Life-style advice to men who have had one or more abnormal sperm function tests
Any alteration in adverse factors can take 10-12 weeks to show an
normal fertilisation after intercourse, but cannot be guaranteed to do so. A
poor swim up has less than 4 million/ml rapidly motile sperm and would be
unlikely to achieve fertilisation after normal intercourse or standard in-vitro
Parameters measured in sperm function tests
fertilisation (IVF). Persistently poor sperm swim ups usually require
1. Semen Volume: The semen volume is the amount of fluid, millilitre (ml)
intracytoplasmic sperm injection (ICSI) to achieve fertilisation and
produced and the normal range is 2 to 4 ml. Reduced volumes occur if part
of the specimen misses the collecting jar, or in certain disorders of the
“accessory” sexual glands ie prostate gland and seminal vesicles.
Why might my sperm test be abnormal?
Increased volume occurs with current or previous infection of the prostate
All men produce abnormal sperm tests at some point in their lives. Temporary
2. Sperm density: The normal level is at least 20 million per ml of semen and
factors that can lead to abnormal results are:
levels up to 250 million/ml can be seen. The average is 60 million/ml.
3. Sperm motility: The best sperm are rapidly motile and the normal result is
1. Inadequate or excessive abstinence from ejaculation prior to the test
at least 25% rapidly motile sperm. Moderately (or medium) motile sperm
can achieve a pregnancy, but are less likely to do so. Poorly motile sperm
3. Any illness, infection, injury or operation, but especially involving the male
are very unlikely to achieve normal fertilisation and pregnancy.
sexual organs, and especially with a high temperature. Even a heavy cold
4. Sperm morphology: Morphology is the physical appearance of the sperm.
or “flu” can affect sperm function for up to 12 weeks.
A normal sperm sample has at least 15% normal forms (using very strict
4. Wearing tight underwear, sitting or driving for long periods (2 hours or
criteria). Slightly reduced % normal forms are unlikely to be significant
(down to 12%), if the other parameters are good. Considerably reduced %
5. Exposure to chemicals, eg industrial occupations/farming
normal forms (less than 12%), when other parameters are reduced (ie
6. Recreational drugs including alcohol, tobacco or cannabis
density and/or motility) suggest a low chance of normal fertilisation and
7. Pharmaceutical drugs, especially drugs used in cancer treatment, some
pregnancy. The morphology of the sperm is not related to the genetic
antacids eg Tagamet and some blood pressure drugs eg Propranolol
material (chromosomes). Generally, the proportion of sperm with abnormal
8. Diet: The normal western diet is high in fat and low in certain important
5. Inflammatory cells (White blood cells): An increased number of white
9. “Normal” variation: because of this at least 2 tests are always requested,
blood cells suggests some inflammation within the male sexual organs,
which may (or may not) be related to infection. If increased numbers of
10. Unexplained – Frequently there is no obvious cause found for abnormal
inflammatory cells are observed, you will be asked for a semen sample for
culture, to detect infection, and you will be given an antibiotic. A second
antibiotic may be required if the inflammatory cells persist.
What can I do if I have had an abnormal sperm function test or 2 very
6. Agglutination: This is where sperm stick together so they cannot travel in different tests?
the usual way. Up to 5% agglutination may be seen in the normal sample.
10% agglutination, or more, is abnormal and can occur with inflammation or
This may be just a normal variation and so you should wait for the next test.
anti-sperm antibodies, especially after surgery, infection or injury of the
However, you should try to lead as healthy a lifestyle as possible in the weeks
male sexual organs, particularly vasectomy.
leading up to the next test and while trying to conceive. Improved lifestyle
7. Blood in the semen: This is always abnormal and usually requires referral
8. Sperm swim up (SUP): This is a functional part of the sperm test and What can I do if all or most of the sperm function tests are abnormal?
looks at the ability of the sperm to swim against gravity in a special culture
medium. A normal swim up has at least 8 million/ml rapidly motile sperm
In this situation, provided there are some sperm in the swim up, a spontaneous
and would be expected to achieve normal fertilisation after intercourse or
pregnancy is possible, though the fewer sperm in the swim up, the lower the
insemination. A suboptimal swim up has less than 8 million/ml but at least
chance of pregnancy. You should lead as healthy a lifestyle as possible and
4 million/ml rapidly motile sperm. This sample may be able to achieve
further sperm tests may be requested to determine if there is improvement.
Occasionally, other investigations may be required, including: A scrotal ultrasound, if a varicose vein is suspected a semen sample for culture, if inflammatory cells are seen a sperm antibody test, if there is “agglutination” of sperm blood tests for hormones and chromosomes when there are very few, or no
LIFE-STYLE ADVICE TO MEN WHO HAVE HAD ONE OR MORE ABNORMAL SPERM FUNCTION TESTS
Sperm take 10-12 weeks to mature and so any adverse factor, eg “flu”, a
heavy cold, a testicular injury or operation, exposure to chemicals or drugs (including a single episode of excessive alcohol) can affect sperm production
for up to approximately 3 months. Conversely, any improvement in lifestyle
LIFESTYLE ADVICE TO MEN WHO ARE TRYING TO
can take 10-12 weeks to produce an improvement in sperm function tests and sperm fertilising ability.
Recommended Lifestyle Measures SPERM FUNCTION TEST RESULTS
1. Healthy diet, low in fat but high in green vegetables and fruit
2. Stop smoking completely and avoid smoky atmospheres (ie passive
Sperm function tests are required to assess male fertility. The results can vary
considerably and so, to try to give an accurate assessment, you are asked to
abstain from ejaculation for 3 to 5 days before producing your sample for
5. Wear loose boxer-style underwear and avoid hot baths and hot
6. Avoid sitting/driving for long periods. Try to take hourly breaks - 2 hours of
If you abstain for longer than 5 days, then the number (density) of sperm will
driving heats scrotum (and testicles) by 2°C.
often increase, due to an increase in the proportion of dead or poor quality
7. Take vitamin C, zinc and selenium (recommended daily allowance)
sperm. These dead/poor quality sperm can release chemicals which
8. Avoid inhaling, or direct contact with noxious chemicals, eg organic
adversely affect the good quality sperm, and so can produce a worse result.
solvents and organophosphate pesticides. You may need to wear a mask
If you ejaculate in the 3 days prior to the analysis, the number (density) of
9. Try to reduce stress: A consultation with the fertility counsellor may be
sperm will often reduce, though the proportion of good quality sperm will be
beneficial to develop stress reducing strategies.
10. Mention to your Fertility Doctor, Nurse or Scientist, any pharmaceutical
drugs you are taking - they may affect sperm function.
It takes a sperm 3 months to mature, and any adverse factor during that time
can damage sperm maturation for up to 12 weeks. Examples of adverse factors are detailed in the section below entitled “Why might my sperm test be
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