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Difficulty in conception, semen analysis done. What could the reason be?

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Answered by

Infertility Specialist
Practicing since : 2000
Answered : 3767 Questions
Hello Doctor,

My semen analysis report is -

Volume - 3.2 CC
Color - Creamy White
Viscosity - Normal
Reaction - Alkaline
Liquefaction time - 30 min
Sperm Count - 70.4 million/ml
Viability - after one hour - 55%, after two hour - 50%, after three hour - 45%, abnormal forms - 15%
RBC/HPF - nil
WBC/HPF - 2-3
Organisms - nil
Spermatogenic cells - present
Motility - normal progressive - 20%, moderate activity - 25%, poor to fair activity - 10%, non-motile - 45%
Fructose - positive
Sperm agglutinates - +
PH - 8.5

Please let me know if I have any problem. We are trying for baby for last six months.

Posted Mon, 3 Jun 2013 in Infertility Problem
Answered by Dr. Mahesh Koregol 5 hours later
Hi XXXXXXX thanks for your query. I read your query and I understand your concerns. Following is my reply : 1) Your semen analysis seems to be fine. No need to worry. 2) Since you are trying for last 6 months, I would like to know age of your wife and any investigations done on her. Please let me know about the same so that i can help you more. Regards, Dr. Mahesh Koregol. IVF & Infertility Specialist
Above answer was peer-reviewed by
Follow-up: Difficulty in conception, semen analysis done. What could the reason be? 50 minutes later

Thank you for response. I have uploaded copy of semen result. I am particularly worried about motility and viability as numbers are below reference. Is there problem with my sperm motility or viability? secondly, does PH, WBC and sperm positive sperm agglutinates indicates any infection or they are normal number? I had pain (after sitting in chair for long time) in prostate region few months back and doctor gave me cifran 500 (one tablet after dinner) for 5 days that cure pain in prostate region.

My wife's age is 31 years and no investigation had been done yet. She is having normal periods.

Answered by Dr. Mahesh Koregol 26 minutes later
Hi XXXXXXX thanks for additional information. Let me clarify your sperm report in more detail for your information. : 1) The reference values in your report are wrong. Now everyone is following world health organizations 2010 criteria for semen analysis. Your report mentions reference values much older. 2) Your sperm cont is excellent and very few men have such good count. Motility lookung looking at your count is little low but i presume it is wrong reported. Men with this motility rarely have low motility. 3) sperm agglutination presence and few WBCs, pH values indicate minor infection which generally clears off. If infection was really a matter, it would have raised liquifaction time to more than 60 minutes which has not happened. Hence even i doubt the WBC report, agglutination, pH values given in your report. I have seen thousands of semen analysis reports done till now. Bwsed on this i understand many reports are not up to XXXXXXX Hence if you have such a good count at 35 years age, your report of other parameters in question are of doubtful significance. 4) If you still suspect the presence of infection , i suggest you get semen culture and sensitivity tesylt of your semen done. This report will confirm presence of infection and antibiitics it is responsive to. I prefer you get another semen analysis and culture sensitivity done in another good lab to know the authenticity of report. If culture report shows infection to alter pH, WBC, agglutination, we can treat with simple antibiotics ( still it looks unlikely that there is major infection which will pass off ). Majority of men with this parameter conceive without problems. Please get back to me for more clarification. Regards, Dr. Mahesh Koregol
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Follow-up: Difficulty in conception, semen analysis done. What could the reason be? 2 days later

Thank you very much for detailed response. It was very informative and helped me understand the results in details.

Do you suggest any tests for my wife? I was reading about ICI, is it safe to do ICI and will it increase chances? are there any side-effects of ICI?

Thank you again,
Answered by Dr. Mahesh Koregol 14 hours later

I am glad that you understood my explaination.

1) If you are planning to try naturally for some more time or undergo IUI ( intrauterine insemination), it is important that you undergo a test called HSG ( hysterosalpingogram).

2) SHe also needs to get Antral follicle count on second day of her menstrual cycle.

3) Also get blood tests AMH, FSH, LH on second day of her cycle.

4) After confirming these reports to be normal, you can go ahead trying for pregnancy naturally under supervision of a infertility specialist who will do follicular growth scan and do regular ultrasound and tell you when are best days to have intercourse.

5) ICSI ( Intracytoplasmic sperm injection) is an expensive procedure and may not be necessary right now as it is expensive. But it is a goos option and high success rates than trying naturally or IUI. It is safe procedure done widely.

Hope your doubt is cleared.

Dr. Mahesh Koregol
IVF & Infertility Specialist
Above answer was peer-reviewed by
Follow-up: Difficulty in conception, semen analysis done. What could the reason be? 9 days later
Good afternoon doctor,

I have uploaded new prolactin + progesterone report. Wife's blood sample was given on 11th May and her last period started on 21st April

Want to know if things are fine or either of us need medication or further investigation.

Answered by Dr. Mahesh Koregol 7 hours later

1) your wife's prolactin is good. Her progesterone is bit low. But dont worry about it as it is not very significant in diagnostics.

2) Your report has excellent count and morphology.

3) Motility is bit low and white blood cells ( pus cells) are few. Hence I advice you to get semen culture and sensitivity test done which will help in giving antibiotic sensitive to organism grown in culture.

Let me know if there are more doubts

Dr. Mahesh Koregol
IVF & Infertility Specialist
Above answer was peer-reviewed by
Follow-up: Difficulty in conception, semen analysis done. What could the reason be? 34 minutes later
Hello Doctor,

I was reading about progesterone and came across websites describing progesterone level of above 20 ng/mL (in mid luteal phase) to get pregnant. My wife's count is about 0.51 ng/mL.

Please advise.

Answered by Dr. Mahesh Koregol 9 hours later
Hi XXXXXXX i had already mentioned in previous reply about low progesterone levels. If her cycles are fine it is not a reason to worry. Progesterone at 21 day of cycle should be around 20 which is generally not investigated by many women. I suggest you get follicular scan done in next cycle to check if she is ovulatingand getting corpus luteum which secretes progesterone hormone. Repeat day 21 progesterone again . As i dont believe in coming to diagnosis based on single value. If still she has low progesterone, treatment is simple. Just add progesterone tablets in second part of cycle which will compensate for low progesterone and wont harm in,any way. Hence dont worry much about it. Regards, Dr. Mahesh Koregol
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