The Test Sample
What is being tested?
A semen analysis measures the quantity and quality of the fluid released during ejaculation. It evaluates both the liquid portion, called semen or seminal fluid, and the microscopic, moving cells called sperm. It is often used in the evaluation of male infertility.
Semen is a viscous, whitish liquid that contains sperm and the products from several glands. It is fairly thick at ejaculation but thins out, or liquefies, within 10 to 30 minutes. Sperm are reproductive cells in semen that have a head, midsection, and a tail and contain one copy of each chromosome (all of the male's genes). Sperm are motile, normally moving forward through the semen. Inside a woman's body, this property enables them to travel to and fuse with the female's egg, resulting in fertilization. Each semen sample is between 1.5 and 5.5mL (about one teaspoon) of fluid, containing at least 20 million sperm per mL, and varying amounts of fructose, buffers, coagulating substances, lubricants, and enzymes that are intended to support the sperm and the fertilization process.
A typical semen analysis measures:
- Volume of semen
- Consistency (thickness) of the semen
- Sperm concentration (density)
- Total number of sperm (sperm count)
- Sperm motility (percent able to move as well as how vigorously and straight the sperm move)
- Number of normal and not normal (defective) sperm in terms of size and shape (morphology)
- Coagulation and liquefaction
- Fructose (a sugar in semen that gives energy to sperm)
- pH (acidity)
- Number of immature sperm
- Number of white blood cells (cells that indicate infection)
Additional tests may be performed if the sperm count is low, has decreased motility, abnormal morphology, or if the seminal fluid is found to be abnormal. These additional tests may help identify abnormalities such as the presence of sperm antibodies, abnormal hormone levels (testosterone, FSH, LH, prolactin), excessive number of white blood cells, and genetic tests for conditions that may affect fertility, such as Klinefelter syndrome, cystic fibrosis, or other chromosomal abnormality.
In some instances, radiologic testing using ultrasound, CAT scanning, or MRI may be employed. A biopsy of the testicle may also be needed. Sometimes a test called cryosurvival is done to see how well semen will survive for long-term storage if a couple would like to store sperm for future pregnancies.
How is the sample collected for testing?
Most laboratories require samples to be collected on-site as the semen needs to be examined within 60 minutes after ejaculation in order to maintain the quality of the specimen.
Semen is collected in a private area by self-stimulation. Some men, for religious or other reasons, might want to collect semen during the act of intercourse, using a condom. If this is the case, the health care provider should provide the condom or sheath because lubricated condoms can affect test results.
Sperm are very temperature-sensitive. If collection is done at home, the sample should be kept at body temperature (98.6oF/37oC) by keeping it next to the body during transportation. It should not be left at room temperature for an extended period of time and should not be refrigerated.
Sperm motility decreases after ejaculation; thus, timing and temperature are critical to obtaining accurate information. Poor sampling may require repeat testing.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
To give sperm a chance to replenish, abstain from ejaculating for 2 to 5 days before the sample is collected. Longer periods of abstinence may result in a greater volume of semen but decreased sperm motility. You may also be asked to avoid alcohol consumption for a few days before the test as well. Follow any instructions that are provided.