When a couple makes the decision to have a baby, they usually don't expect to have any serious problems. Count the days, on the right day the connection is made and "voila," pregnancy happens. That may be true for some people, but for others it isn't quite so easy. After a period of trying to conceive without a pregnancy, a visit to the doctor is necessary. The doctor will order some tests to determine the cause of the problem and then a course of action can be determined.

The First Test

There are many tests available for both men and women to determine their fertility. Usually the first test for a man is a sperm and semen test to determine the health of the sperm. Sperm is collected into a specimen jar and taken to a lab where it is examined under a microscope to evaluate the count, shape, appearance, and motility (ability to move).

What Constitutes Fertility?

Laboratories often vary in the details they provide to the physician requesting the information for a sperm count. Generally, the count, when it is part of a fertility evaluation, should include the total count and the motile density. A fertile man has a sperm density count of 20 million sperm per ml or more, and a motile density of 8 million sperm per ml or more. The most important part of the semen analysis is the motility count because it lets the physician know the total number of sperm possible that will be capable of progressing to the point of fertilizing the egg. This number also helps the physician determine whether or not the analysis is normal as well as providing information should reproductive assistance be necessary for the couple.

There's More To It Than Numbers

Along with the amount of sperm, there is an evaluation of the size, shape and appearance of the sperm. This process must be done under a microscope and usually dyes are used to help distinguish both normal and abnormal characteristics and findings. The shapes of human sperm have been categorized into four groups. The first, normal forms, have oval head shapes, the midsection is intact and uncoiled, and there is a single tail. The evaluations show if there are sperm with abnormal heads, too large or too small, tapering, teardrop shape, or double headed or headless. These abnormalities in appearance are called "amorphous" changes and comprise the second group.

The third group relates to the tails of the sperm. Sometimes the tails are coiled or bent, and at times they are broken with less than half the normal length intact. All of these are considered abnormal sperm, as are those with two or three tails. The fourth group is IGCs. Immature germ cells can be easily confused with white blood cells. The presence of white blood cells in the sperm is of grave concern; therefore, if a report of IGCs comes in from the semen analysis, it is important for the doctor to assure they are indeed IGCs and not white blood cells.

The first part of the evaluation is complete and the lab technician now moves toward determining the motility (movement) and other semen characteristics.

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