We are having fertility problems and have not been able to conceive for over one year after an early miscarriage. My husband's sperm count and motility are normal, although the most recent postcoital test revealed very few sperm. The pH of my husband's semen was 9.0 and 8.6 for two analyses. Is this indicative of an infection? Should further tests be performed on either or both of us to check for infection? My doctor has not commented on the pH at all. --Anne

The elevated pH may be an indication of infection or simply due to delay in analysis after the sperm is provided. I would only be concerned if a large number of white blood cells are seen in the specimen. I rarely recommend sperm cultures.

I no longer perform the postcoital test as the results are not helpful in predicting fertility outcome. Assuming your doctor has performed a complete evaluation, the most appropriate option would be to consider ovulation induction and intrauterine insemination.