According to a study published by the World Health Organisation (WHO) in 2012, one in every four couples in developing countries are affected by infertility. Semen analysis of freshly ejaculated sperm remains an essential diagnostic tool in the initial investigation of male infertility. A routine semen analysis is sometimes referred to as a sperm count but, in fact, a proper semen analysis includes much more than just a sperm count. The semen specimen is analysed for volume, viscosity, pH, colour, as well as sperm concentration, motility and morphology. The test is ideally performed following the guidelines set by the WHO methods that haven’t changed much over the past couple of decades.
Diagnostically, a routine semen analysis provides some indication of testicular and genital tract function, but prognostically, a routine semen analysis is unable to either accurately gauge fertility potential or predict reproductive outcome. There are two fundamental approaches to understanding the clinical use of a semen analysis:
- As a means of assessing a mans reproductive health, and
- Whether a mans ejaculate contains enough potentially functional sperm to effectively colonise his partners reproductive tract and reach the site of fertilisation in the Fallopian tubes.
Specifically with regards to the latter, sperm kinematics (characteristics that describe sperm movement, as opposed to the proportion of motile cells) has become the focus of many studies in order to establish real clinical value for semen analysis. Its value is greatly enhanced by adding sperm functional tests such as cervical mucus penetration, hyperactivation and DNA fragmentation.
- Sperm cervical mucus penetration
This test measures the ability of sperm in the semen to pass through cervical mucus or equivalent substance, and is equivalent to the historic Kremer test performed years ago. Studies have shown that at least 5 million sperm in the ejaculate should be able to pass through cervical mucus.
Hyperactivation is a functional change in the sperm movement pattern which usually occurs during the capacitation process one of the important physiological events sperm have to undergo in order to achieve fertilisation. Sperm must be able to go into a whiplash-like motility pattern to help them penetrate the zona pellucida. If this test shows poor results, there is a chance that the sperm may not be able to fertilise an egg on their own, and intracytoplasmic sperm injection (ICSI) may be the best choice. Hyperactivation has been shown to be one of a combination of sperm function tests which can be used to predict successful fertilisation in vitro. The cut-off point for potential fertility is 20% hyperactivated sperm.
- DNA fragmentation
DNA fragmentation is associated with poor embryo development, low implantation rates and high miscarriage rates. Studies have shown that the outcomes of both in vitro fertilisation (IVF) and ICSI were adversely affected when high numbers of sperm with DNA fragmentation were used. Therefore the assessment of DNA fragmentation has been advocated as a predictor of assisted reproductive treatment (ART) success.
Guidelines for semen analysis
Please follow these guidelines when you want to have a semen analysis done for fertility reasons or after a vasectomy.
- 3 Days of abstinence is needed i.e. no sexual intercourse or masturbation.
- The specimen must be produced by means of masturbation only, directly into the sterile container provided by your doctor (also available at any Lancet depot). Be sure to collect the whole ejaculate.
- No condoms or lubricants can be used because of its toxic effect on the sperm.
- Do not contaminate the specimen in any way (soap, water etc.).
- The specimen can be produced at home, provided that it is not older than 1½ hour when it reaches the lab.
- Keep the specimen at body temperature (in the shirt’s pocket or trousers’ pocket). Please don’t allow it to cool down.
- If you had a vasectomy, please allow at least 8 weeks after the operation before you give a specimen to be tested.
These tests are done on appointment only and can only be submitted at certain Lancet Labs.
Please phone us during office hours for an appointment at:
012- 664-8596 (Lab)
083-302-1048 (Sr. Nikki)
- Flora Clinic, 14 ave, Roodepoort – Thursdays only between 7:00 – 8:30 am (Lancet Lab on Lower Ground Floor, use Main Entrance)
- Glynwood Hospital, Corner of Harrison & Princess st, Benoni – Wednesdays only between 7:00 – 8:30 am (Lancet Lab on Ground Floor in the hospital)
- Morningside Mediclinic, Rivonia rd, Morningside – Tuesdays only between 7:00 – 8:30 am (Lancet Lab at Rochester Place, Block A, ground floor – next to Morningside Mediclinic)
- Lancet Corner, Corner of Stanley & Menton rd, Richmond, Auckland Park – Mon – Fri between 7:00 – 8:00 am (Please submit at Patient Reception in Menton rd.)
- Unitas Hospital, Lifestyle Management Park (next to the hospital), Unit 4, 2nd floor, Room 212. Mon-Fri between 8:00 – 10:00 am
- Louis Pasteur Hospital, 8th floor, room 835. Mon-Fri between 7:00 – 9:00 am
Cost of the test
The cost is R1100 for a semen analysis and R200 for a post-vasectomy test and it needs to be paid when the specimen is submitted – no medical aids.