Half the Equation: Unlocking Male Fertility Through Semen Analysis

Infertility is often seen as a female issue, but the truth is men are half the equation. In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols shifts the spotlight to male fertility and the critical role of the semen analysis in evaluating reproductive health. A semen analysis isn’t just a basic test—it’s a window into the “medical health” of male fertility, providing insights into parameters like volume, sperm count, motility, and morphology. Dr. Amols explains what these parameters mean, how they’re assessed, and why they matter in the journey toward parenthood.

But what happens when a semen analysis looks normal, yet infertility persists? Dr. Amols delves into advanced tests that take male fertility evaluation to the next level. Learn about DNA fragmentation testing, which assesses the integrity of a sperm’s genetic material—crucial for successful fertilization and healthy embryo development. Discover SpermQT, a cutting-edge diagnostic test that evaluates sperm functionality, energy production, and molecular markers, offering a more comprehensive fertility profile.

Dr. Amols also discusses the scenarios where these advanced tests are most useful, such as unexplained infertility or repeated IVF failures. He shares actionable advice on lifestyle changes, antioxidant therapies, and advanced sperm selection techniques that can help improve sperm health and optimize fertility outcomes.

Whether you’re starting your fertility journey or supporting a partner through theirs, this episode will empower you with knowledge about the often-overlooked role of male fertility. Join us as we uncover how these tools can provide a deeper understanding of sperm health and help unlock the full picture of fertility.

Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.

Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com.

Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com.

Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Transcript

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Today we talk about men. They're half the equation. Infertility. So let's figure out if they're half the problem by testing them. I'm Dr. Mark Amol, and this is Taco about Fertility Tuesday. In this episode of Talking About Fertility Tuesday, we were diving into the world of sperm health. We'going to be talking about the SEME analysis and what it means. We're going to specifically talk about two advanced tests that are coming out that help us understand male infertility. Now, when most people think of infertility, they think of the female as, matter of fact, many females even think it'them. The thing is that men are half the problem it comes to infertility. And so we need to evaluate them. Now, unlike women, who have multiple tests that they have to do, there really is just one test for men, which is the SEMA analysis. Now, that doesn't mean there aren't further tests for men. There are if there are problems found. But the first initial test to determine if there is a problem is going to be the semen analysis. Similar to how the menstrual cycle is kind of the medical health of the female, the semen analysis is kind of the medical health of the male. When the semen analysis is off, then we know there could be other things wrong, such as hormonal issues or maybe even problems at the testicles. Just like when a woman's menstrual cycle is off, we know there could be other issues. The thing is, I'm always surprised when people come to me and say, oh, my SEME analysis was normal. And they'even tell me their doctor told them it was normal. And the thing is, is that really most physicians, other than fertility doctors, not even urologists, really know what these parameters mean. And so what I want to do is I want to talk about these parameters, go over each step so you know what to look for. And then the last thing is'going to talk about. Two new exciting things are coming out or than you probably have heard of and one you probably haven't. I do want to apologize ahead of time for my voice. I am a little bit sick, but I still want to get this episode out. So what is a SEME analysis? A SEME analysis is essentially a man gives a sperm sample and then evaluates that for parameters. Now, usually men will masturbate into a cup and give the sample. There are times people cannot masturbate, and for that reason, there are other ways to get the sperm. One of those ways is going to be with a special condom where they can have intercourse and then put the condom in the cup and then that can be evaluated. The other way is there is also vibratory stimulation that can also help with ejaculation, as well as an electrical stimulation that can also cause ejaculation. Now there are basic parameters of a immun analysis that includes the volume, the concentration, the count, the motility and the morphology. Now in addition to those, there are some other things such as the grade or progressive motility, ph, viscosity and liquefaction time. Other additional parameters would be vitality as well as fructose levels and even further testing. You can look at things like white blood cells, round cells, agglutination, and even antiserrm antibodies. But the basic main parameters are going to be volume, sperm concentration, count, motility and morphology. So let's start first with volume. So the volume should be at least 1.5 milliliters or greater. That's not a lot of sperm. Matter of fact, many men are kind of freaked out when they realize how little sperm comes out and that's actually normal. Now it's important to understand that sperm itself doesn't take up a lot of volume. So most of the volume has come from the prostatic fluid or the seminal vesicle fluid. When the volume is lower, there could be a problem. So if its less than onelil, we call that hypospermia. So what kind of things can cause this? Well, one of them is called retrograde ejaculation. Especially men with diabetes can have problems with ejaculatory process. And that can cause a sperm to actually go backwards into the bladder versus coming out of the penis. And so one of the things you do to evaluate that is you do a retrograde analysis. But after the SEME analysis is given, you then check the urine and see if there's sperm in it. If there is sperm in it, then you have retrograde ejaculation. Other causes of having low volume can be things like a similar vesicle blockage or prostatic blockage, or even a thing called congenital absence of the vas deferens. Usually pre provideed CBAVD for congenital bilateral absence of the vas deferens. The vas deferens also comes from the same part that makes similar vesicles. So if you are missing the vas deferens, which carries the sperm from the testicle to the penis, you will also be missing the se vesicles which make up most of the volume. And that will cause you then to have low volume sperm One of the ways we'able to distinguish the different types of volume issues is by looking at the ph. The prostate is more acidic and the syol vesicles are more alkalinic. So if you're missing the syol vesicles, you're going to have more acidic sperm. If the ph is normal and the volume is low, then you start thinking of other things such as ejaculatory process issue. So then the question is why does it matter? What matter is because the vagina is like an upside down triangle. We like to think of as a tube, but it's not a tube. As you get towards the top of the vagina it actually gets whiteider. And for this reason the sperm, if it's very low volume, can kind of get lost in those vaginal folds and doesn't really cover the cervix as well. And that could lead to infertility. One of the best treatments for low volume is doing IUIs because the sperm count is usually there is just low volume. If you have retrograde ejaculation, then they take the urine, clean it, take the sperm from it and can also do IUIs if there's enough sperm. So that takes us next to sperm concentration. Now when we think of sperm we think of count. What's my count? How many sperm do I have? But in reality it's not just