As a urologist specializing in male fertility, perhaps the most common question I get asked by new patients is, “am I fertile?”
To find out, I’ll examine them, draw hormones and get two semen samples for analysis. As soon as I get the results back from the lab, I’ll review them and go over the numbers with my patient. Most of the time, it’s good news and I tell him that the results are “normal.” Often, there is one semen parameter—like concentration, motility or morphology (the numbers of sperm, their ability to move and their shape)—that may not meet the normal value for that particular laboratory.
In a very interesting study published by Guzick. et al. in the New England Journal of Medicine, they set out to define which males were fertile by semen analysis parameters. They looked at 765 couples who were unable to conceive for at least a year and 696 fertile couples as the control groups. All the men were 20- to 55-years-old. All of the women partners had normal evaluations.
The resulting semen analysis numbers greatly overlapped among the groups. Fertile men had a mean (average) concentration of more than 48 million sperm/cc, 63% motility and 12% normal morphology . The values that best defined infertility were a concentration of less than 13.5 million sperm/cc, less than 32% motility and less than 9% normal forms. Patients defined as indeterminate had concentrations ranging from 13.5 million sperm/cc to 48 million sperm/cc, 32–63% motility and 9–12% normal morphology. As you might expect, infertility increased with decreasing sperm concentration, percent motility and normal forms.
(NOTE: Infertile males were also more likely to smoke and drink. So if you’re looking to start a family, here’s another good reason to break those habits now.)
The study concluded that while the parameters provide useful information for diagnosing infertility none of the measures alone or in combination can be diagnostic of infertility. A semen analysis is like a photo snapshot – you might look different day to day or different times throughout the year, and so might your semen analysis.
More often than not, the real question my patients want to know is “can I have a child?” For most men I see, the short answer is “yes”…under the right circumstances and treatment. Of course, men are only half of the equation. It takes both partners in the relationship to achieve a pregnancy, and depends on what, if any, assisted reproductive technology they are both willing to go through. Ultimately the old adage is true, it takes two to tango. Enjoy the dance.