We are receiving more and more questions each month from male readers who are trying to get to grips with why they are struggling to conceive. So, we turned to Shabana Bora, Consultant Gynaecologist and Victoria Wells, Clinical Embryologist from The Lister Fertility Clinic,to answer the most frequently asked questions about sperm
When you are told that you need to have a sperm test, what should you expect?
When a couple have been trying for a pregnancy they may wish to check that the sperm is normal as part of the initial investigations. This is easily requested by the GP who can refer you to have the test at the local hospital or you can pay to have a test performed privately. The test can be done in the hospital if they provide a private room or it can be done at home. Samples produced at home need to be organised with the laboratory performing the test and then taken to the clinic within 1 hour. The results of the test are usually processed immediately by the laboratory but the time it can take to have the result explained can vary from clinic to clinic. If the test is performed through the GP, the GP can explain the results to you.
How long should you abstain before a sperm test?
We recommend that the period of abstinence is between 3 and 5 days, this is to standardise the results and to ensure that there is enough sperm to obtain an accurate analysis of the sample.
How is sperm tested?
The most basic sperm test involves a small amount of the semen sample being pipetted onto a specialised microscope slide. The slide is examined by a highly trained Andrologist or Embryologist using the high magnification of the microscope.
What are you looking for?
A special grid on the slide means a count can be made of the number of sperm, the percentage that are moving and how well they are moving. The morphology (shape of the sperm) can also be assessed and the overall volume of the sample is also measured. The Lister offers a comprehensive semen analysis as standard and also checks for anti-sperm antibodies, and then prepares the sperm sample as if it was being used for fertility treatment. This provides a useful insight to confirm the types of fertility treatment that the sperm sample might be used for
What determines whether sperm is good quality?
A good quality sperm is one which can ultimately fertilise an egg and create an embryo that can result in the birth of a healthy baby. This is determined by the quality and quantity of the genetics inside the sperm head, ultimately packaged into a normal morphologically shaped sperm, capable of swimming and penetrating an egg to fertilise it. There is no way to identify a healthy sperm just by looking at it but if an overall semen assessment is normal then we would generally expect there to be good quality sperm in the sample, though unfortunately this is not always the case. More specialised tests such as DNA fragmentation testing, or poor embryo development in an IVF cycle can provide extra information about sperm quality.
Some sperm may not appear to be good quality as they do not meet the initial criteria of normal morphology or they may be completely immotile. However, ICSI or IMSI means that they can still be used in fertility treatment and may potentially be genetically normal.
What is the difference between mobility, motility and morphology?
Motility and mobility refer to how many of the sperm in a sample are moving and how well they are progressing. This is essential information as there may be a situation where a sample has a high count but very few that are moving which would have a significant impact on the fertility potential.
Morphology refers to the shape of the sperm. Sperm need to have a smooth oval head and single long tail to be able to move progressively and attach to the surface of an egg. Given that a normal sperm count is in excess of 15 million/ml, it can be surprising to learn that the vast majority will have an abnormal morphology! A normal morphology score is 4%, so effectively 96% of the sperm cells in the sample can be abnormally shaped and, providing the other parameters are normal, then it would be graded as a normal sample.
If you have a low level of any of the above (mobility, motility and morphology) is there anything you can do to increase the level? If yes, what, and how long does it take to improve?
If sperm production is being negatively affected by a factor such as smoking or poor diet then lifestyle changes will have an impact for some men. Some men do seem to have low or poor sperm parameters for no easily discernible reason so there may not seem any improvement even when they try to make lifestyle changes.
It is important to bear in mind that even if a sperm count remains low after a 3 month regime of making positive changes, then there may be some benefit on a genetic level that can not be identified through a routine semen analysis so a healthy lifestyle is worth undertaking by all men hoping to achieve a pregnancy with their partner.
The sperm production cycle is approximately 3 months long, so any positive changes won’t generally have an impact for at least three months.
What should a good sperm report look like? What are the figures your sperm needs to reach in order to be viable?
The World Health Organisation have determined the criteria that a sperm sample needs to meet in order to be considered within fertile parameters.
Minimum Volume 1.5ml
Minimum Sperm Count 15 Million/ml
Total Motile Count of 40%, with at least 32% progressively motile
Minimum 4% normal morphology
However, this should be taken in the contact of trying to achieve a pregnancy naturally. If a man has sperm that is consistently outside the normal defined parameters there might be options to improve the result, or to use fertility treatment often involving ICSI or IMSI to achieve a pregnancy.
What causes poor sperm quality?
Some prescription drugs and the use of illicit drugs, specifically anabolic steroids, can reduce sperm quality and there has been a link between drinking excessive amounts of alcohol and sperm production. Cigarette smoking, pollutants and other environmental factors have also been shown to be damaging to sperm quantity and quality. There has also been a correlation between obesity and stress and male infertility.
Sperm can also become damaged by a number of ways during its production; common problems may be infection, such as STIs or from a varicocele. Varicoceles are swollen veins around the scrotum which can cause the testes to become too warm and affect sperm quality. Surgical treatment of a varicocele may improve the quality over time.
We recommend all men to concentrate on improving lifestyle measures in order to optimise sperm quality when trying for a baby. The avoidance of hot baths, saunas and jacuzzis where possible and wearing loose fitting underwear may be beneficial. I also advise them to avoid heavy drinking, smoking and focus on eating a healthy diet with foods rich in antioxidants, this includes blueberries, strawberries, spinach and kale and reducing the consumption of processed and packaged food. Staying fit and healthy has also been shown to reduce stress levels and improve sperm quality. There are numerous over the counter male fertility supplements which contain all the correct supplementation to ensure healthy sperm production which commonly contain selenium, zinc and vitamins C and E.
Why do some men not have any sperm at all? Is there anything that can combat this?
When it comes to sperm, problems with conceiving may be due to either the amount of sperm produced, the movement of the sperm or the quality of the sperm.
Azoospermia is a term used to describe cases where men have no sperm seen in their sample (this is rare) and can either be caused by a blockage from where the sperm is produced in the testes into the ejaculate or a problem with the production within the testes. If azoospermia is diagnosed the man is referred to a specialist Urologist or Andrologist to investigate the cause. If the problem is due to sperm not being produced due to insufficient hormones then the treatment with hormones may reverse the process. If the problem is due to an obstructive issue (sperm not reaching the testis and therefore the ejaculate) then it may be possible to retrieve sperm directly from the testicle surgically and this sperm then used for IVF with ICSI (intracytoplasmic sperm injection).
At what point do you have to think about using a sperm donor?
In some cases where men are azoospermic where there is no reversible cause then donor sperm can be considered. This is the case if men carry a genetic abnormality preventing normal sperm production for example or in cases where patients have had testicular cancer and/or orchidectomy (removal of the testes). There are numerous sperm banks both inside and outside the UK. Sperm donation can be either known (the donor is a friend or a relative to the male partner) or anonymous. Specialised fertility clinics can help provide information about how and from where to choose and obtain donated sperm and offer options for treatment with donor sperm. Treatment with donor sperm in the UK means that any child born from donation will have the legal right to obtain identifiable information about the donor (name and address at the time of the donation) when they turn 18 years of age. Both donors and recipient patients or couples are recommended to have implication counselling so they fully understand the donation process.
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