Sunday, October 29, 2017

Why is it so hard to interpret a semen analysis test?


The sperm test is the simplest and commonest test done for evaluating an infertile couple. It allows us to evaluate a man's fertility, and because it's cheap, it's the one which is done first.

However, its apparent simplicity conceals how complex interpreting this test really is !

Because it's a routine test, one of the biggest problem is that lots of laboratories do it , and most of them have no idea how to do the test properly ! The technician does not have enough experience, and will often not have the right equipment ( such as a phase contrast microscope; or calibrate sperm counting chambers) .
This is why a lot of men end up with very unreliable reports, which their doctor cannot interpret intelligently, because they can't be trusted. This creates a lot of confusion ! This is why we see many men whose sperm counts fluctuate all the way from 5 million per ml to 60 million  per ml, depending on which particular laboratory they do the test from ! The irony is that all the reports are most probably wrong.  To add insult to injury , doctors will start "treatment" based on these reports - and it will be impossible to assess whether the treatment is helping - or harming !

Thus, it's very common to find round cells in the semen and these are usually sperm precursors, which are quite normal. However, these are often mis-reported as " pus cells ", and the poor man is treated for months on end with antibiotics to treat the " infection " !

Similarly, most labs are just not capable of staining the sperm to check their morphology - the proportion of normally shaped sperm in the sample, and these numbers are just cooked up by the technician.

The problem is not just poor quality labs however. Often men don't do the test properly because they have not been given the right instructions. There needs to be at least a 3-day abstinence period ;  the man needs to make sure that he collects the entire ejaculate in a clean container ; and the sample should be delivered to the lab within an hour or so . Unfortunately, lots of men don't follow these instructions , and sometimes they are too embarrassed to tell the lab that they have spilled the sample !

Another  huge problem is that gynecologists don't have the expertise to interpret the semen analysis report properly . Gynecologists are specialists in taking care of the health of women, and never see a man in their professional practice. Yes, they can figure out if the report is normal or not, but unfortunately they're not good at being able to understand the nuances of an abnormal sperm test report. This is why they often end up confusing the patient , and send him for all kinds of "advanced" sperm function tests ( which are promoted by the sperm testing laboratories  because they generate extra revenue for them!)  These tests serve absolutely no purpose at all, and make a bad situation even worse, because they don't provide any useful clinical information at all.

Often gynecologists will refer men with an abnormal report to a urologist or an andrologist, and this just compounds the problem,  because the left hand has no idea what the right hand is doing, and the treatment of the infertile couple gets fragmented and uncoordinated !

The truth is that there is very little effective treatment a male infertility specialist can offer, but because he needs to demonstrate his expertise, he will ask for a whole new batter of additional tests ! These include all kind of pointless , expensive and embarrassing tests, such as a colour Doppler to check for varicoceles ; and transrectal scans to check for ejaculatory duct obstruction. As part of the panel of tests which are ordered to be "thorough" with the evaluation, many doctors now also order hormonal blood tests ( FSH, LH, prolactin, testosterone); as well as chromosomes studies - all of which are a complete waste of time and money. The poor patient ends up going from one doctor to another , and since no one has a clue what is happening, he loses confidence in all the doctors.
It's not just a limitations with doctors - the truth is that medical science still doesn't know what a normal sperm test report is ! Many decades ago, a normal sperm count used to be considered to be 60 million per ml.  A few years ago, it was 20 million per ml. Currently, the "new normal" is 15 million per ml. It's hardly surprising that infertile men are going to say, "Hey, if science doesn't even know what a normal sperm count for a fertile man is, then how can they help me to interpret my particular report?"

The dirty little secret is we can't. We can tell a man with a zero sperm count that he can't father a pregnancy in the bedroom, but we can't really tell a man who has sperm in his semen whether he can get his wife pregnant or not !

This might seem surprising ! After all , isn't that the purpose of a semen analysis ? Yes, that's what an ideal sperm test would do, but a semen analysis is an extremely crude test , and doesn't provide us with that information. Yes, it does tell us what the sperm count is, and whether the sperms are moving or not, but that's not the question which the man is asking ! He wants to know, "Can I get my wife pregnant or not?" This is a completely different question , and because it's much more complex , it's not possible for us to answer this as yet.

After all, the fertility of a couple doesn't just depend on the man's sperm count or motility - it also depends on his wife's fertility ! This means that it's possible that if he had married a younger, more fertile woman, then he would have been able to get her pregnancy even with a very low sperm count !

This is why infertile men often end up getting such a raw deal - and this is why it's best for them to go to an infertility specialist , who deals with the infertile couple as a unit - and not just either a gynecologist ( who has no idea how to deal with infertile men) or an andrologist ( who has no idea how to treat infertile women!

You can see what a sperm test report should look like at
http://www.drmalpani.com/knowledge-center/resources/book/chapter4b

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !







3 comments:

  1. Anonymous1:29 PM

    Dear Doctor
    I had written to you before and filled up my details in the second opinion form few months back.. I am 37 and have a child from a natural conception who is 7 years old.. 2 year back I miscarriaged and since then nothng happened. Several rounds of clomid and 2 IUI I did an IVF cycle last month in Nova IVI Bangalore. They retrieved 7 eggs out of which 5 fertilised and 3 made it to day 3 and 2 were transferred on 3rd day. The 3rd egg didn't make it to day 5. However the cycle failed and my beta was negative. I didn't had anything to freeze as well. the doctor says it must be the quality of my egg but I am in a fix now as nothing seems to work for me. I asked for the photos but they said they don't take photos as the radiation might harm the embryos.

    Can I have your personal email id where I can share all my reports.If at all I want to undergo another cycle which I am keen to do with you if I decide what can I do to improve the quantity and quality so I am prepared for the next cycle and I get good eggs. Do I need to come to Mumbai first for a consultation. Please suggest me some supplements which I can start taking.

    Last but and important question. do you think IVF will work in my case given my age and the low quality eggs as they say I have.what should be the gap between one cycle to another to start again.

    Thanks
    Manisha.

    ReplyDelete
    Replies
    1. Dear Manisha,

      My email is info@drmalpani.com

      The only tangible product an IVF clinic can deliver is embryos ! All good clinics provide embryo photos proactively and routinely

      Any clinic which does not provide embryo photos is a poor quality clinic.

      Taking photos does NOT subject the embryos to radiation !

      Please find a better clinic if you want to maximise your chances of success - one which does only blastocyst transfers and provides embryo photos routinely to all patients

      Dr Aniruddha Malpani
      Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
      Mumbai 400 005. India

      Clinic Mobile: 9867441589

      Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

      Helping you to build your family !


      Watch our infertility cartoon film at http://www.ivfindia.com

      Please add a google review for us at http://bit.ly/2tN1wdb


      Read our book, How to Have a Baby - A Guide for the Infertile Couple,
      online at www.DrMalpani.com !


      Delete
    2. Anonymous4:15 PM

      thanks a lot Doctor . I will definitely get in touch with you over the email with my IVF summary.
      I had seen lot of positive cases with this clinic and it s well known brand I don't know what went wrong with me,

      thanks
      Manisha

      Delete

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