What you need to know about the infamous Semen Analysis

by Karen Reynolds, L.Ac., M.S., R.N.; Mill Valley, CA.

A semen analysis, often colloquially called a “sperm count”, is not used only to count sperm. It also evaluates sperm production (quantity) by the testis, assesses how the sperm are moving (quality), and examines secretions of the genital tract.  A semen analysis does not singularly determine a man’s fertility. Many additional factors must be reviewed and considered. From the standpoint of processing of semen samples: not all labs are the same. In my fertility acupuncture practice, I have stopped sending my patients to larger, unspecialized laboratories, such as those in community hospitals or large corporate labs. This article reviews pros and cons about the types of options available and important considerations for collection for the most accurate results. At the end of this post, I have additionally listed some definitions and terminology.

Semen samples are best processed in an “andrology” lab. Such labs are generally associated with Urology or Reproductive Endocrinology offices.  This is important as a semen analysis is a time-sensitive procedure that requires a certain level of technical expertise to perform accurately. Processing by an andrologist is inherently superior for multiple reasons.  Firstly, an andrologist has advanced training and skills in assessing semen samples and extensive experience in proper handling. Secondly, dedicated andrology labs typically have state of the art equipment with more accurate counting chambers and more formal analytical methodologies. In unspecialized lab settings, semen specimens frequently are relegated to the least senior technician on site, or to the technician available at that moment. For that reason the specimen may be handled and processed by less experienced individuals.

A study published in The Journal of Human Reproduction in 2000 showed marked variability in the same semen samples analyzed at different facilities. Results for the same semen specimen ranged from a count of 3 million sperm/ml to 492 million sperm/ml. Erroneous results can be emotionally devastating, can cause unnecessary stress, can change the course of medical care, and are wasteful.

In other words: your semen analysis results from an unspecialized lab might tell you that Elvis is in the building but it won’t go into detail about how many cheeseburgers he’s eaten or how well his hips are swiveling. Yes, this is a campy analogy, but I’m sure you understand my point. If you are going to the trouble of spending time and money to produce a sample, you want it to accurately reflect what is going on with your sperm production.

Additionally I strongly encourage men to schedule the semen analysis in conjunction with a complete medical history and examination by an experienced Urologist. Beyond the natural drive to father a child, each man needs to be evaluated for a disease processes that may cause an abnormal semen analysis, or for mechanical issues or genetic pre-disposition which might affect not only semen quality but his health in the future. Currently it is accepted that infertile men can have higher rates of testis and prostate cancer after the diagnosis of infertility is made.  Unfortunately, the male infertility evaluation is sadly lacking in current conventional practice as the focus has tended toward the women and Assisted Reproductive Technologies (ART). Please remember: a semen analysis alone is insufficient to inform a couple whether male infertility is

a) curable,

b) caused by an important health condition, or

c) a risk factor for later disease development.

Another vital consideration is your comfort level and how you are treated. At a Urology office such as The Turek Clinic in San Francisco, CA (www.theturekclinic.com) you will find professional staff, a quiet, private setting and a seamless process for appointments. You can literally show up at 8AM and be completely done well before noon. In those few short hours the semen analysis is collected and processed. The results are interpreted for you the same day by Dr. Paul Turek, and a comprehensive history and physical exam is completed during a consultation hour. It is commonplace to need to meet on-site with Dr. Turek only once and follow ups can be scheduled per telephone, in the comfort of your home or office. Your time will not be wasted and you’ll come away having had a hassle-free, thorough, reliable exam and testing process.

The Turek Clinic

www.TheTurekClinic.com

Blog: www.TurekonMensHealth.com

55 Francisco Street #300

San Francisco, CA 94133

(415) 392-3200

I hope this article is helpful for your journey to fatherhood and having a family. In my acupuncture clinic, I specialize in male and female fertility, women’s health, and functional endocrinology. Drawing from my 20 years of experience as an ICU nurse, I make extensive use of lab testing. I also utilize acupuncture, dietary changes and nutritional supplementation to optimize health, wellness and vitality for the amazing men and women who I have the great honor treat.

Below are important considerations for obtaining your semen sample as well as some additional information regarding terms you may see on your results.

If you have questions, please feel free to contact me at:

kreynolds@balancerestored.com

Balance Restored Center for Integrative Medicine

600 Miller Avenue

Mill Valley, CA 94941

Ring: 415.381.8500 Ext. 4

See my blog for additional information:

http://karen-reynolds.com

Semen samples require specific steps in collection and transport. Here are some important directions to assure accurate results.

