Male factor infertility is not as prevalent as female factor infertility; however, it is important that both the male and the female of a couple, seeking unexplained infertility treatment, undergo evaluation. Couples who experience infertility without a known cause usually seek a medical evaluation from a reproductive endocrinologist, like Dr. Cecil Long, when all other options have been explored. At the America Institute of Reproductive Medicine – Alabama (AIRM), we can perform a semen analysis for men concerned that the issue is with their sperm. Dr. Long has extensive experience in the surgical extraction of sperm, such as microsurgical epididymal sperm aspiration (MESA), testicular sperm aspiration (TESA), percutaneous epididymal sperm aspiration (PESA), and the microdissection of the testis, also called microsurgical testicular sperm extraction (Micro-TESE). Couples who are unable to conceive using their own sperm may opt to use third-party reproduction with donor sperm to achieve pregnancy.
Methods of Collection
The screening procedure can provide a wealth of information about the health and function of the male reproductive system, as well as the fertilization potential of sperm. The main parameters the sperm will be tested for:
- Ejaculate volume
- Sperm motility (movement), the percentage of sperm that moves forward normally
- Sperm morphology (size, shape, and cellular properties), the percentage of sperm that have a normal shape
- Sperm count, the number of sperm per mL in one ejaculation (low sperm count is considered less than 20 million sperm per mL)
In most cases, semen is collected via masturbation. The man will masturbate in a private collection room at the fertility office and will ejaculate into a sterile sample container. Patients may also obtain the semen sample at home but must take certain steps to deliver it to our lab so it is not contaminated. If the semen sample does not have any sperm, the following minimally invasive procedures can be used for surgical sperm extraction for fertility treatments. Since the quantity of sperm obtained by any of the surgical extraction procedures is often quite low, in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are the only viable options for a chance of conception.
Testicular sperm aspiration (TESA): A needle is inserted into the testicle to gather tissue and fluid. TESA is most often used when azoospermia, lack of sperm production, is caused by an obstruction of the reproductive tract. The epididymis (a tube in the testicles that carries sperm) is left untouched to minimize injury.
Percutaneous epididymal sperm aspiration (PESA): A needle is inserted through the scrotum and into the epididymis to collect sperm. PESA is most often used in cases where obstruction is an issue.
Microsurgical epididymal sperm aspiration (MESA): A microsurgical procedure that collects sperm from the epididymis, which transports sperm from the testicles to the vas deferens or urethra; used most often in cases of a blockage in the epididymis or obstruction, such as a vasectomy.
Microdissection of the testis or microsurgical testicular sperm extraction (Micro-TESE): Testicular tissue is extracted directly from the testicle. Micro-TESE is used for individuals with non-obstructive azoospermia, or poor sperm production.
"Dr long and his staff are absolutely amazing! He is so hands on and helps you understand everything!"- C.A. / Google / Apr 14, 2018
"Dr. Long is amazing! We started seeing him at Brookwood in 2014 for our fertility issues. When we heard that he opened up his own practice, we followed him there. He has the perfect balance of knowledge, bedside manner and sincerity that we look for in a doctor. He has not given up on us and that is a major plus!"- R.G. / Google / Apr 05, 2018
"My experience with Dr. Long has been nothing short of amazing. His expertise and bedside manner are the best I have ever experienced and he is always willing to go above and beyond to be available and attentive to any questions or problems for patients. His office staff is truly the friendliest and it feels like you are their only patient whenever you are there. I love Dr. Long and am so thankful to be one of the many patients he has helped!"- R. / Healthgrades / Feb 22, 2018
"Dr. Long is the best. Truly. His willingness to be attentive and available and make you feel at ease and at home has made for the best experience with a doctor I have ever had. The staff at his office are top-notch and you feel like you are the only patient whenever you are there. If you are dealing with infertility or any issues related to infertility...do not wait! Go see Dr. Long!"- R.F. / Google / Feb 12, 2018
"Dr. Long helped me and my husband get pregnant last year. He figured out exactly what was wrong with me and preformed my hysteroscopy and laparoscopy last April and we had our first and only IUI in May. We got pregnant on our first IUI. We used him at ART and continued to use art for the 12 weeks. Our whole experience was great and wish Dr. Long the best of luck!"- S.E. / Facebook / Jan 06, 2018
What to Expect
Since there are many factors that may temporarily affect sperm production, a single semen analysis is sometimes not sufficient to provide the information needed to diagnose male infertility, unless it is perfectly normal. If an initial semen analysis is abnormal, there may be a benefit to repeating the analysis to get another assessment. There should be a 2 – 4 week gap between the tests. Based on the results of the semen analysis results, a referral to a urologist may be recommended.
Instructions for Collection
An appointment must be made in advance for all semen analysis, intrauterine insemination (IUI) sperm preps, and sperm cryopreservation. Please call to schedule an appointment.
For semen analyses ordered by outside physicians, we must have a signed laboratory requisition from your referring physician before results or samples can be released. Requisitions can be brought to the office or can be faxed. Please be prepared to provide photo identification for security and quality control purposes.
For semen analysis, IUI sperm preps, or IVF procedures, an abstinence period of at least 48 hours but no more than 7 days is advised. Please refrain from ejaculation by any method during this abstinence period. Abstinence periods outside this range may yield unreliable results and may require repeat testing.
- A sterile, clean specimen is important. Before arriving at our fertility clinic, please wash the genital area thoroughly.
- Collect the sperm by masturbation into the sterile specimen container provided by our offices. Note: other methods of collection may result in a contaminated specimen and may not provide a reliable or representative analysis.
- Household containers should not be used, as they can be toxic and result in an inaccurate semen analysis
- Please do not use lubricants, as they can be detrimental to sperm
- If you feel you need a lubricant, please come by the office and we can provide you with a non-toxic lubricant. Please use the smallest amount of lubricant possible and take extreme care not to get any into the specimen container.
- Ejaculate into the specimen container without touching the interior. Put the lid on tightly and label the container with your name.
It is best to collect specimens at our office to avoid contamination and expiration. Specimens may be collected at home if brought to the office within 45 minutes of the collection time. The specimen should be kept near body temperature during transport and without exposure to extreme heat or cold.
Semen analysis via masturbation has few risks or side effects. Surgical sperm extraction or aspiration poses minimal risks to the patient, including:
- Bruising or tenderness of the scrotum
- Mild discomfort
- Infection of the incision area
Plan Your Procedure
- Recovery Time
- Average Procedure Time
- Post-op Follow-up
Know Your Numbers
A semen analysis is performed by first collecting a semen sample at home or at our office. Once received, the sample will be examined for volume, consistency, pH, a concentration of sperm per mL, motility (movement), and morphology (shape). This type of testing will help us understand some of your infertility issues. A semen analysis can also confirm if a vasectomy or vasectomy reversal has been successful. Contact AIRM for more information or to schedule an appointment in our Birmingham, AL office.