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Thursday, October 29, 2009

The Semen Analysis: What it can and cannot tell us about male infertility.

For most men, the fertility evaluation starts with a semen analysis and most of these men will have normal semen analyses.  Does this mean that they are fine?  Does it mean that they don't have a male factor--a condition that is preventing their sperm from fertilizing an egg?

The answer is no it does not.

The semen analysis is a very crude indicator of a man's true fertility potential.  In other words it is very possibl to have a serious male infertility factor yet have a normal semen analysis.  How is this possible?

The semen analysis looks at a number of measures.   These features are:
  • Seminal fluid volume
  • Seminal fluid pH ( a measure of acidity)
  • Seminal fluid viscosity (a measure of liguidity)
  • Sperm concerntration
  • Sperm motility
  • Sperm morphology ( a measure of the sperm's shape)
While an abnormality in one or more of these measures indicates that a male factor may exist, an analysis in which all these features are normal does not mean that such a condition is absent.

So why do it at all?

Because it is the best we have and it is a good place to start.  It is a good, though imperfect, screening tool.   Used this way, if several semen analyses are normal, then it is less likely that the man will have a male factor condition.

Of course, as in everything in medical practice, there are exceptions.  Men who smoke or who are exposed to other environmental toxicants can have normal semen analyses yet have sperm that do not function properly.  I have this also in men with testis tumors and occult diabetes (undiagnosed diabetes).  I have also seen this in men with varicoceles.

So how, in my opinion, should we counsel a couple with infertility.  I think it is reasonable to start with several semen analyses rathe than just one.  If 2 or 3 are normal and the man has no urologic complaints, than the couple may proceed with assisted reproduction aimed at the women.  However, if after several attempts at the lower cost assisted reproductive procedures, like artificial insemination, the woman is still not pregnant and the  next option is for the couple to proceed to in-vitro or ICSI, then I think referral to a urologist is reasonable and beneficial.  Often it is the urologist who uncovers a treatable and reversible male factor that was probably contributing to the couple's infertility problem.  At best, after correction of the male factor the couple can enjoy a natural, unassisted pregnancy.  At worst, the couple proceeds with in-vitro after a brief and inexpensive delay. 

Thanks,

Dr Schoor

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