What Should Happen After You Get Your Semen Analysis Results

Semen analysis in normal range- Although this a positive sign, it does not prove fertility and additional semen/sperm testing should be considered when conception is still not occurring despite 3 or more cycles of precisely timed intercourse with documented balanced menstrual cycles and peak on the woman’s chart. Or if there is a history of miscarriage. Otherwise, it would be prudent to begin focusing on other possible areas of infertility in the couple and then re-test again after several months.

The additional semen or sperm testing that could be pursued includes DNA fragmentation, anti-sperm antibodies, and/or other sperm function testing. Recommendation for this testing may be based on a number of factors such as conception history, length of infertility and other health or fertility factors for both spouses. Due to costs, the timing of this can be determined by the couple.

• DNA fragmentation testing- The most important contribution of the sperm is the haploid DNA that combines with the egg to produce the new unique person. Sometimes the DNA becomes fragmented which would result either in failure of conception or miscarriage. There are several different types of DNA fragmentation tests, and it is best to follow the laboratory’s normal ranges. The sperm chromatin structure assay is the most common test, and it is reported as a DNA fragmentation index. Typically, results below 20-30% are normal, 20-50% are moderate and results above 50% are severe. Moderate levels of DNA fragmentation may be helped with treatment, but severe levels are less likely to result in term pregnancy.

     Abnormal results indicate there are high levels of oxidative stress causing free radical damage. There could also be a metabolic issue resulting in the initiation of programmed cell death (apoptosis) of the developing germ cells. Evaluation for anatomic and endocrine abnormalities should be performed. Infection, varicocele, or smoking will increase the possibility of oxidative stress. In addition to confirming an adequate men’s vitamin intake, anti-oxidants such as hydrogen tablets in water may be beneficial. Moderate levels of DNA fragmentation may be successfully treated but severe levels (> 50%) have a low chance of natural conception.

• Anti-sperm antibody testing- Recommended when there is evidence of sperm agglutination, clumping, or reduced progressive motility. For a positive anti-sperm Ab test, defer treatment for 4-6 effective cycles but then possible treatment with Prednisolone 20mg 2x/day for 10 nights followed by 5mg/day for 2 nights could be tried after a full health analysis is conducted. This should be started 9 days before the woman’s estimated peak day. Men should have a chest x-ray before starting and blood pressure monitoring during treatment and discontinue if side effects are experienced. This strategy can be effective for about 21-33% of men with significant titers of ASAB (Hendry et al., 1986; 1990).
• Sperm function testing- Other sperm function testing may include assessment for the ability of the sperm to fertilize an egg. This testing includes capacitation, acrosome reaction, hemi-zona pellucida binding and hamster sperm penetration assays. These tests are harder to find today however due to the implementation of IVF with ICSI which has caused artificial reproductive technology to be a replacement for research into diagnosis and possible treatments.  There is a lack of data on how to treat the man when these abnormalities are found.

Semen analysis results in abnormal range- If the results come back abnormal, it is a good idea to re-test. Conclusions should never be made based on one lab result. Abnormal results however can be a good motivator to begin diet, exercise and lifestyle changes. A restorative approach should then be started by looking for underlying health issues. Even minor or sub-clinical health issues may affect fertility before it is even otherwise recognized. The amount of testing employed should be weighed against the cost and stress of this testing. Stress has a very negative impact on fertility and finding coping mechanism such as prayer, fasting, asceticism, hobbies, spiritual guidance, etc. should be deployed. Don’t forget to step up and keep romance and fun in your life. The ability to treat or manage the outcome to correct the deficiency should also be considered because unfortunately we don’t know a lot about how to correct male infertility. The severity of the result may likewise also cause more urgency for additional testing.

The following sequence for additional management is recommended.

• Always have a conversation with your provider to rule out errors in collection and transport of the specimen. Abrupt temperature changes, sunlight or contamination can influence the results.
• A second SA should be scheduled to be performed within 3-6 months to confirm results, but use the information to motivate change. 
• Once male factor is identified there should be a differential diagnosis and identification of treatable causes of male factor infertility. A total motile count below 5 million may make conception very challenging but in general, only the absence of sperm will completely rule out the possibility of natural conception.

More information on the differential diagnosis and the testing employed can be found in another article by that name.