A semen analysis is an important diagnostic tool that can indicate male factor infertility. The male partner collects a semen sample in a sterile cup, either at home or at the medical center. A small volume of the specimen is placed on a Mackler counting chamber, which has a grid with 100 squares. The sperm concentration is determined by counting the number of sperm in ten squares, then multiplying by 1 million. The motility of the specimen is determined by calculating the percentage of the sperm that are moving in the same 10 squares. The progression of the sperm (forward motion) is graded on a scale of 0 (no motility) to 3+ (moving quickly across the grid in a forward direction). The pH, agglutination (attraction between sperm), viscosity (gelatinous texture of the sample), and number of red and white blood cells are recorded.
A morphology slide of the semen is also prepared. This allows the sperm to be stained and viewed under a high power microscope to determine the percentage of sperm with normal morphology (shape). Listed below are the parameters determined by the World Health Organization for a normal semen analysis.
Concentration – >20 million sperm per milliliter
Volume – 2-5 mL
Motility – >50%
pH – 7.2-7.8
White Blood Cells – <5 per high-powered field
Progression – 2+-3+
Red Blood Cells – 0 per high-powered field
Agglutination – none
Morphology – > 14% normal forms
If a sample is determined to be below these standards, the couple may be experiencing male factor infertility. However, a normal semen analysis does not necessarily discount a male factor. Although we are testing for the phenotypic (how it looks) attributes of the semen, we cannot account for the genotypic (the genetic composition) attributes of the sperm. Depending on the severity of the male factor, couples may still be able to undergo IUI (Intrauterine Insemination) treatments or they may be referred on to IVF (In Vitro Fertilization) with ICSI (Intra Cytoplasmic Sperm Injection), where one sperm is directly injected into an egg, bypassing the need for millions of sperm.