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Lab test update - semen analysis

Chemical pathologist Dr Stuart Smellie and obstetrician Mr Jerry Oghoetuoma use a GP case history to discuss use of semen analysis

Chemical pathologist Dr Stuart Smellie and obstetrician Mr Jerry Oghoetuoma use a GP case history to discuss use of semen analysis

How does the sperm count help in managing infertility?

41212692If the female partner is having regular periods and has a ‘day 21' progesterone – actually seven days before anticipated first day of menses – of more than 30nmol/l, she is almost certainly ovulating.

The next step would be to exclude pelvic abnormality by performing a hysterosalpingogram or a laparoscopy and dye test. If a significant semen abnormality is found, this can be avoided or at very least deferred and where possible the male subfertility further investigated.

How should the various other sperm analysis parameters be interpreted and what is their relevance?

This man has a sperm count of about 25% below the lower reference limit, with low normal motility and normal morphology values. This indicates that he is producing sperm of fairly normal quality with borderline motility but that his actual count is on the low side. His testes are therefore functioning. The first thing I would look for is factors that might be reducing his count.

A detailed past medical, social and occupational history should identify possible culprits (see box, below). Do not forget the importance of reducing alcohol consumption and smoking. Also consider any medications he may be taking that reduce the sperm count.

Your local fertility specialist can advise on these.

If the results are suboptimal, should the test be repeated? If so, when?

We would normally say that unless severe oligospermia or azoospermia were present, then a repeat in two or three weeks would be appropriate. If results are borderline, then wait three months for a complete new spermatogenesis cycle to complete before repeating the semen analysis. Meantime it would obviously be appropriate to examine for things such as a varicocele, which is certainly more common in male infertility even if a causal relationship is not certain.

The three-month period will also allow any contributing lifestyle factors to be addressed.

Are there any other tests that should be considered when assessing male fertility?

If the patient has severe oligospermia or azoospermia, the next step is to assess testosterone and gonadotrophins (LH and FSH).

Low testosterone with high FSH suggests non-obstructive Sertoli cell testicular failure, whereas high LH indicates Leydig cell dysfunction.

There may be a few patients with low gonadotrophins. Fertility can often be restored in these so-called hypogonadotrophic hypogonadism patients with exogenous gonadotrophins.

Other tests such as karyotyping would only be used if you had a strong suspicion that the patients might for example have the 47XXY karyotype.

Screening for cystic fibrosis carrier state is also useful in patients with severe oligospermia.

Anti-sperm antibodies and other sperm function tests are best left for a fertility specialist to decide on in individual cases.

What information should be given to men about sample collection to ensure a valid male fertility test?

It is very important that careful conditions are followed when submitting a semen sample. The patient should not have ejaculated for two to three days, the specimen should be obtained by masturbation – rather than coitus interruptus – into a wide-topped container, brought straight to the laboratory and protected from extreme temperatures.

The sample should be taken straight to the laboratory so that it can be examined within the hour.

Mr Jerry Oghoetuoma is consultant obstetrician and gynaecologist at Bishop Auckland Hospital, County Durham

Dr Stuart Smellie is consultant chemical pathologist at Bishop Auckland Hospital, County Durham

Competing interests: None declared

Semen analysis The case Key causes Key causes

Causes of reduced sperm count and/or motility
• Older age particularly after age 40
• Emotional and physical stress
• Overheating – regular use of saunas and so on
• Some recreational drugs – alcohol, cocaine, cannabis
• Occupational exposure to a range of chemicals
• Severe obesity
• Previous irradiation – easily forgotten
• Previous testicular infections or epididymitis – notably mumps, sexually transmitted infections and so on
• Previous genital surgery and trauma

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