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What Does a Male Semen Analysis Measure?

A male semen analysis is helpful when trying to get pregnant

Experts estimate that male factors are to blame in up to 40% of couples who experience fertility issues. A male semen analysis is a valuable tool for couples as they begin their fertility journey.

As a result, many couples find it extremely helpful for the man to take a sperm test at the earliest sign of difficulty in trying to conceive. Compared to many of the female fertility tests, a male semen analysis is non-invasive, relatively inexpensive, and produces results quickly and accurately.

Using the ExSeed Home Sperm Test to check your sperm quality, you can get the same results as analyzing in the clinic using a microscope.

Semen analysis

Fig 1 – Male Semen Analysis with ExSeed Health

What do we measure in a male semen analysis?

Firstly, semen is the fluid a man ejaculates during orgasm. The sperm cells within the semen are the cells that can fertilize the woman’s egg. For most semen tests, the man masturbates into a container, which is then delivered to a laboratory for testing. Almost all laboratories performing sperm tests will evaluate the following semen and sperm parameters:

Semen Volume: Semen volume is the total quantity of ejaculated fluid. A normal amount is between 2 and 5 milliliters. Hypospermia is when the volume is less than 1.5 ml, which is due to for example hormonal abnormalities or ductal blockages. Hyperspermia is a large volume of more than 5.5 ml.

Sperm Count: Sperm count is determined by looking at the semen sample under a microscope. It is a measurement of how many million sperm cells there are in each milliliter of semen. In the literature it also called “Sperm concentration”.

A normal sperm count is 15 million or more sperm cells per milliliter. Oligospermia is when there is below 15 million sperm cells per milliliter. Azoospermia is if there are no sperm cells at all, see Figure 2.

Sperm Motility: Sperm movement

Sperm motility is the forward swimming motion of sperm. For a sperm to fertilize the egg, it must travel quickly through the female reproductive system. This requires a strong swimming action. The World Health Organization (WHO) grades motility as follows [1];

Progressive motility (PR): spermatozoa moving actively, either linearly or in a large circle, regardless of speed.

Non-progressive motility (NP): all other motility patterns with absent progression, e.g. swimming in small circles, the flagellar force hardly displacing the head, or only observing a flagellar beat.

Immotility (IM): no movement.

It’s normal to have more than 32% of progressively motile sperm cells (PR) or 40% as a combination of progressive motile and non-progressive motile (PR and NP). Asthenozoospermia (see figure 2) refers to a condition where a great portion of sperms in a semen sample are immotile or have reduced motility, compared to the WHO reference values.

Total Motile Sperm Count (TMSC): refers to the total number of moving sperm cells in the entire ejaculate.

It is calculated by multiplying the volume (ml) by the concentration (million sperm/ml) by the motility (% moving). Ideally, the TMSC should be above 45 million sperm cells.

What a male semen analyisis measures

Fig 2 – What a male semen analysis measures

Fertility clinics consider the above 4 semen parameters as enough for an initial sperm quality assessment. However, if they discover abnormalities or if infertility persists, one may go to a clinic for a more comprehensive analysis. Such analysis may include:

Sperm Size and Shape – Morphology

Also known as sperm morphology. Abnormal sperm cells may be unable to move normally or to penetrate an egg. As a result, too many sperm cells of abnormal size and shape can pose a significant fertility issue.

Most laboratories will evaluate the sperm cells based on the “Kruger” criteria provided by the World Health Organization (WHO). According to the Kruger criteria, a normal sperm cell must have an oval shape with a smooth outline. At least 4% of the sperms must have an oval head with a connecting mid-piece and a long straight tail.

Take a look at figure 3 to see how a normal sperm cell should look. The condition Tetrazoospermia is when under 4% of sperm cells in a sample are normal.

Sperm cell shapes

Fig 3: A normal-shaped sperm cell (far left), and abnormal sperm cells (all other cells to the right).

Color and viscosity

A comprehensive semen analysis often includes an evaluation of the color and viscosity (thickness) of the seminal fluid, as well as an analysis of the time until the semen sample liquifies. The color should be grey-opalescent. If it appears red-brown, it may be an indication of red blood cells in the ejaculate (Haemospermia). It’s normal for the semen to liquefy in no more than 20 minutes. If it doesn’t liquefy, it may indicate the presence of an infection of the seminal vesicles and/or the prostate.

Semen pH

Semen is typically a slightly alkaline substance, with a normal pH of 7.2-8.0. An abnormally high or low semen pH can cause sperm death. It can also impact the ability of the sperm to swim quickly and/or effectively penetrate the egg.

Sperm Vitality

Sperm vitality relates to how many sperm cells are alive and intact. Dyeing the semen with color determines sperm vitality. The dye stains the dead sperm cells, since they are not intact anymore. The percentage of live sperm should be above 58% to consider it as normal. If it’s below that level, the diagnose is Necrozoospermia.

White blood cell infiltration

It’s normal for semen to contain some white blood cells. However, many white blood cells in a sample may indicate the presence of an infection, which can decrease semen quality. It’s normal when semen contains below 1 million white blood cells/ml. On the other hand, Leukospermia is when it’s above that.

Presence of zinc, fructose, and glucosidase in the semen

The accessory glands release a range of different nutrients in the male reproductive system. Some of these include zinc, fructose and glucosidase. In order to consider a semen sample as normal, the markers should be above a certain limit:

Zinc: ≥2.4 µmol/ejaculate
Fructose: ≥ 13 µmol/ejaculate
Glucosidase ≥20 µU/ejaculate.

What do we need to assess semen quality?

A sufficient first line sperm quality test needs to assess the following:

You get all of the above information when you use our Home Sperm Test. According to the scientific evidence, TMSC is the best indicator of how big the chances are for reaching pregnancy. ExSeed is the only home sperm test device that can provide this on the market.

