Many people believe that fertility is primarily a female issue, yet male-factor infertility accounts for at least 30% of infertility cases. This guide to male fertility testing will outline the many possibilities, when—and why—a man should test his fertility, and what to do if the results aren’t what you expected.
THE SEMEN ANALYSIS IS THE CORNERSTONE OF MALE FERTILITY TESTING.
The analysis of sperm is the initial stage in male fertility testing. A semen analysis is a non-invasive test that involves examining a semen sample, which is commonly obtained by masturbation, under a high-powered microscope to detect the quantity and quality of sperm.
A SEMEN ANALYSIS CHECKS FOR THE FOLLOWING:
The concentration of sperm (quantity)
The number of sperm per milliliter of sperm is known as sperm concentration. The number of sperm per milliliter of semen is used to determine sperm concentration. According to the World Health Organization, a typical sperm concentration is at least 15 million sperm per milliliter.
What role does sperm concentration have in male fertility? Because sperm face several hurdles in their approach to the egg after ejaculation, including vaginal acidity, cervical mucus (which can aid or impede sperm’s journey to the egg), and the chance of being lodged somewhere else in the reproductive system, such as up the incorrect fallopian tube. Given that only about 1% of sperm make it to the egg, it’s understandable why starting with a large number of sperm is advantageous.
Motility of sperm (movement)
The movement of sperm is referred to as sperm motility. Flagellations of the sperm’s tail move them forward, with a little aid from the female reproductive system. The motility of sperm affects whether they reach the egg and, if they do, whether they can pierce the egg and fertilize it.
Straight lines or broad, sweeping circles are optimal for sperm movement. Motility refers to the percentage of sperm that move, while progressive motility refers to the percentage of sperm that move in this ideal manner. According to the WHO, a typical result is at least 40% motile sperm (with at least 32% migrating gradually).
Fun fact: For centuries, it was thought that sperm traveled ahead by making fast back-and-forth tail motions (similar to fish), but a new study published in July 2020 found that sperm “roll as they swim, much like joyful otters corkscrewing through water.” The corkscrew motion can only be noticed with highly high-tech equipment, so it doesn’t change the relevance of measurement of motility—but it does give sperm a bit more personality.
morphology of sperm (shape, size, and structure)
According to Legacy, a male fertility company, optimal sperm anatomy looks like this:
- a tail that aids it in “swimming” toward the egg
- a midpiece containing mitochondria that power the motility of the sperm
- a nucleus that stores genetic material for possible offspring, and a skull that houses the nucleus.
- An acrosomal vesicle is a structure at the sperm’s tip that contains enzymes that help the sperm access the egg.
If a sperm is malformed, it may have trouble traveling toward the egg or fertilizing it if it has many heads or tails, no head or tails incorrectly formed parts, or is too big or too little. Morphology, often known as “normal forms,” is a measurement of how many sperm have the right shape, size, and structure (NF). A normal morphology result is 4 percent NF or more, according to the WHO.
Factors affecting sperm
The amount of fluid ejected is referred to as semen volume. Low semen volume—less than 1.5mL, according to the WHO—doesn’t usually have a significant influence on male fertility, but it can signal a blockage in one or more of the male reproductive system’s ducts/glands, which can exacerbate the problem of low sperm count.
Male fertility tests can look at the pH and chemistry of the sperm as well as the volume. An issue in the testicles, such as a blockage or infection, may be indicated by anomalies in semen pH or composition.
When it comes to male fertility testing, all four of the above “semen criteria” are crucial to consider.
MALE FERTILITY TESTING IN THE OFFICE VS. AT HOME
A semen analysis is frequently performed in an andrology (male health-focused) laboratory in a fertility or urology office. The procedure proceeds like this: the male patient receives a sterile specimen cup in which to collect his sperm sample. He can either collect the sample at the office’s “collection room” or produce it at home and bring it to the office, ideally within one hour.
While creating or presenting a semen sample at work is a normal occurrence and nothing to be ashamed of, it can be unsettling for many men. That’s why firms like Legacy offer at-home sperm testing kits, which allow patients to collect their sample at home, mix it with a specific preservation medium, and mail it to the lab. It is no longer necessary to visit the workplace, making it more convenient and less unpleasant.
A word of caution: many at-home male fertility testing devices only test for sperm count, which is only part of the picture of male fertility, as we described previously. If you go this route for male fertility testing, be sure the product you chose provides a detailed report on all sperm parameters.
