My Penis Stuff

Sperm penetration tests check to see whether a man’s sperm can move through cervical mucus and the fallopian tubes to join with (fertilize) an egg. This test is usually done when a couple is having trouble becoming pregnant (infertility).

There are different sperm penetration tests.

• The sperm mucus penetration test checks whether a man’s sperm can move through the cervical mucus. This test is not done very often because there are other fertility tests that give more information about the fertility problem.
• The sperm penetration assay (also called the hamster zona-free ovum test or hamster test) checks whether a man’s sperm can join with an egg. Sperm are mixed with hamster eggs in a laboratory. The number of sperm that penetrate the egg (sperm capacitation index) is measured. This test is done most often at special fertility centers who do in vitro fertilization.

Why It Is Done

Sperm penetration tests may be done:

• When other tests have not found a cause for infertility.
• To see how the sperm function when a semen analysis test has shown some problems, such as slow movement or the sperm look abnormal.
• To check when another test, the postcoital test, has found sperm dead or not moving in the cervical mucus.
• To test sperm before doing in vitro fertilization.

How To Prepare

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean.

Sperm mucus penetration test

For women, this test must be done during ovulation. Follow your doctor’s instructions for checking the level of luteinizing hormone (LH) in your urine. When you check your LH level, do the urine test in the mid- to late morning, and do not drink any fluids that morning until you have done the test. If your test shows that you are ovulating, call for a doctor’s visit for the next day.

For men, the semen sample is collected after the cervical mucus sample is taken. You should not release your sperm (ejaculate) for 2 days before the test. It is important to not go longer than 5 days before the test without ejaculating.

How It Is Done

For the sperm mucus penetration test, samples of your cervical mucus and your partner’s semen will be collected. In the lab, the semen is added to the mucus in a tube. After 90 minutes, the distance the sperm have moved is measured.

Cervical mucus sample

A sample of cervical mucus is collected from the woman during a pelvic examination. For more information, see the medical test Pelvic Examination.

Sperm sample

A semen sample is collected by masturbation. First, you should urinate and then wash and rinse your hands and penis before collecting the semen in a sterile cup. You cannot use lubricants or condoms when collecting the sample. If you collect the sample at home, it must be taken to the lab within 30 minutes. The sample cannot be collected by having sex and then withdrawing when you ejaculate because vaginal fluid may be mixed with the sperm.

For the sperm penetration assay, a semen sample is collected by masturbation. The sperm are mixed with hamster eggs in a laboratory. The number of sperm that penetrate an egg is measured.

How It Feels

Cervical mucus sample

You may feel some pressure or mild discomfort when the speculum is put into your vagina. The speculum spreads apart the vaginal walls, allowing your doctor to look at the inside of the vagina and the cervix. The speculum may be plastic or metal and may be warmed with water or lubricated with a vaginal lubricant (such as K-Y Jelly). Try to relax your legs and hips as much as you can.

Semen sample

Collecting a semen sample does not cause any discomfort. However, you may feel embarrassed about the method used to collect it. If masturbation is against your religious beliefs, talk with your doctor.

Risks

Usually there are no problems from having a pelvic examination to collect a sample of vaginal fluid or from collecting a semen sample.

Results

Sperm penetration tests check to see whether a man’s sperm can move through cervical mucus and the fallopian tubes to join with (fertilize) an egg.

Sperm mucus penetration test

A controlled test can see if the cervical mucus is preventing sperm penetration. This test uses donor sperm and the male partner’s sperm. Both sperm samples are added to a sample of the woman’s cervical mucus. Donor cervical mucus may also be used with the woman’s cervical mucus.

A problem with the partner’s sperm may be present if:

• The donor’s sperm penetrates the mucus but the partner’s sperm does not.
• The partner’s sperm does not penetrate the woman’s or the donor’s cervical mucus.

A problem with the woman’s mucus may be present if neither the partner’s or the donor’s sperm do not penetrate the cervical mucus.

Sperm penetration assay (SPA)

Results vary from lab to lab. Talk with your doctor about whether your results your values are normal.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

• The semen sample has not been collected correctly.
• The test is done at a time when a woman is not ovulating.

What To Think About

• The sperm penetration assay test may be done before in vitro fertilization.
• A normal sperm penetration assay and a normal semen analysis mean that the sperm is of good quality for in vitro fertilization. For more information on infertility testing, see the medical test Infertility Testing.

