Semen Analysis

This information is provided to help patients understand the mysteries of post-op semen analysis. We get many questions in this area both from our patients and others. 

We advise a semen analysis at 3 and 6 months after the reversal surgery unless pregnancy occurs first. Some patients have a tendency not to get a semen analysis after surgery. Many wait to see if a pregnancy will occur first. To be the most help to couples, it is important for us to have the information that the semen analysis provides.

To begin with, the ejaculate volume should be between 1.5 to 5 cc. The first ejaculate initially is coagulated but liquefies 5 to 25 minutes later due to special enzymes found in the prostate. The viscosity is evaluated. Cases of impaired liquefaction or abnormal viscosity have occurred; their relationship with infertility depends on the remaining semen parameters and further testing. The sperm concentration or density is the number of sperm per milliliter of ejaculate. As a rule of thumb, at least 20 million sperm per milliliter of ejaculate is best.  We have had pregnancies with less than 20 million.

Motility is an extremely important parameter. Motility is the percentage of sperm moving. Without good motility achieving a pregnancy is difficult.  At least 50% motility is needed.  The higher, the better. 

Special viability stains can identify sperm that are not moving but still alive. We have used Proxeed, a dietary supplement, in patients with impaired motility and have had success with some patients. Some labs further grade sperm motility in terms of forward progression. Poor motility with falling sperm concentration suggests the possibility of developing obstruction in the anastamosis. Sperm antibodies can produce poor motility and can cause sperm agglutination or clumping together of sperm cells.

Sperm morphology or shape is always part of the semen analysis. Labs use various criteria for morphology evaluation including ”strict” criteria in which greater than 14% of sperm must meet acceptable criteria to have normal sperm morphology. 

The process of spermatogenesis takes on the average 3 months from the time sperm are formed in the testicle to the point where they can be ejaculated. Certain drugs including certain hormones, some antibiotics, certain drugs for cancer treatment, alcohol, opiates, marijuana and tobacco products are some that have been suspect of impairment of spermatogenesis.  

One cannot base any definite conclusion on only one semen analysis. Several are required to base any treatment decisions. Proper collection technique and abstinence period (2 days) before collection are mandatory to have meaningful results.

We hope that this information will give you some insight into this complex subject.