What Is Total Motile Count?


The results of a semen analysis are used for both - analysis of reproductive health and diagnosis of male factor infertility. Cut-off values for all the sperm health parameters have been established by the World Health Organization (WHO) to distinguish between normal and defective sperm. Although the WHO classification suggests accuracy, there is a need to validate different criteria to predict and analyze male factor infertility.1 Total motile count is one such unique aspect of a semen study.

Total Motile Count (TMC), also known as Total Motile Sperm Count (TMSC) indicates the number of swimming sperms in the given ejaculate volume. There should be not less than 40 million motile sperm in the ejaculate.2

How Is The Total Motile Count Calculated?

 
Calculating total motile sperm count is a different way to express sperm quality. TMC is obtained by multiplying three of the sperm health parameters namely: 

  • Volume of the ejaculate (in milliliters)
  • Sperm Concentration (in millions)
  • Number of motile sperms (in percentage)

For a semen sample which is about 3 mL volume, with a concentration of 80 million and 66% motility, the TMC value is 158 million (3mL X 80 million X 66%).

Why Is Total Motile Count Calculation Important?


Let’s consider a man with a semen volume of 3 mL, sperm concentration of 30 million and total motility of 50%. The calculated TMC for these values is about 45 million. 

Consider another man with a semen volume of 5 mL, sperm concentration of 6 million with the same motility. For this sample, the calculated TMC is about 15 million. 

It is worth noticing that both cases have the same percentage of moving sperms in their ejaculate. Yet, the difference in the sperm concentration and semen volume makes the first sample fall in the normal range (>40 million TMC). On the other hand, though 50% of the sperms are motile in the second sample, due to the decrease in concentration and semen volume it falls below the required healthy range (<40 million TMC). Thus, when it comes to evaluation of the semen, it is vital to strike a relation between motility, semen volume and concentration to get a clear picture. It also helps in choosing the right fertility treatment (Artificial reproductive techniques). 

 

Factors Considered In Determining Total Motile Count


1. Semen Volume

Semen Volume is the measure of the amount of semen (in mL) produced by an individual. Semen, a thick whitish fluid released during ejaculation contains the sperms. Too little or too much of semen produced might interfere in the process of successful conception. According to the WHO, the amount of semen ejaculated can range from 1.4 mL to 6.2 mL.2

 

2. Sperm Concentration

Sperm Concentration gives the count of sperms (million/mL) present in one milliliter of the given semen sample. Although millions of sperms are produced at one time, just a handful reach the egg in time to fertilize. Lower sperm count means lesser sperms available for the fertilization process which may interfere with chances of successful conception. As per WHO standards, a healthy sperm concentration may range between 16 million to 208 million.2  

 

3. Motility

Sperm must wiggle and swim through a woman's cervix, uterus, and fallopian tubes to reach and fertilize an egg - which is nothing but Motility. This parameter gives the measure of the amount of sperms (in %) that are active in the given sample. As per WHO, total motility should range between 42% to 90%. 2 

 

Use Of Total Motile Count In Assisted Reproductive Technology (ART) 


Total Motile Count can impact your chances of natural pregnancy as well as success rates of the fertility treatments taken up.

 

1. Total Motile Count For IUI (Intrauterine Insemination):

IUI is a procedure that places sperm past the cervix and into a woman's uterus. The quantity of sperm that can enter the uterus is naturally limited by the cervix. As a result of IUI, the sperm's journey is made shorter, and there's a better possibility for the sperm to come into contact with the egg.3 IUI can be considered when the TMC is more than 15 million*

 

2. Total Motile Count For IVF (In Vitro Fertilization): 


IVF is a technique that involves fusing an egg and sperm in a laboratory dish. If the egg is fertilized, the embryo is transferred to the woman's uterus, where it will hopefully implant and develop further. IVF is a therapy option for women who have severely damaged or missing fallopian tubes since it bypasses them.4  IVF can be considered when the TMC ranges between 15 million - 7.5 million*


3. Total Motile Count For ICSI (Intracytoplasmic Sperm Injection):

When sperm cannot reach the egg's outer layer for a variety of reasons, a treatment known as Intracytoplasmic Sperm Injection (ICSI) can be used in conjunction with In Vitro Fertilization (IVF). In ICSI, a single sperm is directly injected into the egg's outer layer (cytoplasm).5 ICSI can be considered when the TMC ranges between 15 million - 7.5 million*

 

4. Total Motile Count For TESE (Testicular Sperm Extraction):

 Testicular Sperm Extraction (TESE) is a procedure that allows sperm to be extracted straight from the testicle when there are very few sperms or when a person has issues with sperm production. Open testicular sperm extraction can be done with or without the use of a microscope (microsurgical or conventional). The Microsurgical Technique (M-TESE) offers greater benefits than the conventional procedure.6 When the TMC is less than 7.5 million* M-TESE followed by ICSI is advised.

 

Make sure to consult your treating physician for further help.


*Based on LifeCell’s Proprietary Algorithm

 

Ways To Improve Your Sperm Health 


1. Avoid Smoking: 

Semen parameters and sperm function test results are lower in smokers than in nonsmokers. Most of these effects are usually dose-dependent.7

 

2. Reduce Alcohol Consumption And Drug Use:

Drugs (steroids, marijuana) and alcohol can negatively impact sperm health leading to abnormally shaped sperm, decreased sperm motility and/or decreased sperm production. 8 

 

3. Maintain Healthy Weight:

There exists a clear link between obesity and reduced sperm production. Overweight men who want to improve their fertility should maintain a healthy weight.9

 

4. Practice Safe Sex:

Sexually transmitted infections (STIs) are a leading cause of infertility. Having safe sex today may increase your chances of conception in the future.8

 

5. Reduce Heat Exposure:

Men who are exposed to prolonged high heat (like hot tubs or using laptops on your lap)  can affect your fertility by lowering sperm production. 8, 9

 

6. Avoid Commercial Lubricants:

Some commercial lubricants/substances used for lubrication should be avoided during the fertile period. This may reduce sperm movement and their ability to survive.9

 

7. Choose The Right Clothing:

Men who wear heat retaining clothes experience decreased sperm production 8. As per studies wearing brief underwear may decrease sperm quality.9

 

8. Manage Your Stress:

Many stress-reducing techniques like Meditation, Yoga, Music, Therapies etc., can effectively keep stress at bay.10

 

How Can You Check Total Motile Count? 


You can get a semen analysis done. Semen analysis evaluates the characteristics of a male's semen and the sperm contained therein. 

As a result of social stigma in some parts of the world, many men refrain from getting their semen tested. While in-clinic semen analysis was the only choice previously, there is now an at-home option that delivers concrete data. With LifeCell’s SpermScore, get clarity on your fertility by testing 11 sperm health parameters and 14 sperm health conditions from the comfort of your home!

 

 

References 

 

  1. https://academic.oup.com/humrep/article/30/5/1110/591132  
  2. https://www.who.int/publications/i/item/9789240030787  
  3. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/intrauterine-insemination-iui/  
  4. https://www.reproductivefacts.org/topics/topics-index/IVF2/     
  5. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/what-is-intracytoplasmic-sperm-injection-icsi/  
  6. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/surgical-techniques-for-sperm-retrieval-what-should-i-know/  
  7. https://www.reproductivefacts.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/smoking_and_infertility.pdf     
  8. https://www.reproductivefacts.org/globalassets/asrm/asrm-content/learning--resources/patient-resources/protect-your-fertility3/asrm_brochure.pdf  
  9. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/optimizing-male-fertility/  
  10. https://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/stress_and_infertility_factsheet.pdf  

References