Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Does This Semen Analysis Report Indicate?
Question: Hello Dr. I have male infertility problem. I have been married for 5 years with no successful partner pregnancy. I have been getting supplements such as: L-carnitine, Vit E, folic acid and zinc for almost 2 years. In January, 2015 I have had left side varicocelectomy and I was on clomid 12.5 mg daily for 5 months. I had progression in concentration; sperm concentration became 17 million/ml (normal ref >15 million/ml) and even the color of seminal fluid became more natural, whiter than before, but progressive motility still low with abnormal viscosity. Then my doctor prescribed me HCG hormonal therapy 1000 IU (1CC) SQ daily/3 days a week for 3 months and advised me to stop taking the Clomid. I stopped taking the supplements and remained only on HCG therapy. My seminal fluid turned yellow, watery just as before the varicocelectomy with yellow-orange chunks/sperms clumping; sometimes I feel a bit pain upon ejaculation because of the chunks that come out. I am getting worse after HCG treatment. The seminal fluid test results were abnormal after HCG. Sperm concentration: 5 million/ml, progressive motility 24% (normal value: >32%, total motility: 60% (normal: >40%) with also abnormal viscosity. For blood work-- total PSA: 0.45 (normal range: <2 ng/ml), total testosterone: 3.58 (normal range: 2.60-7.80 ng/ml), free testosterone: 1.18 (normal range: 0.95-4.30 ng/dl). I am really confused and worried about my case the doctor said the only way to get my wife pregnant is by using IUI technique, but this will not solve the problem. He said your blood work is normal and you have a physical problem. I am not sure if I am suffering from Chronic UTI or not.. Note: I have submitted 2 test reports for seminal fluid analysis. Please I need your help. Thank you
Brief Answer:
Stop HCG. Start Clomiphene daily once.
Detailed Answer:
Hello XXXXX and welcome to HCM.
As an Urologist, i must advise you to stop the HCG at once.
Both your semen analysis reports are sub-optimal.
There's low sperm count, with low live sperms(poor progressive motility), and lower normal shape and size of normal sperms(morphology).
Theese parameters are together called OLIGOASTHENOTERATOZOOSPERMIA.
You must be on Tab Clomiphene25mg daily once.
You should get a male hormones analysis, tested with blood FSH, LH, PRL, and sugar. Get a scrotal doppler ultrasound scan done.
Carnitene must be continued. Get the prescriptions from your local doctor.
Repeat the semen analysis after a month, with minimum 2 days abstinence.
After seeing the reports, decide about need for ART(Assisted Reproductive Treatment).
Wish you well.
Stop HCG. Start Clomiphene daily once.
Detailed Answer:
Hello XXXXX and welcome to HCM.
As an Urologist, i must advise you to stop the HCG at once.
Both your semen analysis reports are sub-optimal.
There's low sperm count, with low live sperms(poor progressive motility), and lower normal shape and size of normal sperms(morphology).
Theese parameters are together called OLIGOASTHENOTERATOZOOSPERMIA.
You must be on Tab Clomiphene25mg daily once.
You should get a male hormones analysis, tested with blood FSH, LH, PRL, and sugar. Get a scrotal doppler ultrasound scan done.
Carnitene must be continued. Get the prescriptions from your local doctor.
Repeat the semen analysis after a month, with minimum 2 days abstinence.
After seeing the reports, decide about need for ART(Assisted Reproductive Treatment).
Wish you well.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. Thank you for your reply.
1st...I am also thinking about going back on Clomid tablets because I had improvement by using it, but Clomid is not a cure. As I mentioned before, my fluid still in yellow, viscous and think condition with protein aggregation(yellow thick chunks) in the fluid. Taking Clomid and Supplements will not solve the problem. After taking Clomid 25 mg/day Do I need to have complete seminal fluid analysis or Complex?
2nd...I had scrotal doppler when the dr. figured out I had testicular varicocile, then he reversed it by surgery. He did GRE and he said you have no prostate enlargement. I had blood work(impotence profile) last month, my hormone levels were normal. I have no sign for elevated blood sugar. I only had a bit elevated triglyceride and LDL levels because blood was being drawn after 2 hours of having breakfast. By the way, my weight is 98 kg. What do you think/suggest dr., Do I need to undergo transrectal ultrasound to rule out whether the prostate is the cause or not?
3rd...Do you think the yellowish fluid is due to bacterial infection or dehydration? Because it is Summer time for sure we lose water more than we gain.
4th... Do you suggest the UTI is involved in infertility? Do I need to do urine and seminal fluid culture?
5th... If the Chronic UTI is the cause, what is the best choice antibiotic for this case? and for how long?
6th... How long should I take Clomid 25mg/day? 3 months or 6 months?
Please take your time doctor to answer all segments
Thank you
1st...I am also thinking about going back on Clomid tablets because I had improvement by using it, but Clomid is not a cure. As I mentioned before, my fluid still in yellow, viscous and think condition with protein aggregation(yellow thick chunks) in the fluid. Taking Clomid and Supplements will not solve the problem. After taking Clomid 25 mg/day Do I need to have complete seminal fluid analysis or Complex?
