What To Expect During a Semen Analysis and What the Results Mean
A semen analysis is a test that assesses male fertility. Learn what happens during a semen analysis and what your results mean.Medically reviewed by Matthew Wosnitzer, MDMedically reviewed by Matthew Wosnitzer, MDA semen analysis is a test that is used to determine the amount of sperm and the quality of sperm. Semen analysis is an important fertility test for couples who are experiencing infertility—even if a fertility problem has already been identified in the partner with a uterus. While one-third of infertility cases involve the female partner, one-third of infertility cases are related to the male partner. The final third involves both partners or is considered unexplained infertility, which means there is no known cause.Also referred to as sperm count testing, semen analysis includes more information than just a sperm count. It's key to know how to read a sperm analysis report so that you understand any sperm-related fertility issues that may be at play, including sperm count and motility. Many people experience anxiety over the test and the results. Here's what to expect during a semen analysis, what the results mean, and what happens if the results are abnormal.
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Preparing for a Semen AnalysisIf semen analysis is recommended, your health care provider or fertility clinic will provide you with instructions on how to prepare for the semen sample collection. The list of do's and don'ts prior to semen analysis may include the following.Avoid ejaculationYour health care provider will probably tell you that you need to abstain from ejaculation for at least two to three days prior to the test. According to the World Health Organization (WHO), a semen sample should be collected no less than two days after sexual intercourse, and no more than seven days.Avoid excess heat exposureThe testicles are outside the body in the scrotum because sperm are sensitive to temperature. This is why you'll want to avoid high heat exposure in the two to three months before your test, which includes activities such as sitting in a hot tub, using car seat warmers, and excess heat exposure in the workplace. A high fever can also affect your sperm count.If you have been exposed to high heat or experienced a high fever, it can take several weeks for your sperm count to return to normal. Make sure to let your health care provider know if these factors are relevant to you so that your semen collection can be timed properly. Avoid smoking, drinking, and recreational drugsSome experts recommend that you avoid smoking, drinking alcohol, caffeine, and recreational drugs the week before your semen analysis. While there's a possibility that lifestyle habits can negatively impact your sperm count, it's unlikely that giving them up for a week will make a difference in your test results. The process of sperm creation takes place over two to three months. If you want to try to improve your fertility, consider giving up these habits for the long term.Review your medicationsSome prescription drugs can also negatively impact sperm counts. The following medications may affect sperm count:5-alpha-reductase inhibitors, such as Propecia (finasteride) and Avodart (dutasteride)Alpha-blockers, such as Rapaflo (silodosin), Flomax (tamsulosin), and Uroxatral (alfuzosin)Certain antibioticsChemotherapyTagamet (cimetidine)Colcrys, Mitigar (colchicine)Nizoral (ketoconazole)Long-term steroid useCaroSpir, Aldactone (spironolactone) and Procardia (nifedipine) Azulfidine (sulfasalazine)Testosterone supplements or replacement therapyIf you're taking any of these medications, your semen analysis results might be affected. Always tell your health care provider if you are taking any prescription medications, over-the-counter medications, vitamins, or supplements.Your doctor might want you to have the semen analysis while continuing with your medications (to see if they are causing a problem), or they may want you to stop the medication or switch to an alternative. Never stop taking a prescription drug without first talking to your prescribing doctor.
Related: The Best Supplements To Support Male Fertility
Getting the Semen SampleThe semen sample is collected by self-stimulation (masturbation) and ejaculating into a sterile container. The clinic should have a room set aside just for semen collection. They may or may not have materials to help inspire you for the collection, so you might want to bring a magazine or your smartphone. TipMost lubricants contain chemicals that can harm sperm. Your doctor will likely ask you to avoid them when producing the sample. Saliva can also harm sperm, so don't use your own spit as a lubricant either. Ask your doctor about the specialized lubricants that have been approved for use for fertility testing and treatment.
If obtaining a sample via masturbation is difficult, you might be able to collect a sample via intercourse using a specialized collection condom at home. These condoms are different from conventional condoms, which can damage the sperm sample and skew the results. Ask your doctor or fertility clinic about how to obtain a specialized, sperm-safe condom.You might be able to produce the sample at home via self-stimulation. Keep in mind that a semen sample should be evaluated within a particular time frame (generally two hours). If you live far away from the fertility clinic, your doctor might deem it necessary for you to give a sample at the office.
