Fertility – Diagnostic Semen Analysis for subfertility

1. Getting Your Test Requested
   • Before attending for a semen analysis at Fertility Exeter, you must first see a clinician at your GP practice to request semen analysis.
   • Your GP should have given you a plastic sample pot with either a barcode label, or a request form with your details. The request form should have been completed and signed by your GP.
2. Getting Your Appointment Booked
   • • You will need an appointment to submit your sample for analysis. This can be booked online at www.fertilityexeter.co.uk.
     • Like any other medical appointment, your appointment time is specific. If you are running late or struggling to produce your sample, please let the clinic know. If you miss your appointment time by more than 15 minutes without notifying the clinic that you are running late, you will be asked to reschedule.
3. Getting Your Sample
   • You should abstain from having an orgasm for 2-3 days before your appointment, for the most accurate results.
   • – You should provide your semen sample through masturbation. Producing by the withdrawal or ‘pull out’ method is not recommended, because you might not capture all of the sample, and contamination from the vagina can affect your results.
   • You should produce your sample without the use of any shop-bought or natural lubrication, including saliva. Shop-bought lubricants contain chemicals that can harm sperm, and natural lubricants such as water or saliva are also harmful to sperm. Your result may be misleading if lubrication has been used.
   • Ideally, your semen sample should be submitted to the clinic within 60 minutes of production, but up to a maximum of 90 minutes is acceptable. If this is not going to be possible for you due to distance from the clinic, then there are on-site facilities for you to produce your sample. Please let the clinic know in advance if you would like to use these facilities, by booking a “sample on-site” type of appointment.
   • It is important you do not produce your sample in a public place, such as a hospital/public toilet, or in your car.

Please note that the information below is specific to semen analysis performed at Fertility Exeter. If you have had a semen analysis performed elsewhere, please contact the lab for guidance on your results.

Definitions

• “Semen” refers to the fluid that is ejaculated, which the sperm are contained in.
• “Sperm” refers to the cells contained within the fluid you ejaculate, which must swim through the female reproductive tract to fertilise an egg.

Volume

• Volume refers to how much semen you produced when you ejaculated.
• A volume over 1.5ml is considered normal.
• If the volume is over 6.5ml, you may have some inflammation in your reproductive tract, and you should speak with your doctor.
• The volume may be low if you did not catch all of your sample in the pot. Please let your doctor know if you did not catch all of your sample in the pot and you think this might have affected the results.

Sperm Concentration

• Concentration refers to the number of sperm cells per millilitre of semen
• A concentration over 16 x10⁶/ml (16 million per ml) is considered normal.
• Having a lower concentration of sperm can mean there are less sperm available to fertilise an egg, making pregnancy less likely.
• If the concentration of your sperm has been given as a range (e.g. “30-40” or “60-70”) this means that the concentration has been estimated. This is usually because your sample was viscous. ‘Viscous’ means the semen had a thick, sticky consistency. This can make it difficult to perform an accurate count. Sometimes there is a reason semen is viscous, such as inflammation in the reproductive tract or dehydration. However, for most people with viscous semen, there is no obvious reason why.

Motility

• Motility tells you the percentage of sperm which are motile (moving). Sperm need to be motile, to move through the female reproductive tract and reach an egg.
• At least 42% of your sperm should be motile.
• A reduced proportion of motile sperm may mean less sperm are travelling through your partners reproductive tract, making pregnancy less likely.
• Sometimes, sperm are moving but they are doing so slowly, or they are not progressive (i.e. they are only moving on the spot). If a large portion of your sperm are moving slowly or non-progressively, this will be clearly noted on your report. This is still considered an abnormality with motility.

Morphology/Normal Forms.

• Morphology refers to the shape of your sperm.
• At least 4% of your sperm should have a normal shape.
• It is thought that a sperm which does not have a normal shape may be less likely to pass through the reproductive tract and may have reduced ability to fertilise an egg. However, research supporting this is mixed, and scientists have different opinions about the importance of this value.
• Low morphology may be linked to lifestyle factors such as smoking, obesity, drug use, and poor diet.

