Abnormal Semen Parameter ? Is it the new normal ?
In a short span of ten years, we have seen semen analysis test report or sperm test report of men in urban locations decline from 2 out of 10 showing abnormal semen analysis test report to almost 3 to 4 out of 10 showing abnormality.
For patients who are generally healthy and visiting the Fertility clinic for an initial fertility checkup, an abnormal semen analysis test report comes as a shocker! Generally healthy men mostly expect to see a normal semen analysis report, however when they see an abnormal or not so normal semen analysis report, the first instinct is to think that this is all a scam and a way for Fertility specialists to make money by prescribing more medicines!
So if you are a hale and healthy guy in early thirties and have undergone a semen analysis test recently only to find an abnormality in sperm count, sperm motility or sperm morphology ………….read on, this does not always mean that you will always need additional treatment to become a father. The semen analysis report needs to be interpreted by an IVF Specialist or IVF doctor who will try to put things to context.
Any standard Andrology lab will use the WHO Laboratory Manual 6th Edition to interpret the result of the semen analysis test and compare the standard reference range of various semen parameters to label the semen sample as normal or abnormal. One thing to remember is that the latest WHO manual (6th edition) for Semen Analysis Test prescribes to use a term called “Border line” for samples that do not fall within the Normal range, yet are not so extreme that it should be considered Abnormal.
Simple example would be that the reference range of normal motility of sperm is 50% or more, meaning, semen samples showing progressive motility of 50% or more sperms are considered normal. However if a sample shows 40 % motility, it should not be labelled as Abnormal yet. According to WHO 6th Manual, it should be labelled as Borderline and the IVF specialist should consider other semen parameters like total sperm count in reference to determine the final impression for the Semen analysis report. Also, it is important to note that Laboratory technicians are not doctors, their job is simply to mention what they have seen under microscope, the interpretation of the result should always be done by an Infertility Specialist.
So in short, there are three most important things in the semen analysis report: Sperm count or sperm concentration, sperm motility (speed) and sperm morphology (quality).
What is more important Sperm Count or Sperm Motility?
The ability of sperm to reach to an egg during the process of fertilization is primarily a number game. So having a higher sperm count can compensate for a little lower motility i.e. slower sperm.
Example, Consider two semen samples:
Semen Sample A: With sperm concentration of 40 Million per mL with a forward motility of 15% will have around 6 Million sperms moving forward in the reproductive tract.
Semen Sample B: With 10 Million sperm concentration and 50% Motility will have 5 million sperms moving forward.
Hence even though sample B has lesser than normal sperm concentration, it is only marginally inferior to sample A which has poor percentage sperm motility.
What is the normal sperm Count range ?
As per WHO 6th edition, the normal range for sperm concentration is 20 Million sperms per mL or more and normal range for sperm count is 35 Million or more sperms per ejaculate.
One important thing to remember is that even if the sperm concentration is less than normal, the total sperm count is more important when interpreting semen analysis report.
Example: A sample with concentration of 18 Million sperms per mL can have a sample volume of 2 mL making the sperm count to be 36 Million which is in the normal range.
What is the difference between sperm count and sperm concentration?
Sperm concentration is measured as number of sperms present per mL of the semen sample. Sperm count is the total number of sperms per ejaculate represented in Millions. Hence sperm count is a product of sperm concentration and total semen volume.
Semen Analysis test Report shows Oligozoospermia ? Do I need to worry ?
Oligozoospermia is a term used for low sperm number in an ejaculate.
So if the total sperm count in an ejaculate is less than 35 Million, then the sample is termed with Oligozoospermia.
As explained above, just the sperm number by itself does not decide the fate of a man’s fertility. It is a combination of other parameters like sperm motility and sperm morphology.
Any sample with low sperm count is termed with oligozoospermia. Hence it is important to know the sperm concentration as well as motility before one interprets the result.
