Advanced sperm analysis: evaluating the total motile sperm count

The basic semen analysis is a male fertility test that serves to assess the quality of the semen.

Sometimes, a semen analysis includes the totale motile sperm count (TMSC), a parameter that more accurately determines whether the sperm quality is good or poor.

From results of this advanced semen analysis, the specialist can better advise couple with the appropriate assisted reproductive technique: intrauterine insemination (IUI) or in vitro fertilization (IVF).

The different sections of this article have been assembled into the following table of contents.

What is advanced semen analysis

The advanced semen analysis is a complementary test to the basic seminogram that allows a more precise evaluation of the seminal quality. It provides the number of spermatozoa with progressive motility that exist in the semen sample. These are the spermatozoa with fertilizing capacity.

First of all, before evaluating the total motile sperm count (TMSC) in advanced semen analysis, a basic semen analysis is done to evaluate the fresh semen sample. This ejaculate must then go through a sperm capacitation process that separates the sample into two fractions:

Sperm concentration.

Here you will find the good quality spermatozoa that will be analyzed to obtain the TMSC.

Semen plasma

This is where the immobile sperm and non-sperm cells in the ejaculate (epithelial cells, leukocytes, etc.) will remain. This fraction will be discarded.

Results of the advanced semen analysis

Sometimes, the advanced semen analysis is also called a sperm capacitation test, since the ejaculated semen sample must go through all this processing. We will discuss below in more detail.

Sperm capacitation

Sperm capacitation is a process that occurs naturally in the female reproductive tract after unprotected sex.

As they advance through the cervix and fallopian tubes to reach the egg, the sperm cells, undergo a series of physical and chemical changes that give them the ability to fertilize. One of the changes, for example, is the hyperactivation of the spermatozoa, which allows them to move at a greater speed and more vigorously.

During the capacitation process, the semen plasma is released and sperm that have difficulty moving forward will also be left behind.

Natural sperm capacitation

To perfrom a TMSC or any other fertility treatment, it is necessary to capacitate the semen in the IVF laboratory imitating what happened naturally.

By doing so, it is possible to check the qualities of the semen after it has been capacitated and whether the sperm obtained will be able to fertilize the eggs easily.

Types of Sperm capacitation

The two most common seminal training techniques in andrology laboratories are:

Swim-up

the semen sample is centrifuged in a tube, leaving the sperm and other non-sperm cells at the bottom. The seminal plasma is removed, a culture medium is added and the sample is left in the incubator for some time. During this time, the most mobile spermatozoa will "swim" to the surface, while cells and immobile spermatozoa will be retained at the bottom of the tube. The culture medium is recovered with the good spermatozoa and the TMSC is performed.

Density Gradients

two media of different density are placed in a tube and the semen sample is placed on top of the two gradient layers. After centrifugation, the denser spermatozoa (with greater vitality and mobility) will have been able to cross the gradients and settle at the bottom. Therefore, on this occasion, the sample remaining at the bottom of the tube is collected to perform the TMSC.

Sperm capacitation methods

In both capacitation techniques, the ultimate goal is to eliminate plasma, poor sperm, and non-sperm cells, while concentrating the sample with highly vital and motile sperm.

You can read more information about this process at the following link: What is Sperm Capacitation?

Advanced semen analysis results

Once the capacitated semen sample is obtained, the motile sperm count is performed under the microscope with the Makler camera.

It is said that a well-capacitated sample is one in which a high percentage, close to 100% of spermatozoa with progressive motility is obtained. Obviously, this will also depend on the values obtained in the previous seminogram.

The total number of mobile spermatozoa obtained is very valuable information for deciding which assisted reproduction technique is appropriate for achieving a pregnancy.

The following assisted reproduction techniques can be used:

Artificial insemination

This treatment is recommended when the TMSC is higher than 3 million. For the AI technique to be successful, the semen sample must have a high concentration of progressive motile spermatozoa.

In vitro fertilization

IVF is chosen when TMSC is below 3 million. Moreover, in the case of severe male factor with TMSC of less than 1 million, the use of ICSI for fertilization will be recommended.

Assisted reproduction technique according to EMR

In short, advanced semen analysis report gives us the information we need to decide on the correct treatment to maximise chances of success, with regard to the male factor. However, in order to finally determine the technique, it is also necessary to also take into account the results of the woman's fertility tests.

FAQs from users

Can advanced semen analysis results improve over time?

The advanced semen analysis is a test associated with the basic semen analysis to assess its quality reporting the amount of sperm with progressive motility in a sample of capacitated semen. Sometimes, this study allows defining the appropriate assisted reproduction treatment.

In vivo sperm production fluctuates over time, so it would be advisable to perform at least two functional tests within a reasonable period of time to establish an adequate diagnosis.

Is semen analysis and advanced semen analysis the same?

No. The motile sperm count test or advanced semen analysis report is a complementary test to a basis semen analysis that is carried out to confirm the parameters evaluated in the latter. Therefore, the advanced seminogram provides more clinical information.
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What are the best results in an advanced semen analysis report for IUI?

The concept of advanced semen analysis with motile sperm count (MSC) tells us the number of spermatozoa with good motility in each ml of ejaculate after sperm preparation in the laboratory. This count allows us to choose the most appropriate assisted reproduction technique.

It is considered that in order to perform an artificial insemination (IUI), the MSC must be above 3 million spermatozoa. Although this is the cut-off point most accepted by scientific societies, the lack of solid studies in this regard means that some clinics prefer to apply stricter criteria by setting the MSC limit for performing an IUI at 5 million. Even so, being more or less rigid when evaluating the MSC to indicate IUI or IVF will also depend on factors that contribute to the sterility of the couple in question (age of the woman, underlying condition, etc.).

Beyond the MSC, we must take into account that in cases of highly altered sperm morphology (% of normal forms less than 1%), we will speak of severe teratozoospermia and an IUI will not be indicated either. The MSC test does not take into account sperm morphology.

What are the normal results in advanced semen analysis reports?

There are no established normal values, simply if the motile sperm count is high, it will be easier to achieve a natural pregnancy.

In the case of male infertility with medium-low MSC, it may be possible to achieve pregnancy with artificial insemination. On the other hand, if the MSC is low, the appropriate technique will be IVF. Finally, if the MSC is extremely low or zero, ICSI will be necessary to achieve fertilization because the sperm cells do not have sufficient motility to reach the egg by themselves.

How much is an advanced semen analysis report?

Depending on the clinic, a basic semen analysis is situated between $100 - $300 whereas the advanced semen analysis costs approximately $290 in the U.S.

A semen analysis report in the U.K. has a cost between £90 - £130 in a private clinic. However, patients can get a semen analysis for free on the NHS.

Recommended reading

If you want to know all the details about the seminogram and its results, we recommend you continue reading here: What Is a Semen Analysis Report? - Purpose, Preparation & Cost.

There are also other male fertility tests that can be done to assess a man's fertile potential. You can consult all this information in the following link: Male Fertility Testing - How Do You Know if You Are Infertile?

References