2nd...I had scrotal doppler when the dr. figured out I had testicular varicocile, then he reversed it by surgery. He did GRE and he said you have no prostate enlargement. I had blood work(impotence profile) last month, my hormone levels were normal. I have no sign for elevated blood sugar. I only had a bit elevated triglyceride and LDL levels because blood was being drawn after 2 hours of having breakfast. By the way, my weight is 98 kg. What do you think/suggest dr., Do I need to undergo transrectal ultrasound to rule out whether the prostate is the cause or not?
3rd...Do you think the yellowish fluid is due to bacterial infection or dehydration? Because it is Summer time for sure we lose water more than we gain.
4th... Do you suggest the UTI is involved in infertility? Do I need to do urine and seminal fluid culture?
5th... If the Chronic UTI is the cause, what is the best choice antibiotic for this case? and for how long?
6th... How long should I take Clomid 25mg/day? 3 months or 6 months?
Please take your time doctor to answer all segments
Thank you
Brief Answer:
Forget color of semen, prostate gland, and UTI just now.
Detailed Answer:
Hi again.
1. Clomiphene is to improve number of live healthy sperms(motility).
The improvement is gradual and not overnight.
Forget the color of the semen. It has no relevance.
Normally, the semen test is repeated after 3 months.
2.After varicocele surgery, you do a scrotal scan to check, if your varicocele has any recurrence, or other side varicocele has developed.
Check if your FSH is normal. Your bad cholesterol is elevated. According to the levels, beyond a certain level, it'll need treatment.
3.Forget your prostate gland in fertility check-up, for the time being.
Hope all your doubts are cleared.
Wish you well.
Forget color of semen, prostate gland, and UTI just now.
Detailed Answer:
Hi again.
1. Clomiphene is to improve number of live healthy sperms(motility).
The improvement is gradual and not overnight.
Forget the color of the semen. It has no relevance.
Normally, the semen test is repeated after 3 months.
2.After varicocele surgery, you do a scrotal scan to check, if your varicocele has any recurrence, or other side varicocele has developed.
Check if your FSH is normal. Your bad cholesterol is elevated. According to the levels, beyond a certain level, it'll need treatment.
3.Forget your prostate gland in fertility check-up, for the time being.
Hope all your doubts are cleared.
Wish you well.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. Mangat thank you for your answers. I still have questions. I can admit that Clomiphene had major improvement on me, especially, when I took it after varicocilectomy for almost 5 months.
During the period of being on Clomid and before for almost 2 years, I was on supplements like L-carnitine, argenin, folic acid, vit E, zinc and omega 3. I only got improvement in sperm count. The viscosity remained abnormal and progressive motility remained low.
How can I improve the progressive motility(the most important question that I need full elaboration on)? Do you recommend me to start using CoQ10 enzyme plus other supplements? and please mention the exact dose of L-argenine because there is a margin level of taking argenine. With overdose, it has a negative impact on the sperm count.
Note: FSH, LH and prolactin levels are within the normal range.
Thank you
During the period of being on Clomid and before for almost 2 years, I was on supplements like L-carnitine, argenin, folic acid, vit E, zinc and omega 3. I only got improvement in sperm count. The viscosity remained abnormal and progressive motility remained low.
How can I improve the progressive motility(the most important question that I need full elaboration on)? Do you recommend me to start using CoQ10 enzyme plus other supplements? and please mention the exact dose of L-argenine because there is a margin level of taking argenine. With overdose, it has a negative impact on the sperm count.
Note: FSH, LH and prolactin levels are within the normal range.
Thank you
Brief Answer:
Repeat scrotal scan and restart Clomiphene.
Detailed Answer:
Hi again.
You must maintain Clomiphene, Carnitene,and Co-Q forte.
Get your scrotal scan for better advice.
A minimum of 20 million normal sperms/ml is needed for fertilization and pregnancy.
Repeat scrotal scan and restart Clomiphene.
Detailed Answer:
Hi again.
You must maintain Clomiphene, Carnitene,and Co-Q forte.
Get your scrotal scan for better advice.
A minimum of 20 million normal sperms/ml is needed for fertilization and pregnancy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. let's assume I did the scrotal ultrasound and everything was normal, what would be the next step according to your perspective? And you did not mention about the estimated dose for L-argenine and do I need to take it or not?
Thank you
Thank you
Brief Answer:
Don't assume reports.
Detailed Answer:
Hi again.
Don't assume reports.
Very often we're in XXXXXXX with the reports.
That's the reason, i insisted on getting it done.
If you drink milk, have eggs, peanuts,walnuts, etc, they're natural sources of arginine. Taken as a medicine, L-arginine, is given at doses, between 20-30g/day, in adults. You should try to reduce your weight, by diet control.
As your bad cholesterol levels (TGL Aand LDL),are high as mentioned by you, arginine is not advisable with cholesterol lowering medication. Be careful.
If you do mention the levels of TGL and LDL, i can advise you about that also.
Don't assume reports.
Detailed Answer:
Hi again.
Don't assume reports.
Very often we're in XXXXXXX with the reports.
That's the reason, i insisted on getting it done.
If you drink milk, have eggs, peanuts,walnuts, etc, they're natural sources of arginine. Taken as a medicine, L-arginine, is given at doses, between 20-30g/day, in adults. You should try to reduce your weight, by diet control.
As your bad cholesterol levels (TGL Aand LDL),are high as mentioned by you, arginine is not advisable with cholesterol lowering medication. Be careful.
If you do mention the levels of TGL and LDL, i can advise you about that also.
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
