Andrew Siegel MD 1/19/2019
The journey of sperm from ejaculation to egg fertilization is an arduous process that is nothing short of a marathon, or perhaps more like a “tough mudder” race. The pilgrimage covers challenging and demanding terrain with abundant obstacles and impediments — the hills and valleys of the vaginal canal, the unwelcoming and entrapping cervical slime, and in the final leg, the extreme narrows and expanse of the fallopian tubes. The few mighty sperm that are capable of overcoming these formidable obstacles and stumbling blocks are not always able to cross the finish line and penetrate the egg, so there is often no winner in this marathon. In that case, these elite sperm perish, having been so close, but so far away.
Image above, Xenzo at English Wikipedia [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)%5D
A semen analysis is the best test to check a male’s fertility status and potential (or lack thereof when done following a vasectomy). Although a specimen is easily obtained and analyzed, the results can be complex and nuanced. Therein lies the utility of the marathon metaphor as an aide to help explain the complexities and meaning of the results.
Thank you, maxpixel for image above, https://www.maxpixel.net/Egg-Sex-Cell-Sperm-Winner-Fertilization-956481
How does one provide a specimen for a semen analysis?
Most men are highly skilled and experienced at this activity. It requires a minor modification from the usual routine. Instead of cleaning up with tissues, carefully deposit the specimen into the specimen cup provided, seal the top and place the cup into a paper bag and hustle it off to the lab with the accompanying prescription ASAP. The semen will be placed on a slide and examined microscopically. Note that it is important to abstain from ejaculating for at least 48 hours prior to providing the specimen in order for the volume of the reproductive juices to be optimized.
What information will be obtained from the semen analysis?
- Volume of semen (1.5 – 5 cc)
- Number of sperm (> 20 million/cc)
- Forward movement of sperm (> 50%)
- Appearance of sperm, a.k.a. morphology (> 30% normal forms)
- Clumping of sperm, a.k.a. agglutination (should be minimal)
- White blood cell presence in semen (should be minimal)
- Thickness of semen
Marathon metaphor
A marathon is a long-haul endurance race (26.2 miles) with many participants (sperm) and usually only a single winner who crosses the finish line (fertilizes the egg). A sufficient number of participants (sperm count) ensure a competitive race to the finish line with the more participants, the greatly likelihood of a quality finish.
There are about 30,000 runners in the Boston Marathon, but in the fertility marathon there are millions and millions of participants. A fertile male can easily have over 300 million sperm in his semen (that’s 10,000 times the number of participants in the Boston Marathon). If only a minimal number of participants show up on race day (oligospermia), there may be no one capable of crossing the finish line or doing so on a timely enough basis.
The runners need to stay on course, pace themselves and run in a forward direction. If the participants have poor mobility and move erratically without attention to direction (asthenospermia), they doom themselves to losing the race.
A quality runner most commonly has the characteristic size and shape (morphology) of an endurance athlete, which for a long-distance runner is typically long and lean. If one has a build that deviates (head and tail defects) from that of the elite runner, it is likely that they will not finish the race, or not finish on a timely basis.
Runners need to focus and make every effort to meet the challenge. However, if they are not serious about racing and instead of doing business decide to hang out and socialize (clumping together—a.k.a., agglutination) instead of pursuing the task at hand, the outcome will not be favorable.
If marathon security lapses and uninvited stragglers (white blood cells in semen, a.k.a. pyospermia) cross the mechanical barriers and infiltrate the course, the dynamics of the race are altered and the uninvited guests can cause direct harm to the participants, interfering with their ability to complete the marathon.
The runners (sperm) can be affected by the environment (semen) in which they participate. Although these endurance athletes can deal with a variety of weather conditions, if conditions are extreme enough, the pathway to the finish line will be impaired. Severe humidity (semen too thick, a.k.a. hyperviscosity), can be a substantial impediment to a competitive race time. In a severely dry and arid environment (minimal semen volume, a.k.a. hypospermia), the sub-optimal race conditions can also impair the race to the finish line. Similarly, in severe rainy weather (too much seminal volume, a.k.a. hyperspermia), the route can literally be flooded with the marathoners’ capacity for finishing the race compromised.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.
Amazon author page with all books authored including the following:
PROSTATE CANCER 20/20: A Practical Guide To Management Options For Patients And Their Families
MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health
PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food
These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.
Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx
New video on female pelvic floor exercises: Learn about your pelvic floor
Our Greatest Wealth Is Health 