Houston, we have a problem… an abnormal semen analysis can be both confusing and scary. Especially in cases where you find out that you have very few or no sperm at all. What should I do now? Is this fixable? Can I still become a father? The good news is that there are lots of things that doctors can do to correct medical causes of male infertility. However, it is important to make sure you visit a doctor who has specialty training in male reproduction – typically a urologist who has done a residency or fellowship in male reproductive health. Here’s a quick guide of what do next if you get abnormal semen analysis results.
Is My Semen Analysis Abnormal? Do I Need Additional Evaluation?
Semen analysis results can be particularly tricky to understand. For a full breakdown of the semen analysis report, check out our article – Understanding your semen analysis. Here are some rules of thumb to help you decide if you should visit a male fertility specialist.
- You should definitely visit a male fertility specialist if you have any of the following severe issues
- Inability to achieve an erection or ejaculate,
- Persistent testicular pain,
- Presence of abnormal lumps or bumps
- Testicular swelling or shrinkage,
- No semen comes out when you ejaculate (aspermia, retrograde ejaculation),
- High amounts of white (WBCs) or red blood cells (RBCs) present in semen (leukocytospermia),
- No sperm visible during semen analysis (azoospermia),
- A sperm concentration of less than 10 million / ml or a total sperm count of less than 20 million (moderate or severe oligospermia),
- 0% normally shaped sperm (teratospermia)
or less than 10% sperm motility (severe athenospemia),
Many semen analysis findings such as a slightly reduced sperm count (10 – 55 million / ml), poor motility or morphology or reduced semen volume may be linked to lifestyle factors and can be improved by implementing sperm-friendly habits. To help you identify the top things you can do to improve your sperm health, you can take our online risk assessment. You can also download a sperm health app that will help you identify areas of your life that can be optimized to improve fertility.
If you make a dedicated effort to improve sperm health and do not see changes in 6 months or if you do not have any lifestyle related risk factors, it might be a good idea to visit a specialist as you could have a varicocele or other condition that could be impacting your fertility even if the impacts are minor.
Finding a Doctor
As mentioned above, it is very important to visit a doctor who has the right training. The best doctors to see are urologists who have completed specialty training in male reproduction. We have built a database of top doctors in the US who treat male fertility issues. Internationally, you can look for doctors who belong to SMRU or SSMR or the International Society of Andrology. If there isn’t a specialist near you, contact a local urology practice, ob-gyn or fertility clinic to request a referral to the nearest urologist who has specialty training.
The Male Fertility Workup
There are four major components of a complete male fertility workup, the semen analysis, blood tests, a physical exam and medical history. Each piece provides critical information to understand your current fertility status as well as underlying conditions that could be contributing to abnormal semen analysis results.
The Semen Analysis
Assuming that you’ve already completed a semen analysis and had abnormal results, the doctor will request a second analysis to confirm results and establish a baseline for what your semen parameters look like. Semen analyses can fluctuate from sample to sample and day to day so current medical guidelines are to average the results of two tests to get a baseline understanding of where someone is at. This is especially true in cases of azoospermia, or zero sperm, as sometimes you may actually have a very low sperm count that is hard to detect.
In addition to the standard semen analysis, a specialist may order specialty tests for sperm such as DNA fragmentation, sperm function tests, or epigenetic tests. This is particularly true when they are looking for harder to diagnose causes of infertility. (If you have failed fertility treatments or have been trying to conceive for a very long time but have relatively normal looking semen parameters).
The second major assessment done in almost all evaluations of male fertility are a series of blood tests that can help identify underlying causes of low / zero sperm count.
Hormone Profile: Doctors can look at hormone levels to get a fairly non-invasive look at how your reproductive system is functioning. There are several key hormones required to enable the production of sperm. Minimally, it is recommended to check FSH (follicle stimulating hormone) and Testosterone levels. Additionally, doctors may order LH, prolactin, estrodial and TSH to get a more complete picture of how your endocrine system is functioning.
Genetic Screening: There are a number of genetic causes of male infertility including Y chromosome microdeletion, XXY or Klinefelter’s syndrome and CF gene carriers. These well-established genetic causes of male infertility can be easily screened for in a blood test and can guide options for next steps, particularly in cases of azoospermia. Additionally, there are less well established genetic and epigenetic links to certain genes and poor sperm quality. Some doctors may want to order additional genetic tests for patients who have severe teratospermia or oligospermia.
The Physical Exam
The physical exam may be the most uncomfortable part of the male fertility workup, but it is very important for diagnosing underlying conditions that can cause poor sperm quality. During the exam, the doctor will check for structural issues such as varicoceles, inguinal hernias, blockages or other plumbing problems that could impact sperm. He will also check to make sure each testicle is healthy – has good size, shape, and texture and for any signs of infection of the reproductive tract. Occasionally, the doctor will request imaging studies (ultrasound or MRI) to check for microblockages, cysts, signs of cancer or lower grade varicoceles.
The final piece of any male fertility workup is a detailed medical history that looks for past issues that could have caused testicular damage or for current potential contributors to reduced reproductive health that could help explain poor semen analysis results. A print out of our risk assessment report could be a helpful tool to guide your conversation with the doctor. In general some things they will ask about include:
- Known family issues with infertility
- Past illnesses, injuries & surgeries
- Onset of puberty
- Sexual health symptoms
- Lifestyle questions
- Recent illness
- Current / past medications
- Past / current use of testosterone or athletic performance enhancers
Getting the Most out of Your Appointment
Getting your health in order so that you can start your family is important, so here are a few tips to help you get the most out of your appointment with your doctor:
Take Paperwork: Gather up any reports, blood work, semen analysis results or other information that you feel might be useful for the doctor.
Be Prepared: write up a list of all the past things that you think could have impacted your fertility so that you don’t forget to mention any concerns.
Be Honest: These doctors understand men and have heard everything. It is important to be as honest as possible with them about your past. Past STDs, use of athletic performance enhancers, current or prior drug use, or other issues with your lifestyle are not going to cause them to judge you but will help them more accurately diagnose and treat sperm issues.
Ask Questions: Don’t be afraid to ask the doctor to break it down for you. This is your appointment. You are paying for it. You should walk out feeling like all your questions were answered and you have a clear understanding of what’s next.
Plan Ahead With Your Partner: Some men are better able to open up with the doctor when they are just 1 on 1. Other men benefit from having a second person there to help ask questions and absorb what the doctor has to say. Think about your relationship with your wife and decide if it would be helpful or harmful for her to attend the appointment with you.
Get a Second Opinion: Starting your family is a big step. Some treatment options can be invasive or expensive or both. It can help to get a second opinion if you do not feel confident about a diagnosis or recommended treatment option.
Take the Wheel: Ultimately, how you manage your health is up to you. Participating actively with your doctor to make decisions and to improve your health will ultimately empower you to feel in control and better about the outcome whatever it might be.
This doesn't need to be a taboo subject left in a closet, nor do men need to go through this alone. Education and community are key elements to improving health. Don't cook your balls is a space for us to share science and experience advance the state of male reproductive health care.