In approximately 30% of couples attending for infertility investigations, ‘a male factor’ is thought to be the likely cause of the infertility. In a further 20% of couples, factors in both the man and the woman are thought to be relevant. It is very important therefore for the doctor to evaluate both partners when considering the reasons for, and the most appropriate treatment for a couples’ infertility.

After an appropriate history has been taken by the consultant, the main component of the investigation of the male is a semen analysis.

This involves a laboratory assessment of a man’s ejaculated semen sample.

Semen Analysis

Where and when should a sample for semen analysis be produced?

So that we can ensure that samples reach the laboratory in optimum condition, gentlemen are asked to attend the clinic and produce a sample for analysis in a private, designated room adjacent to the laboratory. In some circumstances it can be arranged for samples to be brought into the clinic for analysis, providing that they are presented within 1 ½ hours of production.

Samples are generally produced by masturbation or on occasion by intercourse using a special condom without a spermicide (provided by the clinic).

A semen analysis should be carried out following 2-3 days of abstinence from intercourse or masturbation. Shorter or longer periods of abstinence could result in a misrepresentative result.

What is assessed in a semen analysis?

Various parameters are assessed on a semen analysis and these are compared with World Health Organisation standards (WHO, 1999). The main features of a semen sample that are assessed are outlined below.

• The volume of the sample The WHO (1999) quotes 2 millilitres (about half a teaspoon) or more as the normal volume for an ejaculate.
   
• The number of sperm that are present in the sample. This figure is often described as the ‘count’, although it is actually the ‘concentration’ of sperm, i.e. the number of sperm in each millilitre of the sample. The WHO (1999) quotes 20 million sperm per millilitre or more as a normal count.
   
• The percentage of the sperm in the sample that are swimming (the motility) and how well the sperm are swimming (the progression).
  The WHO (1999) states that in a normal sample, 50% of sperm or more should be actively swimming.
   
• The proportion of sperm that have a normal size and shape (the morphology).
  Morphology can be assessed by different methods and our routine semen analysis involves examining a fresh sample. By this test, in a normal sample, 35% or more of the sperm would be expected to show a normal morphology.
   
• The presence of anti-sperm antibodies on the sperm. The WHO (1999) quotes binding of anti-sperm antibodies to 50% of sperm as clinically significant, that is, of potential impact on fertility.

Semen DNA Fragmentation

Sperm DNA is packaged by nature in a different way compared to that of other cells in the body. In sperm cells, DNA is arranged in very tight organised loops so that it can be carried safely to its final destination – the egg. Semen protects sperm from several hazards along the journey. DNA fragmentation occurs when particular reactive oxygen species damage the sperm DNA. If damaged sperm is accepted into an egg for fertilisation, poor quality embryos or miscarriage can result.
 

There is a test that can assess this problem. The sperm chromatin structure assay (SCSA®) can measure a DNA fragmentation index (DFI). Information on how the DNA is packed can be achieved through the advanced analysis, the Sperm Chromatin Structure Assay (SCSA®) which is performed by the company SPZ Lab in Copenhagen, Denmark. Read more about the SCSA® and sperm DNA fragmentation at www.spzlab.com

Treatment includes maintaining appropriate temperature for the scrotum, giving up smoking, reducing your weight and ensuring that any medication that you are on does not cause DNA fragmentation.