A semen analysis measures the amount of semen a man produces and determines the number and quality of sperm in the semen sample.

A semen analysis is usually one of the first tests done to help determine whether a man has a problem fathering a child (infertility). A problem with the semen or sperm affects more than one-third of the couples who are unable to have children (infertile).

Tests that may be done during a semen analysis include:

• Volume. This is a measure of how much semen is present in one ejaculation.
• Liquefaction time. Semen is a thick gel at the time of ejaculation and normally becomes liquid within 20 minutes after ejaculation. Liquefaction time is a measure of the time it takes for the semen to liquefy.
• Sperm count. This is a count of the number of sperm present per milliliter (mL) of semen in one ejaculation.
• Sperm morphology. This is a measure of the percentage of sperm that have a normal shape.
• Sperm motility. This is a measure of the percentage of sperm that can move forward normally. The number of sperm that show normal forward movement in a certain amount of semen can also be measured (motile density).
• pH. This is a measure of the acidity (low pH) or alkalinity (high pH) of the semen.
• White blood cell count. White blood cells are not normally present in semen.
• Fructose level. This is a measure of the amount of a sugar called fructose in the semen. The fructose provides energy for the sperm.

Why It Is Done

A semen analysis is done to determine whether:

• A man has a reproductive problem that is causing infertility.
• A vasectomy has been successful.
• The reversal of a vasectomy has been successful.

How To Prepare

You may be asked to avoid any sexual activity that results in ejaculation for 2 to 5 days before a semen analysis. This helps ensure that your sperm count will be at its highest, and it improves the reliability of the test. If possible, do not avoid sexual activity for more than 1 to 2 weeks before this test, because a long period of sexual inactivity can result in less active sperm.

You may be asked to avoid drinking alcohol for a few days before the test.

Be sure to tell your health professional about any medications or herbal supplements you are taking.

How It Is Done

You will need to produce a semen sample, usually by ejaculating into a clean sample cup. You can do this in a private room or in a bathroom at your health professional’s office or clinic. If you live close to your health professional’s office or clinic, you may be able to collect the semen sample at home and then transport it to the office or clinic for testing.

• The most common way to collect semen is by masturbation, directing the semen into a clean sample cup.
• You can collect a semen sample during sex by withdrawing your penis from your partner just before ejaculating (coitus interruptus). You then ejaculate into a clean sample cup. This method can be used after a vasectomy to test for the presence of sperm, but other methods will likely be recommended if you are testing for infertility.
• You can also collect a semen sample during sex by using a condom. If you use a regular condom, you will need to wash it thoroughly before using it to remove any powder or lubricant on it that might kill sperm. You may also be given a special condom that does not contain any substance that kills sperm (spermicide). After you have ejaculated, carefully remove the condom from your penis. Tie a knot in the open end of the condom and place it in a container that can be sealed in case the condom leaks or breaks.

If you collect the semen sample at home, the sample must be received at the laboratory or clinic within 1 hour. Keep the sample out of direct sunlight and do not allow it to get cold or hot. If it is a cold day, carry the semen sample container against your body to keep it as close to body temperature as possible. Do not refrigerate the semen sample.

Since semen samples may vary from day to day, 2 or 3 different samples may be evaluated within a 3-month period for accurate testing.

A semen analysis to test the effectiveness of a vasectomy is usually done 6 weeks after the vasectomy.

How It Feels

Producing a semen sample does not cause any discomfort. However, you may feel embarrassed about the method used to collect it. If masturbation is against your religious beliefs, discuss alternate methods of collection with your health professional.

Risks

There are no risks associated with collecting a semen sample.

Results

A semen analysis measures the amount of semen a man produces and determines the number and quality of sperm in the semen sample. Results of a semen analysis are usually available within a day. Normal values may vary from lab to lab.

Certain conditions may be associated with a low or absent sperm count. These conditions include orchitis, varicocele, Klinefelter syndrome, radiation treatment to the testicles, or diseases that can cause shrinking (atrophy) of the testicles (such as mumps).

If a low sperm count or a high percentage of sperm abnormalities are found, further testing may be done. Other tests may include measuring hormones, such as testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), or prolactin. A small sample (biopsy) of the testicles may be needed for further evaluation if the sperm count or motility is extremely low.