about the count, its about the concentration. It doesnt matter if you start with a billion sperm. If the concentration is low, it means you have very little sperm sitting at the cervix. Because even though that sperm is in the vagina, only the sperm touching the cervix is going to get in. So if you have a lot of sperm but the volume is high and the concententration drops, you can also have infertility due to the fact that the sperm touching the cervix is a low count. Even though the total count is good, the normal parameter for this is usually around 20 million sperm. Now by definition of the who, they say it's greater than or equal to 15 million, but I usually like to use 20 million sperm. There's a second part to this and that's the motility of the sperm. If your concentration, let's say, is 20 million sperm, but the modal concentration is less than 10 million, that can also causeertility. So it's not just about the concentration, but the modal concentration, which then takes us, to the next part, motility. When you hear motility, it sounds like we're talking about how fast the sperm is swimming. But what's interesting is that's not what motility means. Motility is more about how many are alive when how many are dead. So when you hear 30% motility, it doesn't mean your sperm at moving at 30% the speed than normal sperm. Instead it'saying that 70% of your sperm is dead when you ejaculate it. Now how does that affect fertility? Well, imagine if you're in a room with a hundred people and your'shoulder to shoulder and squeezed into that room and there's one door and you have to get out because there's a fire. Is it going to be that easy? If, 70 or more percent won't move, it going to be tough to get out of that room. And you have a brain, you're able to actually move around people and figure this out. Sperm have no brains. And so in that situation they can struggle to get to the cervix. All those dead sperm will just get in the way and prevent them from being able to move forward. Now, motility can then be broken into types of motility, which we call progressive motility. And this is important as well, because if you have 100% motility, that'great everything is alive, nothing is dead. But if they're just twitching and not moving, that doesn't help you much. And so this can be sometimes reported as a grade like 4, 3, 2, or 1 or sometimes it will even give a percentage of progressive modal versus non progressive modal. In general, you want at least greater than or equal to 40% of the sperm to bee modal or greater than 32% to be progressive modal. If the sperm isnt moving as well, then fewer of them are going to be able to get to the egg. Now to appreciate that, you have to understand that in a normal situation where someone has normal sperm count and no issues, has multiple kids when they ejaculate, there's millions of sperm ejaculated, but only 100,000 sperm actually get into the uterus. And if those 100,000 sperm, only 50 make it to the egg. So you can see now if the motility is, let's say, half of what it's supposed to be, then you could't imagine that even fewer sperm eing at the egg, if at any will. So then that takes us the total sperm count. The total sperm count is how much absolute sperm you have. And that needs to be multiplied by the motility. They give you the total moal count. Now, in general, if all the parameters are normal, meaning the volume, the concentration, motility or fall, then as long as you have about 20 million total moal spem, you should be able to get pregnant naturally without many issues. Now if it's between about 10 and 20 million, this is where people sometimes need artificial inseminations such as IUI and even above 10, more like 12 and above for IUI. Now if you have 10 total million sperm that are moving, then you're talking about IVF at this point and if you're less than 5 million sperm again moving, then you're talking about IVF. With ICSI where we inject the sperm into the egg. The last part is morphology and a lot of people get worried about morphology because this is the way the head of the sperm is shaped. We only expect about 5% of the sperm to be perfectly normal shape. That means 95% of your sperm is not supposed to be perfectly normal shaped. But the thing is, the femo reproductive tract is very good at filtering the sperm. So when the motility is only 2% sor the morphology is only 2%. It sounds bad, but in reality it's not that big of a deal because the female reproductive tract is still going to filter the sperm. So only the best of the best sperm get to the egg. Now if there's only 0% normal sperm, that can be a little bit more concerning and especially if there's other parameters that might be something you need to talk to your doctor about. Now where the morphology comes into play is that when it comes to ivf, if that morphology is low, we sometimes will do ICSI versus doing standard insemination. And this is not because the sperm is bad, but because we don't have a way to filter it like the female reproductive tract. And so we would be concerned that there would be lower fertilization rates without using icsi. Now I mentioned there are some other tests that are sometimes done such as the ph and the liquefaction time, fructose levels and looking at other things such as brow cells, white blood cells andlination. Now for these, if they're off, this is something you're going to talk to your doctor about because those tests by themselves don't matter as much because IUI usually fixes all of them. Even spermmanibodies can be treated with doing IUIs, but in conjunction with other problems it helps us at least understand the problem or let us know we need to do another test. So for example, if someone sees round cells then the concern could be as are they from leukocytes being white blood cells or is this spermatogenesis issue meaning that the sperm did not develop correctly? If there's lots of agglutination then there's concern of could there be antibodies or some type of infection in the liquefaction time. It could be issues with prostatic enzymes are not working well to liquefy the sperm. Fructose levels are