Thursday, June 17, 2010

Fertility and the Infamous Semen Analysis

After last week's blog on male infertility, I thought this topic would make for a great follow-up. We are honored to have our advisory board member, Karen Reynolds, L.Ac., M.S., R.N., of Balanced Restored Center, write a guest blog on this topic for us. Thank you, Karen!

A semen analysis, often colloquially called a “sperm count”, is not used only to count sperm.

It also evaluates sperm production (quantity) by the testis, assesses how the sperm are moving (quality), and examines secretions of the genital tract.  A semen analysis does not singularly determine a man’s fertility. Many additional factors must be reviewed and considered. From the standpoint of processing of semen samples: not all labs are the same. In my fertility acupuncture practice, I have stopped sending my patients to larger, unspecialized laboratories, such as those in community hospitals or large corporate labs. This article reviews pros and cons about the types of options available and important considerations for collection for the most accurate results. At the end of this post, I have additionally listed some definitions and terminology.

Semen samples are best processed in an “andrology” lab. Such labs are generally associated with Urology or Reproductive Endocrinology offices.  This is important as a semen analysis is a time-sensitive procedure that requires a certain level of technical expertise to perform accurately. Processing by an andrologist is inherently superior for multiple reasons.  Firstly, an andrologist has advanced training and skills in assessing semen samples and extensive experience in proper handling. Secondly, dedicated andrology labs typically have state of the art equipment with more accurate counting chambers and more formal analytical methodologies. In unspecialized lab settings, semen specimens frequently are relegated to the least senior technician on site, or to the technician available at that moment. For that reason the specimen may be handled and processed by less experienced individuals.

A study published in The Journal of Human Reproduction in 2000 showed marked variability in the same semen samples analyzed at different facilities. Results for the same semen specimen ranged from a count of 3 million sperm/ml to 492 million sperm/ml. Erroneous results can be emotionally devastating, can cause unnecessary stress, can change the course of medical care, and are wasteful.

In other words: your semen analysis results from an unspecialized lab might tell you that
Elvis is in the building but it won’t go into detail about how many cheeseburgers he’s eaten or how well his hips are swiveling. Yes, this is a campy analogy, but I’m sure you understand my point. If you are going to the trouble of spending time and money to produce a sample, you want it to accurately reflect what is going on with your sperm production.

Additionally I strongly encourage men to schedule the semen analysis in conjunction with a
complete medical history and examination by an experienced Urologist. Beyond the natural drive to father a child, each man needs to be evaluated for a disease processes that may cause an abnormal semen analysis, or for mechanical issues or genetic pre-disposition which might affect not only semen quality but his health in the future. Currently it is accepted that infertile men can have higher rates of testis and prostate cancer after the diagnosis of infertility is made.  Unfortunately, the male infertility evaluation is sadly lacking in current conventional practice as the focus has tended toward the women and Assisted Reproductive Technologies (ART). Please remember: a semen analysis alone is insufficient to inform a couple whether male infertility is a) curable, b) caused by an important health condition, or c) a risk factor for late disease development. .

Another vital consideration is your comfort level and how you are treated. At a Urology office such as The Turek Clinic in San Francisco, CA. you will find professional staff, a quiet, private setting and a seamless process for appointments. You can literally show up at 8AM and be completely done well before noon. In those few short hours the semen analysis is collected and processed. The results are interpreted for you the same day by Dr. Paul Turek, and a comprehensive history and physical exam is completed during a consultation hour. It is commonplace to need to meet on-site with Dr. Turek only once and follow ups can be scheduled per telephone, in the comfort of your home or office. Your time will not be wasted and you’ll come away having had a hassle-free, thorough, reliable exam and testing process.

I hope this article is helpful for your journey to fatherhood and having a family.
In my acupuncture clinic, I specialize in male and female fertility, women’s health, and functional endocrinology. Drawing from my 20 years of experience as an ICU nurse, I make extensive use of lab testing. I also utilize acupuncture, dietary changes and nutritional supplementation to optimize health, wellness and vitality for the amazing men and women who I have the great honor treat.

Below are important considerations for obtaining your semen sample as well as some additional information regarding terms you may see on your results.

If you have questions, please feel free to contact me at or at Balanced Restored Center for Integrative Medicine, 415.381.8500 Ext. 4. Also see my blog for additional information:

Semen samples require specific steps in collection and transport. Here are some important directions to assure accurate results.

•Due to religious or personal beliefs, masturbation for sample collection may not be an option for all men.  In this case, inquire with your MD regarding use of a Milex sheath or a Silastic Sperm Collection device. These specialized condoms are non-toxic to sperm, yet allow for effective collection.

•Abstain from ejaculation for 2-4 days prior to semen collection. Longer or shorter periods of abstinence will impact your results.

•Consult with your MD regarding appropriate lubricants for use during collection.
Most lubricants are toxic to sperm or otherwise impact the specimen.

•Collect in a sterile container-obtain this from your MD.

•Make sure the entire ejaculate volume is collected. All is necessary for an accurate test.

•Samples must be kept at body temperature. Place the sample in a shirt pocket to maintain the temperature.

•Deliver the sample within 1 hour to your testing lab.

•Always check with your lab facility to be certain other requirements are not necessary.

World Health Organization Limits of Adequacy for Semen Samples (1999)
Volume             >1.5 ml
Concentration         >20 million/ml
Motility             >50%
Morphology         >30%
Forward progression     2 on a scale of 0-4

Semen Analysis Terms and Definitions
Density=            how many million sperm per milliliter of semen fluid.
Motility=            the percentage of sperm with any movement
Morphology=            pertains to sperm shape and physical characteristics
Forward progression=    quality of sperm movement rated on a 0-4 scale

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