A man with 34 Million Sperm Count and 50% Motility will do better than a man with 20 Million sperm count and just 20% motility. Even though both these samples will be termed as oligozoospermic, one is better than the other.
It is best to consult an IVF specialist if you have doubts about your semen analysis test report.
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What is more important Sperm Count of Sperm Quality ?
As explained above, sperm count is the total number of sperms present in the ejaculate. Sperm Quality is a measure of the sperm morphology by visually assessing sperms under a good quality microscope. During morphology assessment of sperm, the defects in shape of head, neck and tail of sperm are counted and the overall defect is represented in percentage.
The morphological parameters to test if sperm is normal or not is usually very strict. Most of the sperms in an ejaculate have one or the other defect even for fertile men who have already fathered a child.
Normal semen sample usually have as many as 85% defective sperm. Hence if the semen analysis report shows that the semen sample has only 15% normal sperms it does not mean that it is a poor sample. In fact 15% is a very good number. Typically semen samples with 5% or lower number indicate very poor sperm morphology and warrant additional examination by IVF specialist.
Semen Analysis test Report shows Asthenozoospermia ? What do I need to do ?
Semen sample with less than normal range of motility is given the term Asthenozoospermia. The reference normal range for sperm forward motility is 50%. So any sample with less than 50% forward motility will be termed with Asthenozoospermia.
As explained above, any good IVF doctor will not see the motility only by itself, the specialist will assess the total sperm count and the motility in context to the other things in the report.
If semen analysis report shows Asthenozoospermia, it is best to consult an experienced Fertility specialist who can check all the parameters in the semen and decide to prescribe medicines that can improve overall semen parameters.
It is important to note that the number of days of abstinence usually has a role in determining sperm motility. For asthenozoospermia sample, it is best to keep less abstinence of 1 or 2 days. But again, discuss this with your Fertility doctor. Optimal abstinence days depends on other factors too.
Semen Analysis test Report shows Teratozoospermia ? What shall I do ?
Teratozoospermia is a term used to label semen samples that have sperm with poor morphology. If the semen sample shows lower than 14% sperm with normal morphology, then such samples are labelled with Teratozoospermia.
Poor sperm morphology is indicative of higher oxidative stress within the male reproductive system, meaning that the sperm is subjected to things like leukocytes, oxygen derived free radicals (ROS), higher temperature or toxic chemicals.
Poor sperm morphology can indicate faulty spermatogenesis and or improper packaging of DNA material in the sperm head. This could lead to failed fertilization and hence infertility.
At times the best IVF specialist will simply put you under antioxidant therapy for a few weeks and get the semen analysis test repeated. For most cases of borderline poor morphology, an antioxidant therapy may show improvement if taken for few months. Exercise and loss of weight also improves the semen parameters.
If the sperm morphology is very poor, a good IVF specialist will order DFI test to test the amount of fragmentation in the semen sample. The future course of treatment depends on the result of DFI test.
DNA Fragmentation meaning is DNA with breaks in it’s strands.
Semen Analysis test Report shows OATS ? Will it cause any problem in IVF process ?
If the semen sample has less than normal sperm count, less than normal motility as well as less than normal sperm morphology, then such samples are labelled with OATS which stands for Oligo Astheno Terato zoospermia.
Typically if a patient has OATS, he will have reduced chances of conception by IUI and IVF. Depending on the degree of problem, patients will often be advised to undergo ICSI – Intra Cytoplasmic Sperm injection.
Will poor sperm quality mean poor result in IVF procedure ?
Remember that success of IVF procedure depends on the formation of good embryo. And sperm contributes to 50% of genetic material in making of a good embryo. So yes, if the sperm quality is very poor, it will definitely impact the process of embryogenesis and result in less than normal embryo.
However, techniques like ICSI and advanced techniques of sperm selection can be used to choose the best possible sperm to fertilize and egg. Hence technological advancements in treatment does bypass the poor morphology of sperm at times and helps in retrieving the best sperm for better IVF procedure success.