Related: 12 Ways to Increase Male Fertility
What If I Don't Want the Test?It's not uncommon to be hesitant about semen analysis. Reasons people have for not wanting to do the test include fear of having their "manhood" judged, religious objections to collecting the sample, or embarrassment regarding the method of collection.Others are nervous about providing the sample and anxious to receive the results of a semen analysis. If you are having trouble ejaculating to produce the sample, you're not alone.If you have concerns or fears about the collection or test, talk to your health care provider. It's important that you undergo the test to determine if there is a sperm-related cause for the infertility challenges you are experiencing. If there is a problem, it might be able to be fixed—but you won't know for sure without the testing.WHO Guidelines for Normal Semen AnalysisYou may wonder how to read a sperm analysis report. Different labs and physicians sometimes use different normal value ranges, which can make things a little confusing. Thankfully, your doctor will explain your results to you.
Parameter
Lower Reference Limits
Semen volume
1.3 to 1.5 mL
Total sperm count
35 to 40 million
Sperm concentration
12 to 16 million per milliliter
Total motility
40 to 43%
Progressive motility
29 to 31%
Vitality
50 to 56%
Sperm morphology
3.9 to 4%
The WHO guidelines are based on percentiles, which are based on a group of men who fathered children naturally in a year or less. The lower acceptable numbers represent the 5th percentile of the group (less than 5% of the men who fathered a child in the past year had semen parameter measurements below these cutoffs).Semen Analysis Parameters ExplainedThese semen parameters are only guidelines to consider when investigating what could be causing infertility. Having better or worse numbers than the WHO guidelines does not necessarily mean that you will or won't be able to conceive with your own sperm.Here are the semen health factors that are evaluated in a semen analysis, the normal values according to the WHO guidelines, and what abnormal results could mean. What your doctor considers normal or abnormal for you might differ from the values listed here.Semen ejaculate volumeWhat it is: Semen is made up of more than just sperm. In fact, less than 5% of semen is made up of sperm. Healthy semen includes fluid from:The bulbourethral glands: contains mucus to help the semen swimThe prostate gland: includes zinc-rich fluid to maintain DNA stability of the spermThe seminal vesicles: which includes important nutrients for the spermThe testes: where the sperm come fromWhat's considered normal: Normal semen ejaculate is between 2 milliliters to 5 milliliters of fluid or about one-half of a teaspoon to a little over a teaspoon.If results are abnormal: Low semen volume can be caused by an obstruction of the vas deferens (the duct that carries sperm from the testicles to the urethra), absence or blockage of the seminal vesicle, partial retrograde ejaculation, or a hormonal imbalance. Low volume can also be caused by stress over the test. Alternatively, an abnormally high volume could be caused by inflammation of the reproductive glands.Total sperm numberWhat it is: The total number of sperm found in the provided semen sample.What's considered normal: At least 20 million per milliliter (m/mL) per ejaculate may be sufficient to conceive, but the normal range is considered 40 million to 300 million per mL of fluid. Having a lower-than-normal count of sperm is sometimes called oligospermia. Azoospermia is when no sperm cells are found.If results are abnormal: Having a lower sperm count may indicate a number of problems, including:Chronic or undiagnosed health problems (such as diabetes or celiac disease)Duct problemsEjaculation problems (such as retrograde ejaculation)Exposure to toxic substancesHormonal imbalancesInfectionVaricoceleLow sperm counts can also be caused by certain medications, a recent illness accompanied by high fever, and exposure to heat (as in a hot tub). Smoking, obesity, and excess alcohol intake have also been linked to low sperm count. Azoospermia might be caused by a duct problem, a hormonal imbalance, or a problem with the testes.Sperm concentrationWhat it is: Sperm concentration is the number of sperm found in 1 milliliter of semen.What's considered normal: There should be at least 15 million sperm per millimeter.If results are abnormal: Low sperm concentration may be part of an overall low sperm count. It could also be related to an abnormally high ejaculate volume.MotilityWhat it is: Motility is the percentage of sperm that move. To conceive, sperm must swim up through the cervix and uterus to meet the egg. Total motility refers to any movement, while progressive motility refers to the forward movement in either a line or in a large circle.What's considered normal: At least 40% to 50% of the sperm should be moving, and movement quality should be a 2 or higher on a scale of 0 to 4.If results are abnormal: Asthenozoospermia is the term used for poor sperm motility. Poor sperm motility may be caused by illness, certain medications, nutritional deficiencies, or lifestyle habits like smoking. Many of the causes of low sperm count can also cause poor motility. Often the cause is never found.Viability or vitalityWhat it is: Sperm viability refers to the percentage of live sperm in the semen sample. This is especially important to measure if sperm motility is low, to differentiate between live non-motile sperm and dead sperm.What's considered normal: At least 50% of the sperm cells should be viable. If more than half of sperms are immotile, further testing may be needed to evaluate viability.If results are abnormal: Necrozoospermia is the term used when all sperm in the semen sample is dead. There are a variety of causes for necrozoospermia, including many of the same things that can cause low sperm count. TipUsing a non-fertility-safe lubricant or regular condom can kill sperm, even if they don't contain spermicide. Make sure you tell your health care provider if you used lubricant or a regular condom to produce your semen sample.
