1. Seminal fluid analysis (SFA)

Analysis of semen is an important investigation for male infertility. Semen is the fluid come out (ejaculated) of the penis during sexual intercourse, which contains sperm cells and fluids from several organs around the male genital area. The fluids serve the purpose of supporting the sperm cells and supplying nutrients to them.

Important information needed to be obtained from semen include:

1. The time it was collected,
2. The time it takes to change to water-like substance (liquefaction),
3. The quantity of sperm cells in the semen,
4. Living or dead sperm cells,
5. Sperm cells with normal or abnormal structure,
6. Those that can move and those that cannot etc.

For accuracy of result of semen analysis, the method of collection is very important.

Method of collection of semen for analysis - It is usually advised to collect the semen for analysis by masturbation. If this is not convenient or is against the man’s ideology, it may be collected by withdrawal method during sexual intercourse or using special condom, if this is available.

A plane container is given to the man to collect the semen. This is then transported to the laboratory for analysis.

Normally, sperm count fluctuates from one semen sample to another. So, sperm collected at different times from the same person will definitely have different sperm count. 

Pitfalls to avoid during collection of semen - For accuracy of result: 

1. The period of abstinence should be at least three days but not more than seven days. Either extreme may affect the result.
2. Semen should not be collected with the regular condom (whether male or female). This is because the chemical inside the condom, meant to kill sperm cells, will not allow the sperm cells to survive till the time of analysis, thereby giving false result. If need be for the use of condom, special condoms devoid of spermicides (agents that kill sperm cells) can be used. 
3. The sample should be submitted within 30 minutes of collection. After this time frame, some of the living and agile sperm cells may die or become too sluggish due to the harsh environment. For this to be realistic, the collection of such sample should be done not too far from the laboratory where the analysis will take place.

2. Test for Infection

Along with analysis of semen, a test for infection in the semen is usually done. This is helpful to identify previous sexually transmitted infection, which the man may not have been aware of. Some of these infections may have effect on the sperm quality.

The type of antibiotics which the infection is sensitive to (sensitivity) is also checked to ascertain the type of antibiotics needed to treat the man.

3. Checking for Sperm in Urine 

This is done by post-ejaculation urine analysis – urine is checked for presence of sperm cells. When sperm is detected in urine, it means that sperm travels backward into the bladder during ejaculation instead of moving out of the penis (retrograde ejaculation).

This is usually due to abnormal functioning of the posterior urethral sphincter which should normally close during ejaculation to prevent backward movement of sperm. 

4. Scrotal ultrasound 

This is used to check for varicocoele (dilated blood vessels around the testes), testicular mass and measure testicular volume. 

5. Trans-rectal ultrasound 

This involves inserting the probe of the ultrasound into the rectum to view the prostate gland, which is one of the glands contributing to semen. This scan helps to locate blockage along the tract of this gland, if there is any.

6. Hormones

The main male hormone is testosterone, secreted by the testes. There are other related hormones responsible for male characteristics. These hormones are influenced by hormones from the pituitary and hypothalamus glands located in the brain.

Any abnormality in these hormones will affect the quantity of sperm produced. The levels of these hormones are measured in blood samples and any abnormality can easily be detected.

7. Testicular biopsy 

This may be necessary when there is no sperm cell in the ejaculate. It is done to check if there is actually sperm production in the testes. An instrument like needle is used to collect sample from the testes to examine for sperm cells.

If sperm cells are present, the problem may be that of blockage along the tract. If no sperm production at all, it may be a genetic problem. Genetic problem could also account for extremely low sperm count.

8. Antibody testing

Antisperm antibody may affect sperm function. It may be necessary to test for this especially when sperm motility or semen liquefaction is grossly affected.

9. Recommendation for semen analysis

For a man with normal sperm parameters on the first testing, following the protocol, it may be necessary to proceed to testing the partner, to be sure she is normal, before the man may be subjected to further testing.

However, for a man with abnormal result at the first testing, another testing is usually scheduled for a month later, bearing in mind all the earlier listed precautions. It usually requires three properly tested samples before it is concluded that the sperm quality / quantity is bad.