The Semen Analysis: Part 1

Every time I talk about male fertility and the semen analysis, I feel like there is a giant gap in knowledge. I will be discussing how sperm is made, male and female similarities, and low testosterone. In part 2 I will discuss what we are looking at with a semen analysis, and some things I want you to know about male factor.

Male Factor Infertility

Male factor is the sole cause for infertility about twenty percent of the time. It is a contribution twenty to forty percent of the time. If you come see me and say “I know it’s not my partner. We’ve had kids before. He’s fine. I know the problem is with me.” I am not going to treat you without having his evaluation done first. I have patients get upset about this because I think women like to take the blame or don’t want to inconvenience their partner. However, it is important to evaluate both partners. I am serious about this. I do not want you to waste your time, money, or effort if something happens to be wrong with he sperm. In this case ovulation induction or surgery was never going to work. I think it’s important to make decisions with as much data as possible. If you are coming to see me, you can bet the male partner will get a semen analysis.

Why do we do a semen analysis?

Does sperm change?

The interesting thing about male fertility is that sperm is constantly regenerated. Men have germ cells inside their testes where sperm is produced. Unlike women who are born with a set number of eggs and lose them over time, men grow new sperm. This is seemingly unfair because a male could have had a prior behavior that wasn’t so great and have totally new sperm a couple years from then. It also means that sperm are very sensitive. They are like brand new babies who are sensitive to their environment. Also, sperm can change. So if you come to me and say your partner has a five year old, that’s great. However, it doesn’t make a difference because his sperm now may be drastically different now. Sperm regenerates about every 90 days. This process is called spermatogenesis.

What can cause sperm abnormalities?

When the semen analysis is done, we are looking at an ejaculated sample of sperm. We may have abnormalities based on hormone production meaning the body is not stimulating enough sperm. Environmental exposures can also impact sperm from damage done to the sperm based on something it is exposed to. An obstruction can also block the way of the sperm. We also use obstruction for birth contraception with a vasectomy. This is simply cutting the vas defrens which is part of the ejaculatory duct.

Male and Female Similarities

Men’s brains are just like females’ brains meaning the pituitary gland makes FSH (follicle stimulation hormone) and LH (Luteinizing Hormone). This is the one time in medicine where the hormones are named after what they do in a female rather than a male. I understand that I should be saying people because you could be trans woman with male parts or vice versa. For simplicity, I am using the terms man/woman and male/female in regards to the parts you were born with when it comes to hormones being made. LH is a hormone that in men stimulates Leydig cells to make testosterone. FSH is the hormone from the brain that stimulates two things: LH receptors on Leydig cells and spermatogenesis. It allows sperm to be made and the FSH receptors on Sertoli cells just like it does in women. Testosterone, the hormone of choice from the testes, feeds back to the brain like estrogen does in women. In a woman, FSH tells the ovaries to make estrogen when a follicle is growing. then hat estrogen feeds back to the brain and it sends out less FSH. The brain is like “Hey, there’s already a follicle, we are doing our job.” Feedback with testosterone is the same. So FSH and LH are made, they are stimulating the body to make sperm and testosterone, testosterone feeds back, and says “Hey, we are doing a good job.” So if a man takes testosterone, he is going to plummet his sperm counts. Similarly, if a woman takes estrogen, she is going to inhibit her ovulation. The brains response to seeing estrogen or testosterone is to determine that the process has already been happening.

Low Testosterone

I see a lot of men go to clinics and have complaints or even low testosterone and get diagnosed with low testosterone. Maybe they have fatigue, lack of libido or difficult getting an erection so they get prescribed testosterone. Essentially they are now feeling great, but they are telling their body not to make any more sperm. The effects of that can be profound, and it could take a very long to get sperm production back. So the appropriate treatment for low T if you are wanting to get pregnant is to stimulate the brain to make more testosterone naturally with medications like Clomid or gonadotropins. So in short, no testosterone supplementation for men trying to conceive.

In part two I will discuss in detail what the process of the semen analysis is, and what we look for in the semen analysis.