QuestionQUESTION: Volume: 5 ml
Liquefaction: 20 min
Rapid active progressive: 55
Moderate active progressive: 5%
Sluggish: 5%
Non-motile: 35%
Count: 72 million/ml
Normal forms: 70%
Abnormal form: 30%
Pus cells: numerous
RBC: 2-4
Looking to the following sperm test, do you consider the person to be normal / able to pregnant a woman or not? If not, in which part of the detail you think the problem? And what do you recommend?
Thanks
ANSWER: Hello Slame,
This test is completely normal and pregnancy should be able to occur if the woman is completely normal as well.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
---------- FOLLOW-UP ----------
QUESTION: Dear Dr. Edward,
Thank you very much for your reply.
What happened is I took the previous result to a doctor and he informed me that with this result, the chance of pregnancy is very low. He mentioned that result shows that the non-motile percentage is very high (35%) and needs to be decreased, the forward progressive movement level is also low. in addition to that, he stated that pus cells results (numerous) shows that there is some kind of inflammation which need to be addressed.
He asked to conduct another semen test which I did in a very developed lab, and the result came as follow:
Volume: 5 ml
Liquefaction: 30 min
Count: 70 million/ml
Grade (I) forward progressive movement : 20%
Grade (II) forward progressive movement: 20%
Grade (III) Non progressive movement: 10%
Grade (IV) immotile: 40%
Sluggish: 10%
Normal forms: 92%
Pus cells: 4-6 HPF
RBC: 2-4 HPF
Considering the new result of the immotile, and forward progressive movement, in addition to the level of the pus cells, do you think the chance to pregnant women is still possible? And what do recommend me to decrease the immotile level considering that I am not smoker, drinker, or drug user?
Thank you in advance.
ANSWER: Hello Again,
The current WHO recommendations for motility is >40% and progressive motility >32%. With 70 Million sperm, you have 50% motile sperm which means that 35 Million are available to get to and fertilize the egg (the minimum required is 10 Million). The number of nonmotile sperm is NOT significant in your testing and means nothing. Semen analysis is evaluated based on what is available for fertilization only (motile sperm), not what is not available. You do have some white blood cells in the analysis which might indicate a low, clinically insignificant inflammation. I would send semen for culture to see if there is any predominant bacteria present but also consider treatment with Doxycycline just to make sure.
I stand by my previous response which was that there is no infertility issue present based on your sperm and you should have a normal ability to produce a pregnancy. I disagree with your doctor's conclusions, and often see mistaken recommendations and treatments from doctors in India.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
---------- FOLLOW-UP ----------
QUESTION: Dear Dr. Edward,
This is a follow up to my previous inquiry. I have made the seminal culture as you suggested, and the culture yielded to (Enterococcus species isolated). The seminal analysis of the same specimen showed the following:
Number of sperm: 50 million/ml
Consistency: Normal
Liquefaction time: 30 min
Color: greish
Reaction: alkaline
Rapid forward progression: 25 %
Moderate forward progression: 25 %
Sluggish forward progression: 20 %
Immotile: 30 %
Pus cell: 0-1 HPF
RBC: 0-1 HPF
Epithelial cells: 0-1 HPF
Spermatogenic cells: 2-4 HPF
Normal head: 80 %
What is your impression of both examinations? Is there any abnormal details in both results ? Do you think there a connection between this bacteria and the semen motility? And what do you recommend me?
Thank you in advance
AnswerAgain,
The semen analysis is normal. Normal parameters are:
Count: >20 million (you have 50 million)
Motility, total: >40% (You have 70%)
Morphology: >30% (you have 80% normal forms).
The enterococcus is an intestinal bacteria and probably or most likely a contaminant. Bacteria can certainly kill sperm causing a low motility, but you do not have that problem. So, in all likelihood, it was a contaminant either from when you collected the sperm or from the lab doing the testing. In any case, wince the WBC (pus cells) are 0-1 per high powered field, it is not significant and I would do nothing.
So, again, I confirm that your semen analysis is normal and NOT the problem no matter what your doctor says, and I wouldn't trust anything else this particular doctor says about fertility because he obviously does not have the expertise to know!
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
