What Is A 'Normal' Semen Analysis? Debunking the Numbers
Doing some research for a talk I have coming up, I came across an article from the ASRM (American Society For Reproductive Medicine, the association that sets the standards of care in conventional reproductive endocrinology) about male fertility that made me pause. I read articles from the ASRM often, to keep up-to-date with what our patients can expect from their conventional fertility docs and see if there’s any new research that pertains to natural fertility optimization. It was a committee opinion article on investigation of the infertile male that I was reading at the time of my pause, and I thought our readers might find it interesting.
A semen analysis is the first, and sometimes only, way that a male patient is evaluated by the lab when a couple is having trouble conceiving. When couples haven’t conceived after a year of trying, a male factor is solely to blame in about 20% of cases; male factor contributes to the problem in another 30-40% of couples (making it more common than most couples think). The fact that an abnormal semen analysis doesn’t have to be present for there to be a male factor involved, is the reason this article was written. You have a couple with difficulty conceiving, his semen is ‘within normal limits’ – then what?
As the authors note, “patients with normal semen quality may have sperm that either are incapable of oocyte fertilization or harbor genetic abnormalities that prevent normal fetal development.” Which is huge! Many women with male partners who are TTC, when I ask about their partner’s semen analysis, shrug it off saying that the numbers were ‘normal’ and thus, the problem can’t be with him.
That statement, from the ASRM, casts doubt on that conclusion.
A semen analysis is pretty straightforward – a man provides a sample that is analyzed in the lab within a certain timeframe for a number of different parameters. Semen volume, sperm concentration, motility and morphology are evaluated. In a table in the article I was reading, the usual reference ranges are seen:
“On at least two occasions" the numbers should be above these listed here, considered the lower limits of 'normal.'
Ejaculate volume 1.5mL
Sperm concentration 15 x 10(6) spermatozoa/mL
Total sperm number 39 x 10(6) spermatozoa/ejaculate
Percentage motility 40%
Forward progression 32%
Normal morphology 4%
Sperm agglutination Absent
Viscosity </= 2cm thread after liquefaction
These lower limits of the accepted reference ranges come from data from the World Health Organization, published in 2010.
The way that things are typically interpreted, is in regards to where a man’s numbers lie in relationship to the above lower limits – docs determine whether a man could be part of the infertility issue, based on his numbers.
However, when you look more closely at their explanation of the ranges, you see something interesting.
Here, they start talking about men with documented fertility, versus those who are infertile, and where their numbers were:
“The semen parameters of men with documented fertility have been compared with those of infertile men among couples participating in a clinical trial of superovulation and intrauterine insemination (IUI).”
They then go on to say: “Sperm parameters that predicted male fertility were sperm concentration >48 million/mL, sperm motility >63% and sperm morphology >12%.”
Those numbers are quite a bit higher than the lower limits of a semen analysis.
So in basic terms, ‘passing’ a semen analysis does not mean that you’ve got great sperm quality, and certainly doesn’t guarantee that you’re fertile.
The last bit of this discussion ends with this: “Parameters that predicted male subfertility were sperm concentration <13.5 million/mL, sperm motility <32%, and sperm morphology <9% normal.”
Why is this so interesting to me? Because most couples, when they see that all of the man’s semen analysis parameters are ‘within the normal limits’ – ie. not lower than the lower limits of the reference range – they take that to mean that he’s perfectly fertile, and their issue is solely a female one.
But this article, from the board who sets the standards for all reproductive endocrinology in North America, shows that even numbers that are slightly higher than that lower limit mean that a man is ‘subfertile.’
What we tell our patients is this – passing a semen analysis is great, but it’s not the whole story. Having 4% of your sperm look normal may pass the test, but there’s always room for improvement. Until a male patient achieves the numbers that “predicted male fertility” (concentration >48, motility >63%, morphology >12%), I am always striving to improve sperm quality.
A healthy diet, stressed-reduced lifestyle, regular moderate exercise (no long distances on bikes, though), no excessive heat (laptops off the lap, no hot tubs), good hydration status, acupuncture, and healthy intake of Omega 3 fats, antioxidants and minerals, are imperative for any man who wishes to make a baby.
Call Acubalance at 604.678.8600 to schedule a free 15-minute consult with one of our docs, if you’re concerned about your sperm quality. We work with you for three months, then have you re-do the semen analysis to see what kind of an impact our therapies are having. Very frequently, we see improvements in sperm count, motility, morphology, and semen volume and viscosity when we clean up a man’s diet and provide the essential nutrients needed to create good sperm.
And ladies – get your guy involved!! Let him know that passing a semen analysis doesn’t actually give him a pass on prepping for baby. Good quality eggs, sperm, and a healthy, receptive uterine environment are all necessary to create a healthy baby. It really does take two :)
Dr. Kali MacIsaac HBSc, ND