•Due to religious or personal beliefs, masturbation for sample collection may not be an option for all men.  In this case, inquire with your MD regarding use of a Milex sheath or a Silastic Sperm Collection device. These specialized condoms are non-toxic to sperm, yet allow for effective collection.

•Abstain from ejaculation for 2-4 days prior to semen collection. Longer or shorter periods of abstinence will impact your results.

•Consult with your MD regarding appropriate lubricants for use during collection. Most lubricants are toxic to sperm or otherwise impact the specimen.

•Collect in a sterile container-obtain this from your MD.

•Make sure the entire ejaculate volume is collected. All is necessary for an accurate test.

•Samples must be kept at body temperature. Place the sample in a shirt pocket to maintain the temperature.

•Deliver the sample within 1 hour to your testing lab.

•Always check with your lab facility to be certain other requirements are not necessary.

World Health Organization Limits of Adequacy for Semen Samples (1999)

Volume                                     >1.5 ml

Concentration                         >20 million/ml

Motility                                     >50%

Morphology                             >30%

Forward progression             2 on a scale of 0-4

Semen Analysis Terms and Definitions

Density=                                    how many million sperm per milliliter of semen fluid.

Motility=                                    the percentage of sperm with any movement

Morphology=                            pertains to sperm shape and physical characteristics

Forward progression=           quality of sperm movement rated on a 0-4 scale

The Thyroid Fertility Connection and Hashimoto’s Disease, Part I of III

by Karen Reynolds, L.Ac., M.S., R.N.

Elizabeth is a hardy, healthy small business owner known for her creativity, drive and sense of humor. In the last 2 years she has fallen pregnant easily; but has had 3 miscarriages, each early within the first trimester. Her medical doctor had attributed her pregnancy losses to advance maternal age. Following the last miscarriage, she began noticing that her energy level seemed inordinately high, even after 12 hours of hard work. She also began spontaneously losing weight. This pleased her; but it was peculiar that neither her diet nor activity level had changed.

Next she started experiencing heart palpitations and feeling as though her insides were quaking. Friends and family dismissed it as anxiety, overwork and stress, though Elizabeth is not an anxiety prone woman. These symptoms culminated in awakening one morning with double and blurred vision and a headache so severe that she could not drive or function.

It turns out that Elizabeth has Hashimoto’s disease-an autoimmune disease of the thyroid. Autoimmune means that the body attacks itself or identifies its own tissue as foreign.  It is important to realize that with Hashimoto’s disease, women can have fluctuating bouts of BOTH Hyperthyroid (fast/overdrive) and Hypothyroid (slow/sluggish) symptoms.For some women, the symptoms change rapidly from week to week.

Hashimoto’s disease is complex with regard to how it disrupts fertility and can contribute to recurrent miscarriage. During hypothyroid bouts, the disease impacts progesterone production. During hyperthyroid bouts, the disease imparts extreme inflammatory stress and temperature dysregulation. The matter is further complicated by the fact that some women have the commonly checked TSH blood level (Thyroid Stimulating Hormone) registering within “normal” ranges; yet they do have Hashimoto’s disease. For your review below are listed typical Hyperthyroid and Hypothyroid symptoms.

Hyperthyroid Symptoms

Heart palpitations, heart racing

Agitation

Anxiety

Nervousness

Feeling like your interior of your body is trembling

Insomnia

Loss of weight without diet or activity change

Hypothyroid Symptoms

Marked fatigue, despite getting enough sleep

Unable to lose weight, even with a strict nutritional intake

Gaining weight, even with a strict nutritional intake

Poor concentration

Memory loss

Hair loss/thinning: on scalp, body, and genitals

Loss of outer edge of eyebrows

Extremely dry skin

Dandruff

Constipation despite fiber, fluids, and over the counter medications

By the time Elizabeth saw me for acupuncture, she was physically and emotionally drained.

I was stunned to find that nowhere along her course of evaluation were blood levels for antibodies drawn. This is a must. Labs called Thyroid Stimulating Hormone Antibodies (abbreviated TSH Ab), had been drawn to rule out Graves Disease. These were indeed negative for Elizabeth; but she still had Hashimoto’s.

