Should we be freaking out about sperm counts?
Should we be freaking out about sperm counts?
5 things to know before considering an at-home sperm test
By Cait Gossert, Senior Product Marketing Manager, Celmatix
In 2017, a major analysis of sperm parameters from a number of published studies found that sperm counts across the Western world have fallen by more than 50% since 1973. If you find those numbers alarming, you’re not alone. GQ covered the story under the headline “Sperm Count Zero,” and the lead author on the study, Dr. Hagai Levine, was quoted elsewhere as saying that “the human species is like the Titanic a moment before the collision, or maybe already after.”
At Celmatix, we’re champions of anything that gets people to think more carefully about their fertility, and this is especially important with male factor infertility. Issues impacting the concentration (number), motility (movement), morphology (shape), or function of sperm account for 40-50% of all infertility amongst heterosexual couples, yet most of the conversation about infertility is still focused on women.
That said, alarmist headlines obscure some complicated—and important—truths. If you’re wondering whether “Spermageddon” is coming for you, here are five things to consider before deciding how and when to do a semen analysis.
1) The history of “Spermageddon”
In 1992, Niels Skakkebaek of the University of Copenhagen published a meta-analysis of semen data recorded in 61 papers published between 1938 and 1991. He and his team performed what’s called a linear regression analysis—a method of applying a single straight trend-line to scattered data—and observed that sperm counts had declined sharply (about 50%) in the previous five decades.
“The problem is,” says Dr. Dolores Lamb, Vice Chair of Weill Cornell’s Department of Urology, “the numbers were all over the place throughout the entire study. If their analysis was correct, that line suggested that by 2010, all men would have no sperm. That hasn’t occurred.”
The probable reason for the “all over the place” numbers? Meta-analyses combine data from many previously published studies. When testing methods aren’t standardized, inaccuracies in one dataset can impact the analysis overall.
Given the major advances in testing methods made between the late 1930s and early 1990s, skepticism of the results is well-founded. “Even in the late 1980s,” Dr. Lamb notes, “there was no such thing as proficiency testing for semen analysis, in which small fractions of the same sample are sent to many different labs that should test the sample and get the same results. Without this level of rigor, there was no accountability for accuracy.”
In spite of these limitations, Skakkebaek’s work drew a frenzy of attention, and led to additional studies. One such study, a Danish research project begun in 1996 that was meant to follow 5,000 military draftees for 25 years, released preliminary results in 2010 showing no indication of diminished semen quality whatsoever. Despite questions about the data, and how it was released, this study directly contradicted Skakkebaek’s work.
Fast-forward to 2017, when the “Titanic-moment” results were released. According to the study’s press release, sperm concentration and count declined by 52% and 59%, respectively, among men from North America, Europe, Australia and New Zealand, though no decline was seen in men from South America, Asia, or Africa.
To be clear, this study is heralded as the most comprehensive and rigorously vetted to date. That said, it may be impacted by some of the same limitations that colored Skakkebaek’s study, namely that data across 185 studies spanning nearly four decades may not be equally accurate.
More importantly, a population-level trend may not impact you at all.
2) Sperm count isn’t the only measure of a man’s fertility
A full semen analysis in a medical setting examines multiple factors that may influence a man’s fertility. These may include:
Sperm concentration: The number of sperm present in a 1ml sample of semen. (>15 million/mL is in the normal range*).
Total sperm count: The total number of sperm present in the sample. (>39 million/ML is in the normal range*)
Volume: The total volume of the sample.
Morphology: The size, shape, and appearance of the sperm.
Motility: The percentage of sperm that are moving in the sample.
Progression: The motion and forward progress of the sperm.
pH levels: The level of acidity in the sample should be 7.2 or higher
Viscosity: The consistency of the sample.
Vitality: The percentage of sperm that are living.
Other cells: The presence or absence of white, red blood cells, or immature sperm.
(*=Values obtained from the National Institute for Health Care and Excellence, 2014)
While clinical guidelines establish “normal” ranges, none of these factors are diagnostic of infertility. After all, it takes a single sperm to fertilize an egg, and under some conditions ten million might get the job done just as easily as ninety million.
“If you compare a large group of men who successfully conceived to a group of men who’ve been diagnosed as infertile, you can’t distinguish the fertile from infertile based upon their sperm count unless there are absolutely zero sperm present,” said Dr. Lamb.
Fertility potential is complicated, as it reflects the combined characteristics of both the male and female partners. It can be influenced by age, genetics, lifestyle, past health history, and environmental factors. That makes things confusing, but it’s good news, too. Just because a man has a low sperm count doesn’t mean he’s infertile. There are steps he can take to improve his sperm, and if his partner is highly fertile they might conceive together quite easily.
3) Collection is key
When it comes to collecting a semen sample, method matters. Here are the rules, whether you’re collecting at a fertility clinic or in the privacy of your home:
Abstinence: Abstain from sex and masturbation for between 2–5 days prior to collecting each sample.
No lubricants: Some lubes contain spermicides, and even those that don’t may lead to an inaccurate semen analysis.
Only use the cup provided: Collect the sample only in the sterile cup provided by your doctor or the testing company.
Collect the initial part of the sample: The first part of the ejaculate contains the highest concentration of sperm.
Put a lid on it: If you’re using an at-home test that reads your sample right away it’s imperative that you close the sample cup quickly. Computer-assisted semen analysis may count dust and other debris as sperm.
These important rules lead some specialists to be weary of at-home testing. “Did you spill? Did you drop? Did you drip? Did you keep your abstinence?” asks Dr. Lamb. “if you’re not in a doctor’s office with an expert to ask you all of these questions, chances are you aren’t going to get an accurate report.”
4) Not all samples are analyzed equally
A lack of standardization across testing equipment has plagued semen analysis for years. When lab technicians analyze your sample, for instance, they deposit it into a chamber that holds a specific amount of liquid before inspecting it with a microscope. While the gold standard for such chambers used to be highly-accurate glass slides called hemocytometers, they aren’t often used due to breakability, the necessity for cleaning and drying, and expense.
“Today, most labs use disposable counting chambers, but counting chambers from different manufacturers don’t always provide the same results,” said Dr. Lamb. “A sample deemed to be within the normal ranges in one chamber may seem to have lower counts in another, or vice versa.”
Another important factor is the time between collection and analysis. When a sample is taken in a clinic, the semen must be analyzed within one hour of collection. If you’re using a service that requires you to ship your sample to a lab for testing, be sure to package and ship the sample immediately after collection, as directed.
5) You may not like the results
While it’s exciting that technology exists to test male and female reproductive health at home, do keep in mind that there’s the possibility of receiving less-than-ideal results.
Remember, male fertility isn’t determined by sperm count alone. If you’re taking an at-home test, you’ll get results without the benefit of a fellowship-trained urologist who can guide you through all of the nuances, averages, and distinctions that impact your fertility. Some people may be just fine with this. Nevertheless, interpretation of results may be challenging, so others may prefer to have a urologist present.
Regardless of your testing method, you should always review your results with a reproductive urologist before taking the next step. This expert can take a look at the report, run a comparative test, and counsel you on what to do next.
Dr. Dolores Lamb, PhD is the Vice Chair for Research in the Department of Urology and Director of the Center for Reproductive Genomics at Weill Cornell. She is a former president of both the American Society for Reproductive Medicine and the Society for Male Reproduction and Urology. You can follow her on Twitter @DlambJ