MALE FERTILITY TESTING AT ADVANCED LEVELS
While sperm analysis is the first step in male fertility testing, more advanced tests can be utilized to diagnose less prevalent disorders in specific cases.
FRAGMENTATION OF DNA TESTING
As previously said, sperm carry genetic material for future offspring—half of it, to be exact. In an ideal situation, this genetic material mixes with the egg’s other half of the DNA to form a fully developed, unique embryo cell, which then divides as the embryo develops.
However, much like with egg quality, sperm DNA can be damaged, making it more difficult for those sperm to fertilize an egg and create a healthy kid. DNA fragmentation is linked to a reduced likelihood of conception and a higher likelihood of defective embryos.
While DNA fragmentation is linked to advanced paternal age, other typical causes include sickness or illness with a high temperature, cigarette smoking or drug usage, and toxin exposure.
Male fertility testing for DNA fragmentation comes in a variety of forms. The sperm chromatin structure assay (SCSA), deoxynucleotidyl transferase-mediated dUTP nick end labeling assay (TUNEL), single-cell gel electrophoresis assay (COMET), and sperm chromatin dispersion test are the most commonly used tests (SCD). (Yay for abbreviations!) While each of these tests uses slightly different technologies, the purpose is the same: to analyze the general state of the DNA within sperm.
Sperm DNA testing is not the same as regular male fertility testing, and because these tests only look at a fraction of the millions of sperm in a single sperm sample, the genetic health of the full sample may not be adequately represented. However, for men who have particular, established risk factors for sperm DNA fragmentation, this type of testing is an alternative.
ANTIBODY TESTING FOR ANTISPAM
Antisperm antibodies, which are immune system proteins that wrongly attack and destroy sperm, can occasionally affect fertility. ASAs can be present in sperm or directly bonded to them in semen. ASAs aren’t a natural byproduct of the immune system; they’re usually the result of damage to the male reproductive system, such as testicular torsion, biopsy, or vasectomy.
Because the presence of ASAs is uncommon, male fertility testing does not include them. If a guy has a normal sperm concentration but very low sperm motility, a doctor may request a test to find ASAs in his sperm (a condition known as asthenospermia).
WHY ARE MALE FERTILITY TESTS CONDUCTED?
The most typical reason for male fertility testing is because a couple is trying to conceive or is having trouble becoming or keeping pregnant. However, a semen analysis can be done before freezing your sperm (to guarantee the healthiest possible sample is frozen), after a vasectomy (to confirm it worked) or vasectomy reversal (to check sperm parameters are recovering appropriately), or simply to have more data points regarding your overall health.
WHEN SHOULD MALE FERTILITY TESTING BE CONDUCTED?
Doctors have always recommended fertility tests after a year of trying to conceive (or 6 months, if the female partner is over 35). Experts at Legacy, on the other hand, believe that completing basic male fertility tests, such as a semen analysis, earlier in the process of attempting to conceive can be advantageous.
Why? First and foremost, a sperm analysis is non-invasive and affordable (in-office testing costs roughly $250, while Legacy’s at-home kit costs $150). Second, because men can enhance their fertility through lifestyle changes (see below), assessing the male partner’s fertility early and taking steps to improve it could save time and money in the long run.
NEXT STEPS AFTER FERTILITY TESTING IN MALE
So, you’ve completed a semen analysis—now what? That is contingent on your outcomes. If everything appears to be in order, you may want to explore freezing your sperm. If you’re having trouble conceiving and a semen analysis revealed nothing unusual, you should see a reproductive endocrinologist (if you haven’t previously) discuss female fertility screening and treatment options.
However, if your results were less than ideal, you have a few options:
MALE FERTILITY IMPROVEMENT
Unlike eggs, which have been in the ovaries since before birth and are unaffected by most of the lifestyle choices women make, sperm are produced on a daily basis, and their health can be considerably influenced by nutrition, exercise, smoking, drinking, and even sleep, among other things.
Some men will discover that merely changing their lifestyle habits—quitting smoking, starting exercising, eating more vegetables and good fats in their diet—can enhance their sperm without the need for medical intervention. (Legacy’s guide to sperm enhancement is a good place to start.)
Because spermatogenesis (the process of making sperm) takes about 74 days, expect to observe a difference in your fertility in 2–3 months if you make adjustments. 2–3 months after adopting a lifestyle adjustment, you may want to repeat male fertility tests to see how effectively it worked.