Fertility Options Coach

Having a sperm analysis done can be emotionally difficult, but interpreting the results can be even more unnerving. It is important to have a sperm analysis done early in an infertility workup. There are no symptoms for a low sperm count or poor sperm motility. Finding out early that there is a problem with the sperm can save months of anxiety and can save a woman from having unnecessary tests. Often there are simple treatments such as antibiotics that can improve fertility.

It is important to have at least 2 – 3 semen tests done. You need at least two tests done to determine whether your results are “normal.” If your doctor accepts only one result and does not request a second test, change doctors. The results on any one day can be very different from other days and can lead to believe there is a problem when there isn’t one – or can lead to a false assurance that everything is fine.

A man’s testes produce sperm continuously. The number and health of the sperm can be affected by nutrition, stress, and other health factors. It takes about 74 days for sperm to mature, so if you do find that there are problems you will need to improve your nutrition and overall health for at least 2-3 months to see if that improves sperm count and sperm health. A man’s sperm count may vary so it is a good idea to have more than one sperm analysis done to make sure that the results are accurate.

Mature sperm look a bit like microscopic tadpoles. The enzyme-coated head contains the genetic material for fertilizing the egg. The tail moves back and forth to propel the sperm forward and through the woman’s reproductive system. An average ejaculate contains 40-150 million sperm. Only a tiny percentage of these – a few hundred – will get close to the egg.

The analysis will be looking for several different things:

Sperm Count. Not everyone agrees on the right number for healthy sperm. Generally over 20 million sperm per milliliter is said to be fertile. Some labs consider over 40 million to be necessary for fertility. Again, more than one test is necessary as your count can change with temperature, medications, infections, colds or viruses and other factors. Numbers below 20 million are usually considered low, although they may still result in pregnancy.

Motility. More than 50 percent of your sperm need to be motile (able to move quickly) for normal fertility. At least 65 percent of them must be alive. Their ability to move well is very important in their ability to reach the egg and fertilize it. Being sick or exposure to drugs and tobacco can reduce motility.

Morphology. They will be looking for high numbers of malformed sperm. Those with misshapen heads, broken or poorly shaped tails, and other unusual shapes can not swim well or penetrate the egg. At least 50 percent of your sperm must be properly shaped to ensure fertility.

White and red blood cell count. Infections can cause high levels of white or red blood cells in the semen. This is usually treated with antibiotics.

Clumping. Sperm that clump together may be a sign of antisperm antibodies caused by your body mistaking sperm for an invader. This can also be the result of an infection.

If any or all of these factors are below the norm you may be considered “subfertile.” This simply means that your results are lower than normal. It is not the same thing as being completely infertile. As long as you have some healthy sperm there is a possibility of a healthy pregnancy. It may simply take longer or it may require some medical intervention.

See the vitamins for fertility page for tips on vitamins and supplements that may increase sperm count, morphology and motility. Clearing up any underlying infections with antibiotics can improve sperm counts as well.

If all else fails there are a number of medical procedures that can help even those with very low sperm count or poor motility to conceive.

Men may be particularly sensitive about infertility. Male identity is frequently closely tied to sexual performance and virility. Often there are no symptoms of male infertility other than the inability to conceive so infertility is often considered to be a woman’s problem. The truth is that about 40% of infertility is due to male factors. Men may not talk much about their fertility but it is a common problem.

Male fertility starts with large quantities of healthy, well-formed sperm. About 90% of male infertility is caused by low sperm counts. Low sperm count can be caused by pollution, diet, genetics and many other factors. Other causes of male infertility can include sperm that die too quickly or are not formed properly, and physical problems such as enlarged scrotal veins (varicocele) or fluid accumulation in the scrotum (hydrocele). Correcting circulation to the testes with exercise or surgery may restore fertility.

