation. Once you’ve taken the plunge and consulted a medical advisor, it will be clear that this is a very common situation and one in which the remedial procedures are varied and well established. It can be further reassuring to know, when you consult IVI, that 9 out of 10 couples that consult us due to problems with infertility and put their trust in us reach their goal of becoming parents.


What exactly is involved in the sperm analysis procedure?

The sperm count test is a simple procedure whereby a semen sample is analysed in a laboratory to check the quality and quantity of the sperm. An analysis is carried out which determines the number, activity level and shape of the spermatozoa. A commonly used benchmark result for chances of conception within normal range is a sperm count of more than 39 million in the ejaculate. However it is not purely a matter of the sperm count, there is also the matter of the sperms’ ability to move around, that is their motility. A suitable level which would result in good chances of conception would be with at least 32% of the spermatozoa having progressive motility and at least 4% having a normal shape. With lower quantities than these measurements, the chance of naturally occurring pregnancy falls substantially.

Results from the sperm analysis procedure are normally available within a week. The test may be repeated to confirm the results. If the sperm analysis results show a low sperm count or any other abnormalities, you will have the opportunity to discuss with your medical advisor what the options are for the next steps.


Using a recognised clinic for a semen analysis test

If you suspect that a low sperm count could be contributing to your failure to conceive, it could be tempting to use one of the home sperm test kits that claim to indicate whether sperm count is low. However, you should be aware that these methods have not been extensively studied and some only check for the number of sperm rather than other potential problems like motility. They may also give false reassurance, or suggest that sperm count is low whereas it is in fact normal. It’s better for men to consult an accredited clinic or medical practitioner if they are concerned about their fertility.


What are the causes of a low sperm count or sperm sub-fertility?

Sometimes a low sperm count stems from low sperm production in the testicles. The main causes of this lie in the pituitary gland and hypothalamus, which produce the hormones that regulate the formation of spermatozoa. It could also be the result of genetic disorders or of a range of other testicular problems including lack of development, anomalous development or failure to descend into the scrotum.

Other sperm abnormalities that can occur include motility anomalies and abnormalities in the shape or vitality of the spermatozoa. These types of abnormalities can be caused by infections or the presence of antibodies. They can also result from alterations in the number of chromosomes and DNA fragmentation. Existing medical conditions like diabetes, thyroid disorders and kidney disease can have a similar effect, as can certain medications, drug use, tobacco and stress.


Sperm analysis results: what do they tell you and what are the next steps?

If the results of your semen analysis show a low sperm count, a number of options are available, depending on the cause and whether there are any other complicating factors. IVF may be an option if in your case sperm analysis results show a slightly low sperm count. During IVF, an egg is removed from the woman’s ovaries and mixed with sperm in a laboratory in order for fertilisation to take place. The fertilised egg is then returned to the woman’s womb to grow and develop. Other possibilities include treatment with gonadotrophin hormones, surgery to reverse a vasectomy, or donor insemination.

Another important treatment which has enabled pregnancy to be achieved successfully in cases where severe male factor infertility has been diagnosed is Intracytoplasmic Sperm Injection (ICSI).


ICSI as a treatment for severe male factor infertility

Where a sperm count test has indicated few or no sperm in semen or poor quality sperm, Intracytoplasmic Sperm Injection is often the recommended treatment. It is also recommended in a number of other circumstances. These include cases where male factor infertility is caused by autoimmune issues, where there is difficulty with ejaculation and in cases of cryopreserved samples from men who have had a vasectomy, chemotherapy or radiotherapy. In these cases, the sperm samples are very valuable since there is a limited quantity and the ICSI technique allows their use to be optimised.

If the sperm analysis procedure has led to you or your partner being diagnosed with severe male factor infertility, you may like to take a look at our video about ICSI and IVF, which takes you through the process and explains how it works. In addition, you can always check our website for the most up-to-date information on all of our processes and treatments.


How does ICSI work?

In a nutshell, Intracytoplasmic Sperm Injection allows the egg and the sperm to be brought together directly, facilitating fertilisation. A sperm that has low motility or poor morphology would have greater difficulty achieving this naturally or through the standard IVF technique. These are the stages of the process:


The male partner’s ejaculate sample is then taken. In some cases a testicular biopsy may be performed to retrieve the sperm. This can be helpful in cases of damaged genetic material, also referred to as DNA fragmentation. IVI researchers have discovered that this fragmentation is reduced by 24% in sperm obtained via testicular biopsy, resulting in higher quality and therefore a greater likelihood of pregnancy, fewer miscarriages and a higher rate of live births. This technique can be performed as outpatient surgery with local anaesthesia, and recovery takes just a couple of hours. However the sperm is obtained, sperm selection is the next step. This means that the spermatozoa with the best motility and morphology are selected as candidates for the injection process.

The next stage is the intracytoplasmic sperm injection that lies at the heart of the procedure. Once the oocytes have been retrieved, IVI’s clinical technicians proceed to microinjection of the oocyte. During the process of ICSI, the selected sperm is placed in a tiny pipette and is injected directly into the ovum. In this way, we facilitate fertilisation to the greatest possible extent. The embryos obtained are allowed to develop for 3 to 5 days in the laboratory before one (as recommended) or more are transferred into the woman’s uterus. This part of the process is carried out in an operating theatre, where the embryo is transferred with the help of a specially designed cannula. Sedation is not necessary, since the procedure is quick and painless.


IVI’s continuous research and development

Research is a cornerstone of IVI and its Foundation. The research carried out in connection with reduced DNA fragmentation above is just one example of numerous projects aimed at expanding knowledge of the male factor and its impact on fertility treatments.

If you’d like to know more about how our techniques and expertise can be of help in your particular circumstances, why not get in touch? You can do this through our contact form on line, or give us a call on 0034 – 960 451 185.


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