Michael Feinman, MD
Published in Resolve, for the journey and beyond, Summer 2013
Semen analysis has long represented the standard test for evaluating male fertility. Though still useful, the test is not perfect, as it fails to accurately predict fertility status in certain situations. This article will review the interpretation of a semen analysis and briefly present some of the more advanced alternatives that are now available.
It is appropriate to obtain a semen analysis early in working with an infertile couple. It is unacceptable to put a woman through medical procedures and tests without knowing the status of her partner’s semen. Typically, a man is asked to abstain from any ejaculations for two to three days prior to the test. While making specimens at home is preferred, the sample should be brought to the lab within about an hour. It is important to use a cup provided by the lab, as some materials are toxic to sperm.
While there a number of parameters reported in the analysis, only a few are really important:
Over the past few years, a number of tests have been developed that more specifically evaluate the DNA content of sperm: Sperm Chromatin Structure Assay (SCSA), DNA Fragmentation Test (Reprosource), Comet Assay, and Tunnel Assay. All the versions attempt to analyze the quality of the DNA in the sperm, which may be more informative than just the semen analysis alone.
If the semen analysis or one of these DNA tests is abnormal, the reproductive endocrinologist, along with a urologist who specializes in male infertility will try to find a cause and possible treatment to improve the sperm quality. Occasionally, no cause or treatment may found, but many of these men can still be helped with IVF and intracytoplasmic sperm injection (ICSI).
Michael A. Feinman, MD, FACOG, is the medical director at HRC Fertility, which has centers in Southern California. Dr. Feinman performed one of the first transvaginal ultrasound guided egg retrievals in America and the first in New York. He developed one of the first anonymous egg donor programs in the world at the Albert Einstein College of Medicine in New York in 1987. Dr. Feinman has been featured on the cover of the New York Times and on ABC Evening News.