How is a Semen Analysis Like a Hand of Cards?

Estimated read time: 3 minutes

Men and numbers, what a relationship! Batting averages, golf handicaps, interest rates, stock yields, road race times, you name it. Men are defined by their numbers. Now you’ve had a semen analysis, a whole new set of numbers. What do these numbers really mean?

Mother of All Numbers

The semen analysis should be read in context of the individual. Here is some of that context in which to consider these numbers:

• Ejaculation is a biologic process, like a sneeze, that was never meant to be analyzed, counted, or ordered. But, we do it anyway.
• There is great daily, weekly and seasonal variability in semen quality.
• In and of itself, except when zero, the semen analysis is not a great measure of actual fertility.

Breaking It Down

Here is a loosely structured, high-level view of each of the 4 main variables typically found on a semen analysis.

• This is total amount of fluid in the sample. It arises from 3 sources and varies widely with ejaculation frequency. However, when it is low (below 1.5-2mL) you can hang your hat that something is up. The causes of low ejaculate volume are: collection error, retrograde ejaculation, missing vas deferens, ejaculatory duct obstruction or low testosterone. One of these is the culprit if the volume is low.

• Sperm Count. This is really a “concentration” of sperm per unit of fluid. When it is high, there is really no worry. But when it is low, one should worry, as the sperm count is the closest thing we have to a “biomarker” of a man’s overall health. It is influenced by lifestyle issues (alcohol, hot tubs, obesity, diet, disease, fevers, stress, infections, medications, to name a few), findings on exam (varicocele, epididymitis, blockage) or genetic issues (Y-chromosome microdeletions, chromosome counts).

• Sperm Motility. This is the proportion of sperm that actually move in the sample. And remember, moving sperm do all of the work. Therefore, this variable has the strongest association with actual fertility. Sperm motility appears to be a more sensitive indicator of insults to the body than the sperm count. It also responds more rapidly to corrections than does the sperm count. The same issues that affect sperm count can also affect motility, but they affect motility at lower doses. Other conditions, such as antisperm antibodies or immotile cilia syndromes, only affect sperm motility.

• This is an actuarial analysis of sperm shape. It is a tedious and time-consuming assessment of sperm anatomy that is said to reflect on their “fertilizability.” However, it is difficult to standardize this number well across labs and even among individual technicians. In addition, sperm shape in general has nothing to do with the quality of its genetic payload. Therefore it has little to no clinical value in predicting a successful pregnancy at-home or with assisted reproduction. Typically, a low sperm morphology suggests that the “factory” (testicle) is overheated or somehow impaired and that the product (sperm) that is made has crooked headlights or a bad paint job. It also leads providers to focus more on issues with the individual, his health and the health of the sperm “factory.”

So there you go, a 30,000 foot view of the semen analysis. It’s not really the number of cards you hold as much as it is the quality of the cards and the person who holds them. Words of advice: although you may in fact be “holding all of the cards” they may be “lost in the shuffle.” The cards may not be “stacked against you” but you just need to “play your cards right.”