What Affects the Test

Factors that can interfere with your test or the accuracy of the results include:

• Medicines, such as cimetidine (Tagamet), male and female hormones (testosterone, estrogen), sulfasalazine, nitrofurantoin, and some chemotherapy medicines.
• Caffeine, alcohol, cocaine, marijuana, and smoking tobacco.
• Herbal medicines, such as St. John’s wort and high doses of echinacea.
• A semen sample that gets cold. The sperm motility value will be inaccurately low if the semen sample gets cold.
• Exposure to radiation, some chemicals (such as certain pesticides or spermicides), and prolonged heat exposure.
• An incomplete semen sample. This is more common if a sample is collected by methods other than masturbation.
• Not ejaculating for several days. This may affect the semen volume.

What To Think About

• A semen sample collected at home must be received at the laboratory or clinic within 1 hour. Keep the sample out of direct sunlight and do not allow it to get cold or hot. If it is a cold day, carry the semen sample container against your body to keep it as close to body temperature as possible. Do not refrigerate the semen sample.
• Consistently detecting sperm in the semen of a man who has had a vasectomy indicates that his surgery was not successful, and another form of birth control should be used to prevent pregnancy. A low number of sperm may be present in a semen sample taken initially after a vasectomy. However, sperm should not be present in subsequent samples.
• A man whose mother took the medicine diethylstilbestrol (DES) during her pregnancy with him has a greater-than-normal risk of being unable to father a child (infertile).
• Additional tests may include measuring hormone levels, such as testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), or prolactin. For more information, see the medical tests Testosterone, Luteinizing Hormone, Follicle-Stimulating Hormone, and Prolactin.
• Other fertility testing, including sperm penetration, the presence of antisperm antibodies, or analysis after sexual intercourse (postcoital), may be recommended for infertility problems. For more information, see the medical test Infertility Testing.

A prostate-specific antigen (PSA) test measures the amount of prostate-specific antigen in the blood. PSA is released into a man’s blood by his prostate gland. Healthy men have low amounts of PSA in the blood. The amount of PSA in the blood normally increases as a man’s prostate enlarges with age. PSA may increase as a result of an injury, a digital rectal exam, sexual activity (ejaculation), inflammation of the prostate gland (prostatitis), or prostate cancer.

Prostate cancer often grows very slowly, without causing major problems. Detecting prostate cancer early and treating it may prevent some health problems and reduce the risk of dying from the cancer. However, some treatments for prostate cancer can cause other problems, such as controlling urination (incontinence) or erection problems (erectile dysfunction). Some men may choose not to have a PSA test or treat prostate cancer if it is detected. For example, a man older than age 75 who has no bothersome symptoms of prostate cancer may choose not to treat the cancer if it is found, so he would not need a PSA test.

Why It Is Done

The prostate-specific antigen (PSA) test is done to:

• Watch prostate cancer and see if treatment is working. If PSA levels increase, the cancer may be growing or spreading. PSA is usually not present in a man who has had his prostate gland removed. A PSA level that rises after prostate removal may mean the cancer has returned or has spread.
• Check if cancer may be present when results from other tests, such as a digital rectal exam, are not normal. A PSA test does not diagnose cancer, but it can be used along with other tests to determine if cancer is present.
• Check men for prostate cancer. Experts disagree on the usefulness of PSA testing as a screening tool for prostate cancer. If a PSA test is used for screening, it is usually done for men older than age 50 or for those at high risk for prostate cancer, such as men with a family history of prostate cancer, or for African-American men who have a higher chance of developing cancer than other men. Since other common medical conditions, such as prostatitis, can cause high PSA levels, a prostate biopsy is needed to confirm a diagnosis of cancer.

How To Prepare

Before you have a prostate-specific antigen (PSA), tell your doctor if you have had a:

• Test to look at your bladder (cystoscopy) in the past several weeks.
• Prostate needle biopsy in the past several weeks.
• Prostate infection (prostatitis) or an urinary tract infection (UTI) that has not gone away.
• Tube (catheter) inserted into your bladder to drain urine recently.

Do not ejaculate during the 2 days before your PSA blood test, either during sex or masturbation.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will indicate.

How It Is Done

The health professional taking a sample of your blood will:

• Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
• Clean the needle site with alcohol.
• Put the needle into the vein. More than one needle stick may be needed.
• Attach a tube to the needle to fill it with blood.
• Remove the band from your arm when enough blood is collected.
• Put a gauze pad or cotton ball over the needle site as the needle is removed.
• Put pressure to the site and then a bandage.

How It Feels

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle, or you may feel a quick sting or pinch.

