How to Conceive When You Have Abnormal Semen Analysis?

How to Conceive When You Have Abnormal Semen Analysis?

If you are trying to conceive, but have an abnormal semen analysis, there are a few ways to help improve the chance for pregnancy. 

Couples who are trying to conceive often find that the male partner has an abnormal semen analysis. What options are available to improve your ability to become pregnant? 

What is a semen analysis?

Semen analysis is one of the male fertility tests and it is pretty simple. A man ejaculates into a cup. The fluid is then examined under a microscope. We first see if there are any sperm, some men have none. If there are sperm, then we can see how many sperm there are, how many are moving and how many have a normal size and shape. 

What should you do if you or your partner has an abnormal semen analysis?

I will discuss three different options but the first thing to do is to repeat the semen analysis. Why? Well, it turns out that there is a lot of variation in sperm numbers.

Sperm numbers vary A LOT! Repeat any abnormal semen analysis!

Men with perfectly normal fertility will sometimes have an abnormal semen analysis. It is the couples who have a persistently abnormal semen analysis that are likely to have problems becoming pregnant. Let me explain you what I mean. In one study, scientists recruited five men to collect 15 to 20 semen specimens over about a year and a half. They measured how many sperm there were, which is called sperm concentration. When they analyzed the concentration over time, they saw something pretty amazing. There was a huge amount of fluctuation. The first man collected 16 semen specimens. Most of them were in the 40 to 100 million range which is normal. However, on his 3rd specimen, the concentration jumped to 250 million. On the 13th specimen, it was close to 0. If this man had done only one analysis and it happened to be on this day, we would have mistakenly concluded that this man had a severe fertility problem when in reality he was likely fertile the majority of the time.

In subject number 3, we saw several times when sperm numbers were normal alternating with times when they were low. Subject number 5 had persistently low sperm concentration over the entire course of the study. This is the guy most likely to have a fertility issue.

abnormal sperm conceive

How many semen analyses should a man have?

There is no perfect answer to that question. In general, the more analyses you do, the better your chances are for accurately diagnosing whether a man has a fertility problem or not. Most fertility experts would recommend doing two or three.

Option #1 for an abnormal semen analysis - Testing and treatment

The first option for improving the odds for pregnancy in couples with an abnormal semen analysis are male testing and treatment. Some men will have an identifiable cause for their poor sperm quality. Appropriate treatment in some of those men can improve sperm quality enough to increase the chance for pregnancy. Some of the correctable problems that we can test for are hormone problems such as low testosterone levels, thyroid problems, elevated prolactin levels or inadequate stimulation of the testicles from the pituitary gland. It is important to understand that you may not find a correctable cause in many men. Treatment of these problems does not always result in improvement or enough improvement to make a difference in your chance for pregnancy.

abnormal sperm test and treatment

Option #2 - IUI - Intrauterine insemination

Another option for improving fertility is called intrauterine insemination or IUI. This is when sperm are injected directly into the uterus at the time of ovulation. This can increase the number of sperm that reach the fallopian tubes where fertilization occurs and therefore improve the odds for pregnancy. If a semen analysis is mildly abnormal, IUI can be an effective option which is easy to do and relatively inexpensive.

iui abnormal sperm

Option #3 - IVF - In vitro fertilization

The third option for improving fertility is called in vitro fertilization or IVF. IVF is a very powerful method to bypass an abnormal semen analysis. Instead of putting sperm into a woman’s body to fertilize the eggs, the eggs are removed and fertilized in the laboratory. The technique we use to fertilize the eggs is called ICSI. With this technique, we inject a single sperm into a single egg. This dramatically lowers the number of sperm that we need to get fertilization. So IVF is an excellent technique for couples that have even a very severely abnormal semen analysis.

ivf abnormal sperm

Our Bottom line

Make sure that a sperm problem is real by repeating the semen analysis. If it is real, there are three methods you can use to improve your odds for pregnancy.