It is not rare, in a urologist’s office, for men to request a sperm count. Commonly requested when a couple is having difficulty conceiving, it begins the process of evaluating the cause of subfertility.

However, many men are unaware of important facts related to the “sperm count”.

A sperm count, a component of the semen analysis, forms the cornerstone of evaluating male infertility.

HOW IS THE SPERM COUNT DETERMINED?

A man’s sperm count is determined from the semen analysis. Semen is composed of fluid, derived from the accessory sex organs (seminal vesicles, which are paired glands adjacent to the prostate, prostate, bulbourethral glands and epididymis) and spermatozoa, or mature sperm cells, that is made in the testis.

ARE THERE SPECIAL INSTRUCTIONS TO COLLECT SPERM FOR A SEMEN ANALYSIS?

The semen analysis must follow standards prior to analysis. These include:

* Men must abstain from sexual intercourse for 2-3 days before providing semen for analysis;

* The sample is frequently collected by masturbation. However, the sample may also be collected by sexual intercourse, using a special condom that lacks spermicidal agents that are detrimental to sperm;

* The specimen may be collected at home or in an appropriate laboratory; and

* The sample must be kept at room or body temperature and examined by the laboratory within one hour

of collection.

DOES A SINGLE ABNORMAL SEMEN ANALYSIS MEAN THAT A MAN IS INFERTILE?

A single semen analysis that is abnormal should not be diagnostic of infertility. There is a wide variability of semen composition in any one individual. This was demonstrated in a study of five healthy volunteers in the placebo arm of a male contraception study. Hence, the recommendation is to have a minimum of 2-3 semen analyses done in the evaluation of men with infertility. This helps to obtain

baseline data.

IF MY SEMEN ANALYSIS IS ABNORMAL, DOES THAT MEAN THAT I CANNOT HAVE A CHILD?

The reference values for normal semen analysis parameters are different from the minimum required for conception. Men may have abnormal semen analyses and father children. Men may also have normal semen analyses and are unable to father children. Therefore, the semen analysis is only a guide for evaluation of fertility status.

WHAT PARAMETERS ARE EVALUATED ON A SEMEN ANALYSIS?

The parameters evaluated on a semen analysis are:

* Semen volume

* pH

* Sperm concentration

* Total sperm number

* Percentage motility of sperm

* Forward progression of sperm

* Morphology

WHAT IS DONE IF TWO CONSECUTIVE SEMEN ANALYSES ARE ABNORMAL?

If consecutive semen analyses are abnormal, further tests, combined with physical examination are required, to determine a cause.

IF TREATMENT IS DONE FOR A REVERSIBLE CAUSE OF INFERTILITY, EG VARICOCELE TREATMENT, WHEN WILL THERE BE AN IMPROVEMENT IN SEMEN ANALYSIS?

After treatment of reversible causes of infertility, it is customary to wait for approximately three months to repeat a semen analysis which should accurately reflect results of the treatment.

SHOULD MEN ROUTINELY REQUEST SEMEN ANALYSES?

Semen analyses should be requested by men in the evaluation of infertility. It need not be a routine test in men who have

no problems.

Dr Belinda F Morrison is a consultant urologist and lecturer at the University of the West Indies and Mona Institute of Medical Sciences, Mona, Kingston 6. Please send questions and comments to belinda.morrison02@uwimona.edu.jm.