New guidelines from the World Health Organization have redefined the new 'normal' values for semen analysis but the new lower limits for normalcy are not to be confused with measures of optimal fertility. Low/normal is far from optimal for peak fertility.
The new reference values represent the bottom line - the lowest acceptable values of sperm health - which are much lower than the average values of fertile men. Higher sperm values are know to help speed up the time to conception and are in associated with significantly increased fertility. Normal - especially low/normal - is not optimal when you want to achieve peak fertility but it is helpful to know the bottom-line values.
Male factor infertility is the sole cause of infertility in approximately 20 - 30% of cases, and male factor combined with female factor is associated with 40-50% of all infertility cases. Male infertility is usually diagnosed based upon the results of a semen analysis, which is best performed early on in your infertility work-ups, certainly before using high-tech infertility treatments.
Identifying a semen problem in the early stages of infertility can help you to begin an appropriate natural treatment program more expediently - or if you discover that there is a serious untreatable sperm problem, you are apprized of this early on.
Natural treatments - such as vitamins, herbs and acupuncture - are often dramatically effective in restoring various aspects of sperm health, sometimes in a few weeks, other times over a few months. Despite the vast number of studies on various nutritional and herbal treatments for male sub-fertility and infertility physicians rarely share this information with patients and may instead hasten the progression to IVF with ICSI.
It takes approximately 70 days to create mature sperm. If a sperm analysis shows a problem, repeating the test a few months later is helpful for confirmation as various factors, such as fever, can interfere with healthy sperm production. Repeat tests are a great opportunity to use a program of natural supplements and herbs for a few months and measure the success of your endeavor, the changes can be remarkable.
New guidelines for sperm analysis parameters were proposed by the World Health Organization at the end of 1999 and these are the levels outlined below. They differ from the old semen analysis reference ranges in a number of ways - and the new measures are far lower than average values which are noted for comparison.
With a natural fertility program you may be able to achieve at least 'average' sperm health values which is going to be far better for your fertility potential than values that linger around the lowest acceptable limits.
The natural treatments that are used to increase sperm numbers, motility and morphology can have a positive effect upon other measures of sperm quality such as DNA fragmentation, multiplying the fertility boosting effects of a treatment program. Because miscarriage rates rise with the age of the male partner - as well as the female partner - treatment that boost DNA integrity of sperm may be protective.
The new WHO guidelines were defined through extensive studies on the semen of 4,500 men in 14 different countries spread over 4 continents, all the men had their fertility confirmed through their partners becoming pregnant in less than a year of trying to conceive.
It is important to abstain from ejaculation for the 2-3 days before the test is for accurate results. It is also important to make sure that the male ejaculates 2-3 days before the test as a longer period of abstinence can up the volume and numbers of dead and malformed sperm throwing off the results.
Here are the new minimum values for normalcy according to the new WHO guidelines:
Semen Volume: now minimum 1.5 ml
Previously set at 2.0 ml, this is the total amount of liquid semen produced in one ejaculation, the average semen volume in the study was 3.7 ml.
Sometimes this number is low simply because of 'performance anxiety' causing a lower than usual amount of semen to be produced. If this becomes an issue a special collection condom can be requested and the sample collected more naturally but it is essential that the sperm is tested within an hour of ejaculation for accurate results.
Ejaculating within the 2-3 days abstinence period before the test can decrease the volume also.
It's important to get an accurate measure of volume because other measures of sperm health are percentage based. A low volume can magnify the effect of a low percentage motility or morphology. Similarly if the volume is naturally high, the effect of a lower percentage motility or morphology may be less meaningful.
Sperm Concentration - Sperm per ml: now minimum 15 million/ml
Previously set at 20 million/ml, this number is 25% less than the old range indicating perhaps the global decline in sperm. The average sperm count is thought to be around 60 million/ml and the average in this study was 73 million/ml.
This number is important because when it falls too low - under 5 million/ml - IUI is thought to be rarely successful speeding the progression to IVF with ICSI. Abnormally low sperm counts are called oligozoospermia.
Values over 15 million are considered normal although it's important to remember that higher values are known to increase fertility. Previous studies (2) have shown that the probability of conception is increased with increasing sperm concentration levels up to a threshold of 40-50 million/ml indicating that the new lower limit for normalcy is not ideal for optimal fertility. Low-normal is not optimal.
If your sperm concentration levels fall below 40-50 million/ml natural strategies to improve sperm health may help to give you an edge in upping the odds of conception. Levels between 15 million/ml and 40 million/ml may represent a category of male sub-fertility that is correctable and may result in a speedier conception.
Natural treatments such as nutritional supplements, herbs and acupuncture are often very successful in raising sperm counts and concentration which can open up previously inaccessible treatments such as IUI - and natural conception - when ICSI was thought to be the only option.
Progressive motility: now minimum 32%
This measure of motility demonstrates that the sperm have a good purposeful forward motion giving them a sense of direction which is vital for them to reach their destination.
Total Motility: now minimum 40%
This value includes all motile sperm, those with forward motion and those with more random motion. Previously 50%, this is another downward shift in the accepted limits of normalcy, and the average motility percentage in the study was 61%.
Studies show that the greater the motility the better your chances of conception up to a threshold of 60% motility after which greater motility does not seem to make a difference. If you have low/normal sperm motility values a natural fertility program may be able to help speed the time to conception by raising your motility levels closer to the average. Poor sperm motility is called asthenospermia.
Morphologically Normal: now minimum 4%
Previously 15%, this value refers to the number of sperm with normal shape and structure, 4% is considered the new bottom line of normalcy although the average percentage of morphologically normal sperm in the study was 15%.
Morphology values between 0% and 4% are termed 'teratospermia' a condition known to greatly impair fertility often requiring ICSI.
Previous studies have indicated that fertilization rates were highest when the numbers of morphologically normal sperm were above 14%, and that fertilization rates were very poor, only 7-8% when the numbers of morphologically normal sperm dropped to 4% or below - the level now considered as the bottom line of normalcy (1).
Other studies have confirmed this graded fertilization capacity suggesting that the greater your morphology, the greater your sperm's ability to fertilize an egg. Other studies have shown that sperm morphology under 9% quadrupled the likelihood of male infertility (2).
If your sperm morphology is in the low-normal range, consider a natural fertility program to boost sperm health. This is another example of how 'normal' may not be not optimal for fertility and how raising your levels closer to the normal average may have merit.
Other measures of sperm health include: viscosity, fructose levels, pH to determine the level of acidity/alkalinity and tests for agglutination, anti-sperm antibodies, sperm penetration and 'round cells' which can indicate infection. Blood test are important too, especially if the sperm analysis is abnormal.
Hidden infections are thought to be an under-diagnosed cause of male infertility which may merit investigation too when infertility is an issue.
Other tests for sperm health can be very valuable also such as DNA fragmentation and may be worth considering. As with other aspects of male infertility, poor DNA quality can respond well to antioxidant treatment if you follow a high quality program.
This article is for informational and educational purposes only and is not a substitute for medical diagnosis or treatment for which you should consult a physician.
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Kruger TF, et al., 'Predictive Value of Abnormal Sperm Morphology in In-Vitro Fertilization, Fertil Steril 49:112,1988
Guzick et al., 'Sperm morphology, motility and concentration in fertile and infertile men.' New Eng J Med, 345:1388, 2001
www.who.int/reproductivehealth/topics/infertility/cooper et al hru.pdf