Without getting too personal here, we now have reason to believe that the semen analysis can tell us a lot about the man. In infertility cases, when semen quality is abnormal, I tend to ask questions of the owner that center around health, lifestyle and diet. How well do they eat and keep fit? What are they smoking and otherwise imbibing? How much are they travelling and what are their stress levels? Semen quality is not quite a fingerprint of health, but more like a footprint, or a shadow, often obliquely reflecting faults in reproductive fitness.
Semen is Sneaky
But, like tarot cards, the semen analysis may also be the furthest thing from reproductive reality. Take the man with an entirely normal semen analysis who, despite his best efforts, cannot conceive. Think of this as a fully manned and well-equipped soccer team that simply cannot win. Or a book with a fantastic cover that reads terribly. Termed unexplained infertility, this can often lead a couple down the rocky road of assisted reproduction, and ongoing conception failure. In these cases, the semen analysis can be among the most blunt instruments we have to figure out what’s wrong. Not outdated, but certainly not the full picture.
Pretty Doesn’t Cut It
So, the semen analysis alone does not make the man. Thankfully, there are other, more subtle things we can examine to better assess underlying male fertility potential in cases of unexplained infertility. The oldest of these is strict morphology, which is an assessment of sperm shape. But we now know that except for particular and rare instances, judging sperm by their figures is a shallow endeavor.
Another relatively recent diagnostic tool is sperm DNA fragmentation. This examines the “packaging qualily” of sperm DNA and has very little to do with how it looks or wiggles. Think of exhausted, overheated factory workers poorly packing delicate ceramic vases to ship to homes. The box looks fine but the innards arrive cracked or broken into shards. Unusable by the consumer, or the egg.
Even more recent is the incredibly nuanced field of sperm epigenetics. Although not clearly related to the standard semen analysis, the sperm epigenome can have a major influence upon whether a sperm is naturally fertile and whether it can help produce good quality embryos with in vitro fertilization. And, it can now be measured by mail order.
Bottom line is that there is a lot going on inside otherwise simple looking sperm. So, if it’s not happening at home but should be, or not happening with IUI or IVF with sexy looking sperm, or if donor eggs are failing to become babies, consider “deep dive” testing of the baby gravy.