Are there other tests we should consider having done on the semen?
This describes how well the sperm that are moving are making progress. Only when the motility (% moving) is combined with the forward progression is an accurate picture of sperm movement obtained. Unfortunately, this is often not tested by commercial laboratories. A man's motility may be normal and the fact that the sperm are moving sluggishly or almost not at all will be overlooked if the forward progression is not recorded separately.
This is a more detailed evaluation of the morphology. Slides are specially stained and the sperm examined microscopically under high power magnification. The sperm must meet a stringent set of criteria which evaluate the shape and size of the head, midpiece and tail in order to be considered normal. A Kruger test helps determine which of the available advanced reproductive techniques may be most appropriate and successful. * Anti-sperm Antibodies: Some men may produce antibodies to their own sperm. These antibodies may decrease fertility rates in a number of ways. They may impede the movement of the sperm through a woman's cervical mucous, inhibit the binding of a sperm to the egg, and/or inhibit its penetration into the egg. Men who are at most risk for developing antibodies are those with previous testicular and epididymal infection, trauma, surgery, or large varicoceles. The presence of these antibodies is often not predictable from other semen parameters or from the man's history.
White Blood Cells
The semen may contain a high number of white blood cells, which may be an indication of either infection or inflammation. White blood cells are considered significant if more than one million are found in each milliliter of the ejaculate.
White blood cells cannot be differentiated from other round cells normally found in the semen, (debris and immature sperm) without special staining. If more than one million round cells are found in the ejaculate, a portion of the ejaculate should be specially stained to look for an increased number of white blood cells.
If the white blood cell count is elevated, semen cultures should be performed on a subsequent specimen. Unfortunately, the semen culture cannot be performed on the original specimen as it must be the first step performed on the specimen in order to keep it sterile.
Other Tests In certain situations, specialized tests are needed. These depend on the findings at the time of the analysis and can often be performed on that specimen.
Even if no sperm are seen on the test slide, the sperm count may still not be zero (i.e. there may be very low numbers of sperm in the ejaculate). This has very important implications as it may determine if the couple can conceive using advanced reproductive techniques. This must be assessed by spinning down the specimen so all of the sperm are concentrated in a pellet on the bottom of the tube and then examining the pellet underneath a microscope.
Sperm may be alive but not moving. A specialized staining technique is used to determine what percentage of the sperm are alive and is indicated when the motility (percent moving) is less than 30%.
In men with no sperm or very low numbers of sperm in the ejaculate, it is important to determine whether the sperm are not being produced at all, or whether they are being produced but are blocked from "getting into" the semen. A fructose test can help differentiate between these two problems.
Post-Ejaculatory Urinalysis (PEU)
Some men ejaculate all or part of the sperm backward into the bladder.
This can be detected by having a man ejaculate and immediately afterwards
urinate into a separate cup. The post ejaculatory urine is then centrifuged
to see if any sperm are present.