Semen Analysis: What GPs and Patients Need to Know

We need a good, plush endometrial lining, and if it isn't good we have medicines that can improve it. For example, in a recent case of severe intrauterine adhesions from a missed abortion managed elsewhere, the endometrial thickness was under 1mm in places and completely scarred. We did adhesiolysis and then gave a combination of estrogen and progesterone — estrogen helps regenerate the endometrium. It takes about 3 months for regeneration, though outcomes depend on how bad the scarring is; in some patients with very severe scarring we may not be able to regenerate a good lining at all.

We generally say at least 3 to 4 months of contraception should be used, and conception should not happen within that window.

There are now government of India guidelines on this. Strictly by those guidelines it is 50 for the woman and 55 for the man, though this used to be more liberal — we used to see people at 60–65 also getting IVF done, before the ethical question of who will care for the children led to the cutoff being tightened.

After adhesiolysis we give a combination of estrogen throughout the cycle and progesterone added in the last 14 days, and it takes about 3 months for regeneration, confirmed with transvaginal sonography for endometrial thickness before and after. Many patients start to show improvement even after about a month and a half, where the scarring and adhesions are not so severe that they have permanently damaged the endometrium.

A lot of times when an HSG is done without sedation, the patient tenses up so much that there is a tubal spasm, which can appear as a bilateral proximal tubal blockage. One good approach is to give the patient an anti-spasmodic before the procedure, or do it with a little sedation, which removes many of these false positives. But if it still appears to be a genuine proximal blockage in both tubes, it's better to go directly for a diagnostic hysterolaparoscopy with chromopertubation, since that lets you directly visualise the tubes — and most patients also find repeating an HSG very painful.

About 33% of infertility is due to the female partner, 33% to the male partner, and 33% to a combination of both, making semen analysis essential rather than optional.

The test is preferably done after two to three days of abstinence, with the sample collected in a private chamber at the lab whenever possible, or at home and delivered within about 15 minutes if not.

Modern criteria look at progressive motility of around 30%, total motility around 42%, normal morphology of about 4%, and vitality of around 54%, along with liquefaction time, viscosity and volume.

No. A single abnormal sample is not enough; at least two to three samples spaced over time are needed before concluding that semen parameters are genuinely abnormal.