There are two basic and inexpensive antibody blood tests, which should always be checked when there is a question of thyroid disease or Hashimoto’s. In my practice, I routinely order these markers. My patients pay $29 for each test plus a $7 lab draw fee.

Thyroid Peroxidase Antibodies abbreviated TPO Ab.

Thyroglobulin Antibodies abbreviated TGB.

Elizabeth had extremely elevated numbers of both Thyroid Peroxidase Antibodies and Thyroglobulin Antibodies. Conventional medicine does not typically recognize steps, which autoimmune patients can actively take to attempt to quench the inflammation that occurs within their bodies due to autoimmune thyroid issues. This may be one reason why antibody draws are often not completed. The conventional medicine tack that is frequently taken is that the thyroid will eventually be burned out, so to speak, by the body’s repeated autoimmune attacks. Then the woman will simply be on thyroid hormone supplementation for the rest of her life.

What about the woman’s body, mind and spirit weathering the extremes of these overdrive states? What about the physiological impacts to a woman’s overall health during these flares? Any woman who has ever experienced this phenomena will tell you she wants options.

In addition to seeking medical care and acupuncture, here are some things you can do to take care of your own thyroid if you have or suspect you have Hashimoto’s disease. By following these self-care measures, you can assist your body in more optimal hormone regulation and reduction of inflammation, so as to improve your chances to fall pregnant.

First of all: see your MD and Acupuncturist. Have the appropriate labs assessed and interpreted to determine the function of your thyroid.

Cut out gluten from your diet-FOREVER.

This is a strong statement, I realize. There are voluminous amounts of evidence that gluten is akin to gasoline on the fire of autoimmune issues.  Sometimes my patients will say to me “Can’t I just have a slice of birthday cake once a year?” Please note: one exposure to gluten revs up your immune system for up to 8 months. One slice of birthday cake could have long standing impacts to your thyroid, causing a flare. An autoimmune thyroid flare can in turn cause your body to attack your thyroid. You have power within your habits to attempt to preserve your thyroid’s function. Avoiding gluten is one power you can exercise. I will have more information on gluten and how it affects the thyroid in Part III of this series. Complex carbohydrates that are OK to include in your diet are potatoes, rice, quinoa, and wheat-free oats.

Avoid iodine supplementation and avoid iodated salt.

This may seem counter intuitive. From a biophysiology standpoint, iodine stimulates increased production of Thyroid Peroxidase (TPO). For a woman who has antibodies (Thyroid Peroxidase Antibodies TPO Ab) to her own TPO, this surge of TPO can cause flares. Sea salt is fine. Cook your own food as much as you can.

The other iodine warning is to avoid, if possible, scans requiring use of intravenous iodine based dye. Patients generally must sign consent for the iodine contrast dye to be used. Chemically flooding your system with an iodated dye can do exactly the same thing as iodated salt. However a contrast dye injection is in far greater quantities and infused directly into your blood stream. With any testing procedure, you all must weigh the pros and cons. Actively consider these with your MD, should it be necessary for you.

Increase antioxidants in your diet and with supplementation.

We often hear about antioxidants associated with warding off cancer or used in anti-aging protocols. If you have Hashiomotos disease or suspect it, your body will use antioxidants to quench that flaming fire of inflammation caused by the autoimmune response. The great thing is that antioxidants are abundant in green leafy vegetables, they are widely available as supplements, and there is plentiful information about them on-line. Cindy Bailey’s fabulous book The Fertile Kitchen Cookbook models a diet naturally high in antioxidant rich foods to nourish your body. Additional information on antioxidants will be provided in Part III of this series

In my acupuncture clinic, I specialize in the treatment of fertility of both men and women, women’s health, and functional endocrinology. More of my fertility patients have thyroid issues than those who do not; so this is a treatment passion of mine. Drawing from my 20 years of experience as an ICU RN, I make extensive use of lab testing. I also utilize acupuncture, antioxidants, dietary changes and nutritional supplementation to optimize health, wellness and vitality for the amazing women and men who I have the great honor treat.

Stay tuned for Parts II and III of the Thyroid Fertility Connection!

Be well and Namaste.

If you have questions, please feel free to contact me at:

kreynolds@balancerestored.com

Balance Restored Center for Integrative Medicine

600 Miller Avenue

Mill Valley, CA 94941

Ring: 415.381.8500 Ext. 4

See my blog for additional information:

http://karen-reynolds.com