Risks

There is very little chance of a problem from having a blood sample taken from a vein.

• You may get a small bruise at the site. You can lower the chance of bruising by keeping pressure on the site for several minutes.
• In rare cases, the vein may become swollen after the blood sample is taken. This problem is called phlebitis. A warm compress can be used several times a day to treat this.
• Ongoing bleeding can be a problem for people with bleeding disorders. Aspirin, warfarin (Coumadin), and other blood-thinning medicines can make bleeding more likely. If you have bleeding or clotting problems, or if you take blood-thinning medicine, tell your doctor before your blood sample is taken.

Results

A prostate-specific antigen (PSA) test measures the amount of prostate-specific antigen in the blood. Normal values may vary from lab to lab.

Normal

Because normal PSA levels seem to increase with age, age-specific ranges may be used. However, the use of age-specific ranges is controversial, and some doctors prefer to use one range for all ages. For this reason, it is important to discuss your test results with your doctor. This table is a reference for white males. Results for black and Asian males are slightly different.

High values

• PSA levels from 4 to 10 ng/mL: About 20% to 30% of men (20 to 30 men in 100) with PSA levels in this range may have prostate cancer. A transrectal ultrasound (TRUS) and prostate biopsy are needed to confirm a diagnosis of cancer.
• PSA levels above 10 ng/mL: About 40% to 60% of men (40 to 60 men in 100) with PSA levels in this range may have prostate cancer. A transrectal ultrasound (TRUS) and prostate biopsy are needed to confirm cancer.
• High levels do not always mean prostate cancer is present. PSA levels may be high if the prostate gland is enlarged (benign prostatic hypertrophy, or BPH) or inflamed (prostatitis).

A follow-up test, percent free prostate-specific antigen (free PSA), may be used to see if a prostate biopsy should be done to check for cancer. Men with a low percentage of free PSA have a higher chance of developing cancer as shown in the table below.

Low free PSA values (less than 15%) are more likely to be caused by prostate cancer than high free PSA values.

What Affects the Test

Factors that can interfere with your test or the accuracy of the results include:

• Recent sexual activity (ejaculation) or a cystoscopy.
• Recent use of a tube (catheter) to drain urine.
• Recent urinary tract infection (UTI) or prostatitis.
• Large doses of medicines, such as cyclophosphamide (Cytoxan, Neosar), diethylstilbestrol, and methotrexate for cancer treatment.
• The medicine finasteride, such as Proscar or Avodart, which is used to prevent further enlargement of the prostate gland in men with BPH.

What To Think About

• When combined with a digital rectal exam, the prostate-specific antigen (PSA) test increases the chance of detecting prostate cancer. For more information, see the medical test Digital Rectal Examination (DRE).
• A PSA level within the normal ranges does not mean that prostate cancer is not present. Some men with prostate cancer have normal PSA levels.
• Experts disagree about the frequency of PSA testing to screen for prostate cancer.
  • The American Cancer Society (ACS) recommends an annual PSA test and DRE for men age 50 and older. ACS also recommends annual screening, beginning at age 45, for men who are at high risk for prostate cancer, such as black men and men who have a family history of prostate cancer.
  • Other expert groups, such as the National Cancer Institute and the U.S. Preventive Services Task Force, believe there is not enough evidence to recommend routine screening with the PSA test for all men. Experts that do not recommend annual screening say the high rate of false-negative and false-positive results and the costs and risks of further tests do not support annual screening tests.
• Experts disagree about the type of testing that is appropriate if the PSA level is high. The decision may depend on:
  • Results of your digital rectal exam.
  • Results of any PSA tests you have had in the past. If your PSA level gets higher in a short amount of time, follow-up testing may be recommended.
  • Your age and health.
  • The costs and risks of more tests and treatments.
• Other prostate tests are being evaluated to determine how well they tell the difference between prostate cancer and benign prostatic hypertrophy.
  • The prostate-specific antigen density (PSAD) test compares the PSA value to the size of the prostate gland. The size of the prostate is measured using transrectal ultrasound (TRUS).
  • The PSA velocity test is a measure of how rapidly PSA levels increase over time. PSA levels increase more rapidly in men with prostate cancer and more slowly in men with prostate enlargement (benign prostatic hypertrophy).
• Complexed prostate-specific antigen (cPSA) when used in combination with a digital rectal exam can detect prostate cancer. The cPSA test currently is not widely available.