Male semen analysis: what, when, where, and how? 

There is no perfect male semen analysis test. Some men with low sperm counts can achieve pregnancies without assistance. Other on the other hand with normal sperm count are unable to get pregnant with their partner.

In general, men with better semen parameters have a better chance of reaching pregnancy faster in the process. Optimizing these parameters as much as possible is therefore beneficial for fertility.

At ExSeed Health we encourage all men to have an assessment of sperm concentration and motility. If you test as early as possible, you allow time to improve sperm quality in case there are any inconsistencies.

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Wearing tight pants and underwear

Studies show that men who wear looser underwear have higher sperm concentration and total sperm count compared to men who wear tighter underwear. So, lose the tight clothes and wear something loose to give your testicles some air.

CONCLUSION: learn more about how heat can affect sperm quality here.

Stress

Besides higher mortality rate and various diseases, stress is associated with low sperm quality. Stress is known to be associated with lower testosterone levels and oxidative stress with both playing an essential role in producing and maintaining healthy sperm cells.

CONCLUSION: If you feel stressed, we recommend you get some help so you can have a balanced mental health. For a stress management guide, download the ExSeed app for free and start your personalized action plan today.

Physical activity

Scientific studies show that men who are physically active have better semen parameters than men who are inactive. Fertility specialists also state that regular physical activity has beneficial impact on sperm fertility parameters and such a lifestyle can enhance the fertility status of men.

Prioritizing exercise can help improve your overall health and result in healthy, fast swimming sperm cells that have good chances of fertilizing an egg.

CONCLUSION: Try incorporating exercise in your weekly schedule to you ensure exercising at least twice weekly. We recommend a combination of cardio training and strength exercise. Read more about exercise and male fertility on our blog.

Nutrition

Fast Food
Processed foods damage the health of sperm-producing cells and cause oxidative stress, which lead to poorer sperm quality. Heavy consumption of junk food (every week) can increase the likelihood of infertility since men who consume vast amounts of unhealthy food are at risk of having poor sperm quality. Besides harming your fertility, junk food enlarges your waistline, harms your cardiovascular system, kidneys, and more.

Vegetables
Eating more fruit and vegetables can increase your sperm concentration and motility. It’s important that you consume a healthy diet filled with antioxidants and that you eat vegetables every day. Foods such as apricots and red bell peppers are high in vitamin A, which improves male fertility by nurturing healthier sperm. Men who are deficient in this vitamin tend to have slow and sluggish sperm.

Sugary snacks/beverages: several times a week Excessive consumption of high sugar items can lead to oxidative stress, which negatively impacts testosterone levels and sperm motility. Sugary snacks and beverages are also highly associated with obesity and low fertility.
CONCLUSION: To boost sperm quality, stay away from fast food, processed food, and sugary snacks or beverages. You need to implement a healthy prudent diet filled with necessary superfoods needed for good sperm production. Check out our guide to Male Fertility Superfoods. For personalized guidance and support on how you can start improving your sperm health, check out the Bootcamp.

Heat

Direct heat can inhibit optimal sperm production and cause Sperm DNA damage. Sperm cells like environments that are a couple of degrees lower than body temperature. Avoid overheating from warm blankets, seat warmers, heat from your laptop, hot showers, and saunas.

Cigarette smoking

The exposure to tobacco smoke has significant negative effects on semen quality. The damage of cigarettes and nicotine of course depends on how many cigarettes you smoke per day and for how long, but even low usage (up to 10 cigarettes / day) can inhibit healthy sperm production.  

CONCLUSION: Stay as far away from cigarette smoking as possible if you care about your general health and your fertility. Read more here.

Cell phone

When you have your cell phone in your front pocket, your testicles are exposed to electromagnetic radiation, which studies have shown to damage the sperm cells. Put your phone in the back pocket of your pants or in your jacket pocket.

BMI

There is a clear association between obesity and reduced sperm quality. At least part of the reason for this is that obese men may have abnormal reproductive hormonal profiles, which can impair sperm production and lead to infertility. 

A BMI higher than 30 can lead to several processes in the body (overheating, increase in oxidative stress in the testes, sperm DNA damage, erectile dysfunction) that can have a negative impact on male fertility. This can result in problems when trying to conceive.  

CONCLUSION: BMI is one of the risk factors that influence semen quality and, for example, sperm motility.  

Alcohol

A beer or glass of wine now and then do not really harm sperm quality. But excess alcohol drinking (more than 20 units per week) can reduce the production of normally formed sperm needed for a successful pregnancy.

CONCLUSION: If you want to stay safe, stay under 14 units of alcohol per week. For more information on how alcohol can affect male fertility, take a look at our blog: “Alcohol and Sperm Quality”.

Age

Studies show that women younger than 35 and men younger than 40 have a better chance of getting pregnant. Men can produce sperm cells almost through their entire life, but the sperm cell DNA is more fragile and prone to damage after the age of 40.

As men age, their testes tend to get smaller and softer resulting in a decline in sperm quality and production. These changes are partly because of an age-related decrease in testosterone level, which plays a very important role in sperm

production. Higher male age (>40 years) is not only associated with a decline in sperm production but also with increased sperm DNA fragmentation and worsened morphology (shape) and motility (movement). These negative effects make the sperm cells less qualified for egg fertilization.

CONCLUSION: with an age under 40, you shouldn’t have to worry much about age as a factor in itself. However, studies have shown a slow decline after the age of 30-35 years

and if you are above 40 years of age, your sperm quality can be affected due to increased sperm DNA damage resulting in a decrease of sperm motility and concentration. Remember that you cannot evaluate the quality of a sperm sample by just looking at it – this requires a sperm analysis.