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A: When it is run by an IVF clinic with the sole purpose of selling you IVF **
** This is a generalisation, some IVF consultants do a better job than others at recognising signs which suggest male infertility needs more investigation. But that should be the norm, not the exception.
A semen analysis is an important tool in our arsenal when we are investigating unexplained infertility.
It tells us if sperm is present (around 10% of men struggling with infertility will have very low sperm count, or no sperm present in the ejaculate).
It tells us if the sperm looks structurally correct.
It tells us about the environment that the sperm are living in - which can influence the functionality of the sperm, and impact the quality of the DNA inside the sperm.
Unfortunately it is common for us to find that an IVF clinic has prematurely declared a male partner's sperm as excellent, on the basis of nothing more than a poorly assessed semen analysis.
Many IVF clinics use a simplified version of a semen analysis which doesn't provide much information about sperm health and the state of the environment in which they live.
Some IVF clinics ignore indicators of treatable underlying male fertility issues, instead they opt to declare the sperm to be fine on the basis that they could see some, and they are alive and swimming.
Few IVF clinics thoroughly investigate semen analysis with the goal of identifying and addressing male fertility problems.
In my experience, assertions of 'normal' or 'SuperSperm' are often far from accurate.
An IVF clinic semen analysis will usually contain little more than sperm count, motility, and morphology. Even the reports on motility and morphology are typically oversimplified, making them less helpful for individuals trying to identify underlying issues. That is all the information they need to know from an IVF perspective - if the sperm morphology looks a bit suspect, they might offer to use ICSI instead of IVF - this process involves taking the DNA out of a sperm and injecting it directly into an egg instead of relying on sperm to be able to deliver the DNA.
A semen analysis is not Proof of Fertility - around 10-15% of men with a good semen analysis would find they have fertility limiting issues with sperm DNA fragmentation if they were to look more closely - but it provides lots of useful information about the state of the environment that the sperm are living in, and can indicate when to look more carefully for issues like varicocele or hidden infections. But to be able to utilise a semen analysis in this way, you need an analysis that will report on many of the indicators of semen quality, not one that solely focuses on identifying whether they can see a moving sperm.
We often find that even when clinics have run a more comprehensive semen analysis, they will usually overlook crucial information that could aid in understanding unexplained infertility cases, they fail to explain the potential significance of raised pH, raised levels of debris, a high percentage of immotile sperm etc. This tendency to overlook poor sperm quality means that infertility is often blamed unfairly on the women, on 'poor egg quality', but it also means that many treatable male fertility problems are ignored, and many couples are undergoing IVF when it would be far easier and cheaper to investigate and resolve a male fertility issue. I have seen couples where clear indicators of unhealthy sperm were ignored, leading couples having multiple failed IVF cycles before they started to question the advice they were being given.
Even if IVF is going to be the appropriate pathway, it would make sense to identify and address issues of subpar sperm. When sperm quality is poor, it is likely to have an impact on the sperm's ability to fertilise an egg, on sperm DNA structures and the ability to of that sperm to form an embryo that will grow and develop a healthy baby. If sperm DNA fragmentation is high, there is likely to be a higher rate of loss in the IVF lab, a higher rate of implantation failure and pregnancy loss, and research suggests that poor male fertility can have a lifelong impact on health outcomes for the future child. Improving sperm health would seem a logical thing to do - so why are so many men being told that their semen analysis is normal when there are clear signs that there are investigations that ought to be run?
My tips:
If anyone tells you that they can confirm male fertility is good with nothing more than a semen analysis, RUN.
If your clinic runs a semen analysis and says everything is 'normal', ask for a copy of the test results and get my book to help you to understand what you are looking at: Explaining Male Infertility (Explaining Infertility) eBook : O'Connor, Alex: Amazon.co.uk: Kindle Store
If you are seeing a urologist, make sure that they have a special interest in fertility (I have seen cases where a general urologist's advice is very different to that of a urologist with fertility expertise.)
If you are seeing a holistic fertility practitioner, make sure they have training in how to investigate and treat male fertility. Are they asking you about the semen analysis, are they asking enough questions about a male partner's diet and lifestyle? Too often you will find the focus is on female fertility, and there is not enough focus on male fertility.
If you have had an unsuccessful IVF cycle, don't consider running another one until you have sought an independent assessment of male infertility.
Assessing male infertility takes far more than a semen analysis. You need to consider a semen analysis, semen and urine microbiome test, male hormone test, testicular ultrasound and a sperm DNA fragmentation test (not all of these tests are necessary in all cases!).
Not all semen analysis tests are equal.
In my experience, 'normal' is rarely the case if you have had unsuccessful IVF or if you have been trying to conceive naturally for years without success. Dig deeper.
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