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from the book How to Have a
Baby: Overcoming Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
Previous page: Finding
Out What’s Wrong -- The Basic Medical Tests
Next page: Testing
the Man - Semen Analysis (Page 2)
Table of Contents
Why should the man be tested first ?
Where should the semen analysis be done ?
How do I provide a sample for semen
analysis ?
How does the lab analyse the semen ?
What do sperm look like ?
Why should the man be tested first ?
In the past, infertility was blamed wholly and
solely on the woman. This may have been to protect the fragile male
ego, was because the male psyche equates fertility with virility,
and views failure to father a child with shame. Studies today however
show that 40% of infertility is because of a medical problem with
the man.
The vast majority of men have simply no way of
judging their fertility before getting married (unless, of course,
they have had a premarital affair and fathered a pregnancy - the
ultimate proof of male fertility ! Rarely, however, some men may
know they have a fertility problem - for example, a sexual problem
of impotence, which prevents consummation of the marriage; or one
of hypospadias (in which the urethra is located at the base of the
penis and the semen cannot be put in the vagina); or undescended
testes (in which both the testes are not in the scrotum).
When testing a couple for infertility, the man
must always be tested first. Tests for the woman are far more complicated,
invasive and expensive - it is much simpler to find out if the man
has a problem.
Where should the semen analysis be done ?
The most important test is an inexpensive one
- the semen analysis. The fact that it is so inexpensive can be
misleading, because many patients ( and doctors ! ) feel that it
must be a very easy test to do if it is so cheap, which is why they
get it done at the neighbourhood lab. However, its apparent simplicity
can be very misleading, because in reality it requires a lot of
skill to perform a semen analysis accurately. However, it is very
easy to do this test badly (as it often is by poorly trained technicians
in small laboratories) , with the result that the report can be
very misleading – leading to confusion and angst for both patient
and doctor. This is why it is crucial to go to a reliable andrology
laboratory which specialises in sperm testing for your semen
analysis, since the reporting is very subjective and depends upon
the skill of the technician in the lab.
How do I provide a sample for semen
analysis ?
For a semen analysis, a fresh semen sample, not
more than half an hour old is needed, after sexual abstinence for
at least 2 to 4 days. The man masturbates into a clean, wide mouthed
bottle which is then delivered to the laboratory.
Providing a semen sample by masturbation can be
very stressful for some men - especially when they know their counts
are low; or if they have had problems with masturbation "on
demand" for semen analysis in the past. Men who have this problem
can and should ask for help. Either their wife can help them to
provide a sample - or they can see sexually arousing pictures or
use a mechanical vibrator to help them get an erection.
Some men also find it helpful to use liquid paraffin
to provide lubrication during masturbation. For some men, using
the medicine called Viagra can help them to get an erection, thus
providing additional assistance. If the problem still persists,
it is possible to collect the ejaculate in a special silicone condom
(which is non-toxic to the sperm) during sexual intercourse, and then send this to the laboratory
for testing.
The semen sample must be kept at room temperature;
and the container must be spotlessly clean. If the sample spills
or leaks out, the test is invalid and needs to be repeated. Except
for liquid paraffin, no other lubricant should be used during masturbation
for semen analysis – many of these can kill the sperms. It
is preferable that the sample is produced in the clinic itself -
and most infertility centres will have a special private room to
allow you to do so - a "masturbatorium".
How does the lab analyse the semen ?
After waiting for about 30 minutes after ejaculation, to allow the
semen to liquefy, the doctor will check the semen.
- The volume of the ejaculate. While a
lot of men feel their semen is "too little or not enough"
, abnormalities of volume are not very common. They usually reflect
a problem with the accessory glands - the seminal vesicles and
prostate - which are what produce the seminal fluid. Normal volume
is about 2 to 6 ml. A very low volume will cause problems, because
too little semen may mean that the sperm find it difficult to
reach the cervix. A very high volume surprisingly will also cause
problems, because this dilutes the total sperms present, decreasing
their concentration.
- The viscosity. During ejaculation the
semen spurts out as a liquid which gels promptly. This should
liquefy again in about 30 minutes to allow the sperm free motility
. If it fails to do so, or if it is very thick in consistency
even after liquefaction, this suggests a problem - most usually
one of infection of the seminal vesicles and prostate.
- The pH. Normally the pH of semen is
alkaline. An alkaline pH protects the sperms from the acidity
of the vaginal fluid. An acidic pH suggests problems with seminal
vesicle function – either absence of the seminal vesicles,
or an ejaculatory duct obstruction.
- The presence of a sugar called fructose.
This sugar is produced by the seminal vesicles and provides energy
for sperm motility. Its absence suggests a block in the male reproductive
tract at the level of the ejaculatory duct.
The most important test is the visual examination
of the sample under the microscope.
What do sperm look like ?
Sperm are microscopic
creatures which look like tiny tadpoles swimming about at a frantic
pace. Each sperm has a head, which contains the genetic material
of the father in its nucleus; and a tail which lashes back and forth
to propel the sperm along. The mid-piece of the sperm contain mitochondria,
or the power house, which provide the energy for sperm motion.
Ask to see the sperm sample for yourself under
the microscope - if normal, the sight of all those sperms swimming
around can be very reassuring . You are likely to be awestruck by
the massive numbers and the frenzy of activity. If the test is abnormal,
seeing for yourself gives you a much better idea of what the problem
is! A good lab should be willing to show you, and to explain the
problem to you.
Fig 1.
Sperm as seen under a microscope
You can also see
a video of what live sperm look like under the microscope here.
continued
. . .
Next
page: Testing the Man - Semen Analysis (Page 2)
Previous page: Finding
Out What’s Wrong -- The Basic Medical Tests
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