Under current guidelines from the World Health Organization a sperm sample is considered to be normal if there are at least 20 million sperm per milliliter and at least 50% of those sperm are moving. If there are less than 20 million sperm or fewer of them are mobile, then it is considered to be abnormal. However, the National Cooperative Reproductive Medicine Network proposed new guidelines in 2001 that suggest a sperm count of greater than 48 million per milliliter and more than 63% mobility is normal. Anything between 13.5 million and 48 million would be considered to be in a “grey area” according to the proposed guidelines. Those with fewer than 13.5 million sperm and fewer than 32% mobility would be considered infertile.

There are many simple things you can do to improve sperm quality and sperm count. Nutrition is one of the most important steps to better sperm, although there are also a number of herbs proven to improve your odds of fertility. It is important to note that men also need proper levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone. There are a number of herbs that will help to make sure your hormones are properly balanced.

Start with a thorough health workup and sperm analysis. Talk to your doctor about any concerns that arise. Thyroid problems or diabetes can also interfere with proper hormone levels so it is important to discuss these issues with your doctor.

Between 28% and 71% of men with low sperm count are in fact suffering from an infection in the reproductive organs. Infections of the prostate and epididymis (a tubular structure secretion collectors on top of each testis) can interfere with sperm production or block the path of sperm. Infections can lead to anti-sperm antibodies. Some infections, such as Chlamydia, are sexually transmitted. Many infections have no outward symptoms, they just silently cause inflammation that can block the flow of sperm. They may also cause sperm anti-bodies to form, causing the immune system to kill sperm. Treating the infection with antibiotics can often restore fertility.

Some infections, such as an inflammation of the testicles following the mumps can result in permanent infertility. Chromosomal abnormalities such as Klinefelter’s syndrome may be associated with permanent infertility.

There are natural treatments for many causes of male infertility. Many natural remedies have astoundingly high success rates in scientific studies.

The mere thought of a sperm test is enough to send many men squirming right out the door. Yet male infertility accounts is about as common as female infertility – and the test is much less invasive than many female infertility tests. Why are so many men reluctant to be tested? For some, it is fear of looking like less of a man. For others, it is just a general discomfort with medical things.

If you have been trying to get pregnant for more than a year if you are under 30, or more than 6 months if you are over 30, it is time for both of you to be talking to your doctor. Even if you already know that you have a fertility issue, it is important to have your partner tested as well.

Many women have told me that they have undergone painful and expensive infertility treatments, only to find that their male partner also had fertility problems. A simple sperm analysis is only about $90-125 even without insurance, and it can save a whole lot of heartache and expense.

My husband and I were shocked to find out that he had morphology issues (sperm shape and function). We had assumed that since he had one child from a previous marriage, and we had gotten pregnant with our first child easily, that any fertility problems must be mine.

If you can get your partner to open up about why he is refusing to be tested, it can help clear things up. If not, you can still work towards getting him tested by gently explaining that the test for him is non-invasive and that it will bring you a lot of peace of mind to know the results. You can also explain that in many cases, any problems can be treated easily.

Let him know that by being tested, he can make it easier on you and save money on treatments by narrowing down the cause. Assure him that your feelings for him will not change, no matter what the test results. Men play tough, but they often really fear losing a woman’s love if they are not perfect.

Finally, find some simple but good information online that can help him to understand how important this test is in helping you achieve your goal of a healthy baby.

This article was written several years ago, before my divorce and remarriage. I include it here since so many have told me that it was helpful to them.

There are some crossroads in life you never expect to see. When you find yourself there, you may spend as much time baffled by the location as you do making a decision about which road to choose. Choosing a sperm donor is like this. I know because I have spent the last two weeks trying to choose the biological father my child will likely never know.

My husband has muscular dystrophy and I have polycystic ovarian syndrome. I don’t ovulate and his genes are risky. With the form of muscular dystrophy he has there is a 50% chance that the baby would inherit the disease that is stealing my husband’s strength, his balance, and his dreams. We decided to use donor insemination to protect our child from this disease. Then we learned that he has zero sperm count anyway, so a donor is the only option if I am to have a biological child.

