Inability to Effectively Provide a Semen Specimen
There are some couples for whom a major contributing issue for their fertility is difficulty in providing a semen specimen. These generally fall into three major categories:
#1) Erectile dysfunction
#2) Ejaculatory failure
#3) Normal erections and ejaculation, but inability to collect when needed for fertility testing
Some men starting their fertility evaluation have known risk factors for these problems, such as a history of having a spinal cord injury. Other men with no known risk factors find that they are unable to provide a specimen by masturbation when requested by the fertility lab. Obviously, if a specimen cannot be collected, then even basic semen analysis parameters cannot be evaluated. The first step in these men is to address the erectile and/or ejaculatory problems and manage any related problems that are uncovered.
For men with erectile dysfunction, ejaculatory failure, and spinal cord injuries, please click on the links below for more detailed information. After these links, there is some basic information for men who have normal erections and ejaculation, but seem to have problems with specimen collection for fertility testing only.
Spinal Cord Injury
Collection Problems in Men with Otherwise Normal Erections and Ejaculation
1) Inability to Collect a Specimen in a Strange Environment
Most men find the prospect of providing a semen specimen for evaluation a stressful and embarrassing undertaking. Some men just cannot “perform” in a collection room at the lab, whether due to problems with achieving or maintaining an erection or due to difficulty reaching climax.
If the problem is primarily one of achieving or maintaining an erection, sometimes taking an erection-enhancing medication prior to a planned collection may be helpful. For transient sperm collection difficulties in men who normally have fairly good erections, taking 100 mg of Viagra, 20 mg of Levitra or Staxyn, or 20 mg of Cialis one hour prior to the scheduled collection time, or 10 mg of Stendra fifteen to thirty minutes beforehand, may be of benefit. See “Erectile Dysfunction” section (link above) for details on the proper use of these medications, as well as information about side effects and contraindications to taking them.
If collection-related erection problems persist despite use of these medications, or if the primary problem is an inability to reach climax and orgasm in an unfamiliar environment, then collecting a specimen in the comfort of one’s home may be helpful. As noted earlier, home collections must be closely coordinated with the lab. Specimens must be kept warm (around body temperature, so keeping them tucked into a pocket is fine) and must make it to the lab within thirty minutes. Also, a proper sterile collection cup must be obtained from the lab prior to specimen collection.
2) Inability to Effectively Masturbate in Any Location to Collect a Specimen
Some men who have masturbated normally in the past just have a mental block when trying to collect a specimen for evaluation and cannot reach orgasm even in the comfort of their own home. In these situations, sometimes the man’s partner needs to get involved to help with collection of the specimen; however, be careful to follow the lab’s guidelines regarding allowed lubrication and no use of saliva. Coitus interruptus (having intercourse and then pulling out right before ejaculation) is not recommended: it can be difficult to collect the full specimen, and there is potential for picking up contaminants from the microorganisms normally found in the vagina. A better option is using a special collection condom, which can be then given to the lab technician. Regular condoms cannot be used; you must obtain a specially made collection condom beforehand. Ask the lab if it will provide one or if you will need to purchase one on your own. An example of a commercially available collection condom is the Male Factor Pak, which costs around $15 at Amazon.com. Always check with the lab before using a collection condom to make sure that this is okay with them.
3) Lack of Experience with Masturbation
Although most men begin masturbating with the onset of puberty, some men make it to adulthood without ever having masturbated. While sociological studies have shown that the vast majority of men (at least 95 percent) masturbate, certain religious groups officially frown upon masturbation, and some men from these religious communities may be unwilling or unable to produce a semen specimen for analysis. Depending on the individual’s particular beliefs, a special collection condom (mentioned above) could potentially be used in these circumstances. Working with a local sex therapist can be an effective approach in some situations. Post-coital testing can also be used with some couples to see if decent numbers of motile sperm are reaching the cervical mucus, although exact semen parameters cannot be measured.
See "Uncommonly Used Sperm Testing" for more information on post-coital testing