What is Semen Analysis and why is this test performed?

Semen which contains sperm, is the fluid that is produced during male ejaculation. Semen analysis is a male fertility test to determine sperm health.

There are three main parameters of sperm health:

1. Concentration (sperm count)
2. Progressive Motility (ability of the sperm to swim forward)
3. Morphology (shape and size of the sperm)

According to World Health Organization (WHO), the reference values for Semen Analysis are shown in the table below. These reference values are based on semen data from men with proven fertility in the past 12 months. The semen quality of males with these reference values are considered normal.

Table 1: WHO (2010) reference values for semen parameters

How are these parameters and values related to semen quality?

Based on the reference values provided by WHO, males who have values lower than reference values may result in reduced fertility.

1. Concentration
   The chances of becoming pregnant decreases with decreasing sperm count (low sperm concentration). Males with no sperm seen in their ejaculate are less likely to get their partners pregnant. However, no sperm seen in the ejaculate does not mean that they do not have any sperm. There are medical procedures such as Microsurgical Testicular Sperm Extraction (TESE) and Microsurgical Testicular Sperm Aspiration (TESA) available to retrieve the sperms.
2. Motility
   Men with low sperm motility would have lower chance of conceiving on their own as the sperms have difficulty “swimming” through the female’s cervix, uterus and fallopian tubes before reaching the egg for fertilisation. In such cases, couples may consider going for assisted reproductive technology (ART) treatments.
3. Morphology
   Poor sperm morphology may also adversely affect fertility because sperm needs a certain shape to penetrate the outer layers of the egg. Men with poor sperm morphology may take longer time to achieve pregnancy in their own. Couples may consider going for pulse-driven Intra-cytoplasmic Sperm Injection (ICSI) with In-vitro Fertilization (IVF) treatment which bypasses the initial fertilisation process.

Table 2: Semen parameters lower than WHO (2010) reference values

The importance of semen analysis:

Semen analysis is an important test for the doctor to determine the fertility status of a man and the causes of infertility. Poor sperm quality is one of the common reasons that lead to difficulty in conceiving naturally. Hence, semen analysis is often recommended to couples who have difficulties conceiving a baby on their own. It is usually done prior to any fertility treatment. clinic. Semen analysis is beneficial for couples as it allows couples to prepare themselves for their fertility journey and also enables them to seek fertility treatment timely. Delaying treatment may result in reduced fertility as fertility tends to decrease with age.