Many couples choose to use a donor because of male infertility. Some women choose a donor when there is no potential father in sight while their biological chance of having a baby becomes important because of age. Others, like us, choose a donor because of the possibility of passing along genes that could drastically affect their child’s future.

You buy sperm in one “unit” vials, prices range from $210-$500 and more per vial. The more expensive banks promote their samples as coming from more educated donors (doctorate DNA anyone?). Screening processes for health and family health history seem to be about the same among clinics. All of them are required to test a potential donor for a variety of sexually transmitted diseases. They then hold the frozen samples for 6 months and test the donor again to be sure nothing new has cropped up. If the donor tests clean both times, then the samples are released for potential purchase.

My doctor recommended three banks he works with regularly and I soon found myself surfing through what the sperm banks call “short profiles.” These are the scraps of information that they give you while you try to make one of the most important but uncertain choices you will make in treating infertility. Eye color, hair color, height, some family health history, a few hobbies, education level–these are the basics of making a decision. How can you decide on a biological father with these tiny bits of information?

Some clinics offer long profiles, “staff impressions,” personality tests, baby photos, the chance for your child to know who the donor is after they turn 18, and voice clips. A few even offer photos of some of their donors as adults. Of course, knowledge comes with a price. In general, the more you want to know the more you will pay. Each of these services are offered at a separate fee. Some clinics will also allow you to send in a photo and their staff will match the photo to a donor as much as possible. If you don’t plan to tell anyone you used a donor, this could be a useful. In our case, it seemed silly because our families already know about my husband’s disease.

The clinics that offer these services also tend to be the more expensive to start with. So, you ask yourself, “What is all this worth to my child? Can I put a price on being able to put a human face on an otherwise anonymous donor?” This can make you crazy very quickly when money is not something you have in abundance.

We ended up choosing the lowest priced of the three clinics my doctor recommended. I didn’t see much difference in the basics of the profiles, all were in college or had graduated. The clinic I chose offers a “long profile” and a genetic analysis for a pretty reasonable fee of $15. They don’t offer some of the fancier options like personality tests and voice clips. I find it annoying to have to pay extra for more information about the donor. I am dropping $1,000 on a few sperm samples. I think I should get all the information they have for free. It feels a lot like buying a car without seeing more than the classified ad “Red car, new tires, no major problems.”

When you are working with really basic information you have no choice but to choose what seems like pretty random characteristics. Details that would not even enter my mind if I were adopting suddenly take on huge importance. We had to narrow down our choices and we didn’t have much to go on.

Everyone in both of our families has blue or green eyes. So, we decided that blue eyes were important. Not because we care what color our child’s eyes are, but because I really don’t want to discuss the issue fo using a donor with every idot who asks how our kid got brown eyes when our eyes are both light.

My husband is very tall and many people in my family are very, well, vertically challenged. We didn’t want to risk having a son who got my family’s short genes in addition to those of a short donor. I had visions of our son doomed to a life of buying suits in the boys department. So we ruled out anyone less than 5’10″. Then we ruled out anyone with a family history of severe allergies, cancer, heart disease or diabetes. No sense in doubling the risks I am passing along since these disease are potentially in my genes. This left us with one donor.

I don’t know what this person is like. The profile say they like to read and spend time outdoors. This does start to feel like a bizarre dating service. I half expected to read that long walks on the beach and soft jazz music are his favorites too.

So, as I await our first intrauterine insemination I am left to ponder so many things. Does he have a bad temper? Is he an unbearably picky eater? Does his red hair come with freckles? Will my brown hair genes give us an auburn haired child or will my red highlights lead to red hair for our baby? When he says his hair is curly, does this mean my curly hair DNA and his will combine to an Orphan Annie look our daughter will hate when she is 13? Does he have an oddly shaped nose? Nowhere in the profile does it say what his nose looks like.

When you have little to go on you think weird things. Focusing on all of this keeps my mind off the more important question of whether the insemination will work before our money rusn out. In the end, we’ll be happy with a baby.