How much abstinence should be maintained for semen analysis test ?
Normally patients are asked to maintain 2 to 3 days of abstinence for Semen Analysis Test. However any number of days is ok between 2 to 5 if the analysis is being done for the first time.
Important thing to remember is that if the semen analysis report comes out abnormal, please discuss with the IVF specialist to know how much abstinence should be maintained for the next test.
Lower number of abstinence days (less than 2) would result in lower semen volume. However if the semen sample has previously shown lower motility, patients may be asked to maintain short abstinence.
Can I become a father naturally with Oligozoospermia or low concentration of sperms ?
Depends. Any sample with lower than 35 Million Sperm Count in an ejaculate is considered oligozoospermic sample. However there is a difference between a sample with 34 Million Count and 4 Million Count.
Also as explained above, there are many other things to be considered like sperm motility and morphology to decide if patients can be counselled for trying naturally.
Also remember that medical science is not exact, we have seen patients with less than 4 Million count and poor morphology become father naturally. So miracles are also possible.
Also, before trying to find treatment in alternative medicine or say ayurvedic treatment for increasing sperm count etc. Remember that ayurvedic treatment taken over long run may show improvement in semen parameters for certain cases similar to antioxidant therapy offered to some patients, but not all conditions can be resolved by Ayurveda.
The most important thing to remember is that even if you prefer to get yourself some alternative medicine, it is important to get the female partner assessed for her ovarian reserve. Typically patients in mid thirties with male factor infertility waste too much time in treating themselves, while their wives end up with diminished ovarian reserve with very less chance of retrieving oocytes during IVF process. So consult an IVF specialist to assess the female partner before you decide what treatment do you need to take and for how long.
Will low sperm motility mean low IUI success rate ?
Not always. Like mentioned before. There are many parameters that should be considered in totality not just the motility. Hence best to let the IVF doctor decide and inform you your IUI success rate. Always remember the best IVF specialist will always test the semen parameters first and only then initiate IUI cycle.
Will I need to undergo additional tests if I get an abnormal semen analysis report ?
Depends on type of abnormality and degree of abnormality. For borderline cases of sperm count, sperm motility or sperm morphology, IVF doctor may not order any tests or any medication.
But if the report comes out grossly abnormal like severe OATS, IVF specialist may prescribe you medicine and ask for a repeat for the test in few weeks
Also for cases of azoospermia, which is lack of sperm in semen sample, doctor may prescribe additional tests like blood hormone workup of FSH, Testoesterone etc. even a scrotal USG from case to case basis.
What kind of additional fertility tests do I need to undergo if my semen analysis report comes out abnormal ?
Depends on the type of abnormality. Best to consult a good IVF specialist who will prescribe you required tests. Additional tests could be like blood hormone profile with FSH, Testoesterone, LH , inhibin etc.
If semen analysis test report is very poor, does it mean the IVF treatment cost will be more ?
Again depends on the severity of the problem. In cases of azoospermia, patient may need to undergo TESA or testicular sperm aspiration which will be an additional cost over the IVF procedure cost.
Sometimes TESA is also suggested to patients with Cryptozoospermia or very severe form of OATS because studies have proven that testicular sperm is of better quality that the sperms that may be found in ejaculate of such patients.
Cases of complete asthenozoosmermia meaning 100% immotile sperm, may warrant for usage of chemicals to activate and mobilize the sperms, which may also add to the IVF treatment cost.
In patients with a rare condition like globozoospermia, where the sperm lacks a special kind of coating called acrosome, special activator chemicals may be needed to achieve fertilization, this may also add to the cost of IVF treatment.
Abnormal semen parameters may be the new normal these days.
Abnormal Semen Test Report ?
So do not stress if your semen report comes out abnormal.
Consult a good IVF specialist and know if the type of abnormality is something to worry about.
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