looked at to determine that the seal vesicles are functioning because thats where it comes from. And so if its not there then they would also point to the CBAVD issue or obstruction in the seal vesicles. Now some fun words to learn Caseylay Scrabble are the sperm results. One is called oligospermia and thats when you have a low sperm concentration. The other one is acinospermia and that means reduced motility. If you hear terretosospermia that means it has abnormal morphalologya. And if you hear the word azospermia then that means there'no sperm at all in the ejaculate. Now when we think about fertility, we often focus on the sperm count, the motility and the morphology. The big three of the standard SEME analysis. Now while these are important, they are only part of the story. I always made the joke and say sperm is like the pizza delivery guy. You don't really care what the guy looks like. You care about what the pizza is like. And so the pizza is the DNA. And so if the DNA is not good, it doesn't matter if the pizza guy looks good. It'the DNA that we care about, which is the pizza you care about. So how do you look in that pizza box to find out if your pizza was damaged so it was done correctly? Well, that's what sperm DNA fragmentation looks at. The quality of the sperm'snetic, material or in this state, the pizza. Even sperm that looks perfect under a microscope can have damaged DNA that makes it harder to achieve a health of pregnancy. And then we have a new test called Sperm qt. Its a new player in the field. Think of Sperm QT as a deeper dive into not just the sperm appearance but its functionality. It like running a full diagnostic test on a car instead of just kicking the tires. It looks at the things like how much energy the sperm can generate, how well it can withstand stress and even molecular markers that tell us if it's ready to fertilize an egg. So why are these tests important? So let's start with DNA fragmentation. It's exactly what it sounds like. The DNA inside the sperm has breaks or damage. DNA is like a blueprint. It's the genetic instructions needed to create a baby. If that blueprint is torn or incomplete, the sperm may fertilize an egg. But the resulting embryo could have trouble developing normally. So what causes DNA fragmentation? Well, one of the big culprits is oxidative stress. This is one reactive oxygen in species also known as ros build up and overwhelm the sperms natural defenses. Its like rust forming on like a car. It happens over time, especially when exposed to harmful conditions like smoking, pollution or even heat from tight clothing or varicoceleals. We measure the DNA fragmentation with specialized tests called tunnel or schiza which can detect whether the DNA strands are broken. Higher levels of fragmentation are associated with lower chances of conception, higher miscarrige rates and even reduce success with things like ivf. So as you can see, it does have an important part in the evaluation. But the good news is there are ways to improve it such as lifestyle changes, antioxidant supplements and even advance sperm techniques such as the Zymod chip. This brings us then to Sperm QT which takes things even further. Sperm QT is like the next generation of sperm. Testing instead of just looking at the sperm count, motility or DNA image evaluates how the sperm actually functions. For example, Sperm QT can measure mochondrial activity. This tells us how much energy the sperm has to swim and reach the egg. It also looks at oxidative stress markers which show whether the sperm is under attack from free radicals. But what makes sperm QT unique is his ability to combine all these factors into a predictive score. It doesn't just tell us what the sperm is doing right now. It gives us insight into how likely it is to succeed in fertilizing an egg. Its like getting the crystal ball for male fertility based on science. The other cool thing about Sperm QT is it uses cutting ed technology like machine learning algorithms. This allows it to even go deeper into analyzing the data from the sperm samples. Essentially it its giving you a personalized fertility profile which could be a game changer if youre facing unexplained infertility or repeated IVF failures. So the question is, does semen analysis has been around for a long time. Why do we need something different? Why should we stray from the normal SEME analysis? The answer is while traditional tests are great for giving us a snapshot of the sperm health, they only tell us the whole story. And this is where a DNA fragmentation and sperm QT add a further layer detail that can help us better understand the root cause of the infertility and tailored treatments that are going be more effective for you. Think of it as precision medicine treating the individual, not just the symptoms. At New Direction Fertility Centers we do not do these additional tests regularly. When it comes to sperm DNA fragmentation, I will look at it if we're not planning on using a Zymod chip because it may have effect the same thing when the sperm qt use it when I'm in that situation where I have unexplained infertility and IVF cycles aren't working. However, as a general rule, most people just start with a Seigment analysis and then from there they can add another test if needed. But usually those tests are not added unless there are further concerns of the sperm such as IUIS failing or repeated IVF failures. If you do find out that your partner has high DNA fragmentation, you want to make sure that you make some lifestyle changes, take antioxidants and see if your clin uses the Zymod chip to be able to filter the sperm better. Hopefully this episode was helpful to you. Maybe you're going through this and have male factor problems or know someone who does. If so, maybe you just want to understand seme analysis or you have friends who are interested in that. Please tell them me about this podcast. And as always, if you like this podcast, please give us a five star review on your favorite medium. And most of all, keep coming back. I look forward to talking to you again next week on Talk About Fertility Tuesday.