Total Effective Count/Total Motile Sperm Count

• The Total Effective Count (TEC) – also called the Total Motile Sperm Count (TMS) – refers to the total number of motile sperm in the entire sample.
• A TEC/TMS above 20 million is considered normal.
• If the TEC/TMS is below 20 million, it is likely you have male factor subfertility.

Low sperm count, low motility
The semen analysis report will advise the GP on the report of “abnormal” ranges. If this is the case, a repeat sample is required, with a minimum interval between tests of 6 weeks.
If the repeat sample confirms abnormality, the GP will discuss the option of referral to Fertility Clinic as a couple. It is important to note that fertility referrals in Devon require all information and investigation test results for both partners to be completed and attached.
Devon Assisted Conception policy

Azoospermia
When there is a complete absence of sperm cells in the ejaculate it is called “azoospermia”. This should be confirmed on a second (repeat) sample, minimum of 6 weeks after the first test.
If you have been found to have azoospermia, it is necessary to get a specialist referral to the Fertility Clinic to discuss your options, alongside other required investigations. It is important to note that fertility referrals in Devon require all information and investigation test results for both partners to be completed and attached.
Devon Assisted Conception policy

While lifestyle changes may not improve sperm quality in all cases, they can support overall reproductive health.
However, if you are not ready to seek fertility treatments, there are several things you could try. These include:

• Stopping smoking
  • as research shows smoking can affect sperm
  • speak with your doctor or a pharmacist if you think you would benefit from help stopping smoking
  • Support available for managing stopping smoking can be found here.
• Stopping use of any recreational drugs, including cannabis,
  • as research shows these can affect sperm
  • speak with your doctor or a pharmacist if you think you would benefit from help stopping recreational drugs
• Stopping use of any non-prescription* testosterone, including steroids used by gym-goers to build muscle
  • there is a strong link between these products and reduced sperm count
  • *=consult your doctor if you are taking prescribed testosterone. Do not stop your medication without advice.
• Stopping use of protein powders/shakes
  • these often contain traces of testosterone/steroids even when this is not listed as an ingredient, and research is beginning to show a negative effect of these products on sperm
• Eating a balanced diet
  • speak with your doctor or a pharmacist for advice on weight loss and eating a balanced diet.
• Losing weight if you are overweight or obese
  • research shows that men are more likely to have reduced quality of sperm if they are overweight
  • speak with your doctor or a pharmacist for advice on weight loss and eating a balanced diet.
  • Support available for managing your weight can be found on our weight management page
• Avoid overheating your testicles – by, for example:
  • Wearing loose boxers
  • Taking showers instead of baths and avoiding hot tubs
  • Avoid sitting for prolonged periods of time
  • Avoid placing heat-generating devices like laptops directly on your lap

It is recommended that you wait three months after making any lifestyle changes, before repeating your semen analysis to assess improvement. This is because it takes approximately three months for the testicles to produce a new ‘batch’ of sperm.

The evidence for over-the-counter supplements is limited, so they are not medically recommended to improve sperm. However, taking supplements can help you to feel healthier and can form part of a healthy diet by ensuring you are getting all the vitamins and minerals you need.  Speak with your doctor if you are unsure.

Lifestyle changes do not usually benefit patients diagnosed as being ‘azoospermic’, which is when there is a complete lack of sperm in the ejaculate. The exception to this, is if you have been taking testosterone-containing products.

NHS Website – offers an overview of causes of infertility, which investigations patients might expect to have, and possible treatments. https://www.nhs.uk/conditions/infertility/

Human Fertilisation and Embryology Authority – offers practical information about fertility treatment for people in a wide range of circumstances. https://hfea.gov.uk

If you have been referred for a specialist opinion your details will be reviewed and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

 If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.

• Waiting times
• Find services near you

Support for managing male factor subfertility

Nexys Fertility – Peer support, information and guidance for men experiencing fertility challenges and male infertility. https://www.nexysfertility.com/

HIMFertility – a campaign by comedian Rhod Gilbert. The website is comprehensive in addressing causes of male infertility, debunking myths around male fertility, and provides a link to a Male Infertility support group on Facebook  https://www.himfertility.com/