What Is A Normal Sperm Analysis?
The lower bench mark for normal sperm counts may be a reflection of overall decline in men's heath and significant interference from reproductive toxins, poor diet and lifestyles which are not fertility-friendly.
It's important to note that higher sperm counts, motility and overall sperm quality may help speed the time to conception and are in associated with significantly increased fertility. So being 'normal' - especially low/normal - may not optimal when you want to achieve peak fertility and speed conception.
Male factor infertility is the sole cause of infertility in approximately 20 - 30% of cases, and male factor combined with female factor is associated with 40-50% of all infertility cases. Male infertility or sub-fertility is usually diagnosed based upon the results of a single semen analysis, which should ideally be performed early on in a couples infertility work-up, but it's still not unusual to find the focus of investigative work placed on the female partner first.
Identifying a semen problem in the early stages of infertility can help couples begin a targeted natural treatment program to improve semen parameters - or if a serious untreatable sperm problem is discovered, couples are apprized sooner of the need to move on to high tech methods of conception.
But reproductive endocrinologists sometimes fail to convey the fact that many natural, antioxidant-based treatments for sub-fertile semen - such as antioxidants, vitamins and some herbs - are often dramatically effective for restoring various aspects of sperm health.
Despite the vast number of studies on various nutritional and herbal treatments for male sub-fertility and infertility physicians seem to rarely share this information with patients and may instead hasten the progression to intra-uterine insemination (IUI) or IVF with ICSI. Although urologists seem to share information on natural treatments more readily, many men with sub-fertile sperm are cared for largely by a reproductive endocrinologist.
Sometimes a month is all it takes to make a significant shift but ideally a three month treatment program is recommended as this is approximately the time period that it takes to make a sperm from start to finish.
Natural treatments which focus on increasing sperm count, motility and morphology can also have a positive effect upon another measure of sperm quality called DNA fragmentation which may multiply the fertility boosting effect of a natural treatment program.
High levels of sperm DNA fragmentation have been linked with IVF/ART failure and miscarriage and sperm DNA integrity can improve markedly with specific antioxidant treatments.
When a sperm analysis does show a problem, repeating the test a few months later is helpful for confirmation as semen tests can vary significantly from month to month and various factors, such as fever, medications, and lifestyle factors can interfere with healthy sperm production.
So let's take a look at how the guidelines for sperm analysis parameters have changed. The following changes were proposed by the World Health Organization at the end of 1999 and are outlined below. They differ from the old semen analysis reference ranges in a number of ways - and the new cut-offs are far lower than average values which are noted for comparison.
These WHO guidelines were defined through extensive studies on the semen of 4,500 men in 14 different countries spread over 4 continents, all the men had their fertility confirmed through their partners becoming pregnant in less than a year of trying to conceive.
Here are the new minimum values for normalcy according to the new WHO guidelines:
Normal semen volume: now minimum 1.5 ml
Previously minimum semen volume was set at 2.0 ml, this is the total amount of liquid semen produced in one ejaculation, yet the average semen volume in the study was 3.7 ml.
This number can be low simply because of 'performance anxiety' which may cause a lower than usual amount of semen to be produced. If this becomes an issue a special collection condom can be requested and the sample can be collected more naturally at home, but it is essential that the sperm is tested within an hour of ejaculation for accurate results.
Ejaculating within the 2-3 days abstinence period before the test can decrease the volume also.
It's important to get an accurate measure of semen volume because other measures of sperm health are affected by volume. A low semen volume may magnify the effect of a low sperm counts or a low percentage sperm with good motility or morphology. Similarly, if the volume is naturally high, the effect of low/normal semen parameters may be less meaningful.
Sperm Concentration - This is the number of sperm per ml and is now set at 15 million/ml
Previously this value was set at 20 million/ml, so this new value is 25% less than the previous reference range and the average sperm count is thought to be around 60 million/ml. The average sperm count in this study was 73 million/ml.
Sperm count is important because when it falls too low - under 5 million/ml - IUI is thought to be rarely successful which speeds progression to IVF with ICSI. Abnormally low sperm counts are called oligozoospermia.
Sperm count values above 15 million are now considered normal although it's important to remember that higher values may increase fertility. Previous studies (2) have shown that the probability of conception is increased with increasing sperm concentration levels up to a threshold of 40-50 million/ml indicating that the new lower limit for normalcy is not ideal for optimal fertility. Low-normal may not optimal.
When sperm concentration levels fall below 40-50 million/ml natural strategies to improve sperm health may help to up the odds of conception. Given average sperm count values, it's possible that levels between 15 million/ml and 40 million/ml represent a category of male sub-fertility that may result in a speedier conception if corrected.
Natural treatments such as nutritional supplements, herbs and acupuncture have been found to be successful for raising sperm counts and concentration which can sometimes open up previously inaccessible treatments such as IUI - and natural conception - when ICSI was thought to be the only option.
Progressive motility: now minimum 32%
This measure of motility demonstrates that the sperm have a good purposeful forward motion giving them a sense of direction which is vital for them to reach their destination.
Total Motility: now minimum 40%
This value includes all motile sperm, those with forward motion and those with more random motion. Previously this values was set at 50%, making this another downward shift in the accepted limits of normalcy. The average sperm motility value in the study was 61%.
Studies show that when sperm have greater the motility the chances of conception may go until a threshold of 60% motility is reached. After that point greater motility does not seem to make a difference. When men have low/normal sperm motility values natural fertility strategies may be able to help speed time to conception. Poor sperm motility is called asthenospermia.
Morphologically Normal: now minimum 4%
Previously this value was set at 15% and refers to the number of sperm with normal shape and structure, 4% is considered the new bottom line of normalcy although the average percentage of morphologically normal sperm in the study was 15%.
Morphology values between 0% and 4% are termed 'teratospermia' a condition known to greatly impair fertility often requiring ICSI.
Previous studies indicate that fertilization rates maybe higher when numbers of morphologically normal sperm are above 14%, and indicate that fertilization rates may be poor when the numbers of morphologically normal sperm drop to 4% or below (1).
A number of studies have found fertilization capacity may increase with better sperm morphology suggesting that the morphology influences a sperm's ability to fertilize an egg and some have shown that sperm morphology under 9% may quadruple the likelihood of male infertility (2).
If sperm morphology is in the low-normal range, consider using natural fertility strategies to boost sperm to raise levels or morphologically normal sperm closer to the normal average.
It's important to realize that there are other hidden aspects of sperm quality that matter, aside from sperm counts, motility and morphology. A super-valuable test for a closer peak at sperm health is the sperm DNA fragmentation test and may be worth considering, especially after IVF failure. As with other aspects of male infertility, poor sperm DNA quality can respond well to antioxidant treatment if you follow a high quality program.
This article is for informational and educational purposes only and is not a substitute for medical diagnosis or treatment for which you should consult a physician.
I regularly post extra updates on new fertility research, tips and strategies, along with research on environmental toxins and fertility on my Facebook page
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Kruger TF, et al., 'Predictive Value of Abnormal Sperm Morphology in In-Vitro Fertilization, Fertil Steril 49:112,1988
Guzick et al., 'Sperm morphology, motility and concentration in fertile and infertile men.' New Eng J Med, 345:1388, 2001
www.who.int/reproductivehealth/topics/infertility/cooper et al hru.pdf
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