MorphologyWhat it is: Sperm morphology refers to the shape of the sperm cells. The lab technician closely examines a sample of sperm, checking to see approximately what percentage have a normal shape. The head, midsection, and tail are evaluated, as well as the measurements and proportions between each. Changing Morphology CriteriaBefore 2010, the WHO had different requirements for sperm to be considered "normal" in shape. Labs may have evaluated sperm morphology according to the WHO criteria, or what is known as Kruger's Strict criteria. However, the WHO's 2010 guidelines encourage the use of Kruger's Strict criteria. Speak to your doctor to find out if they are using the outdated WHO criteria or Kruger's criteria.
What's considered normal: At least 4% of sperm in the sample should have a normal shape.If results are abnormal: Teratozoospermia is the term used for poor sperm morphology. Poor sperm morphology may be caused by the same things that can cause low sperm counts. Sperm morphology is poorly understood, and because the evaluation is somewhat subjective, scores can vary on the same semen sample, in the same lab, using the same scoring techniques.LiquefactionWhat it is: When semen is ejaculated, it is thick and gelatinous. This is to help it adhere to the cervix. The semen eventually liquefies to enable the sperm to swim better.What's considered normal: Semen should liquefy within 20 minutes of ejaculation.If results are abnormal: Delayed liquefaction may indicate a problem with the prostate, the seminal vesicles, or the bulbourethral glands, which are also known as the male accessory glands. If delayed liquefaction occurs, your doctor might want to follow up with a post-coital test (PCT). This fertility test evaluates a female partner's cervical mucus after sexual intercourse. If sperm are found and moving normally, the delayed liquefaction is not considered a problem.Semen pHWhat it is: Semen pH is a measurement of how acidic or alkaline the semen is. The seminal vesicle fluid should be more alkaline, while the prostate fluids should be more acidic. In combination, they balance each other out.What's considered normal: The semen should have a pH somewhere in the range of 7.2 to 7.8. Currently, there's no consensus on how more alkaline semen may affect fertility, and so there's no upper pH limit according to the WHO guidelines.If results are abnormal: Usually, low pH is accompanied by other abnormal measurements, including a low volume of semen or low sperm counts. This may point to an obstruction or absence of the vas deferens.White blood cell (WBC) countWhat it is: White blood cells are the cells that fight infection in the body. All semen includes white blood cells.What's considered normal: The white blood cell count should be less than 1 million per milliliter of semen.If results are abnormal: A higher than normal white blood cell count (leukocytospermia or pyospermia) may have many causes. Bacterospermia is when excessive levels of bacteria are found in semen. Some people may have leukocytospermia and not have any active infection or fertility impairment. There is a theory that a possible cause of bacterospermia is untreated dental infections, though this has not been proven.If Your Semen Analysis Results Are AbnormalOne abnormal or borderline abnormal semen analysis result is not necessarily a sign of impaired male fertility. Because so many factors can lead to an abnormal result, your doctor will likely recommend repeating the semen analysis in a few weeks. The American Society for Reproductive Medicine actually recommends that at least two samples be collected, taken about a month apart.Talk to your doctor about what to expect next. Be sure to disclose any possible causes for abnormal results, including recent illness, a love of hot tubs or heated car seats, trouble producing a sample for the analysis, and all the medications you're currently taking, including any recreational drugs.Treatments for Male InfertilityIf the abnormal results are repeated, treatment options will depend on the cause of infertility as well as the female partner's fertility and age. The following are some of the most common options for male infertility treatment:Non-surgical treatments for male infertilityHormone treatments: It is not very common, but in some cases, hormonal treatment may help improve sperm count. Intrauterine insemination (IUI): Intrauterine insemination is a treatment where a semen sample is collected and put through a special washing process before being pushed through a catheter into the uterus. In vitro fertilization (IVF) or IVF with intracytoplasmic sperm injection (ICSI): With IVF treatment, the sperm and egg are put together in a lab to form an embryo. The embryo is transferred to the uterus. In conventional IVF, the sperm are put together with an egg in a petri dish. With IVF-ICSI, a single sperm cell is directly injected into an egg. There are additional risks and costs with ICSI, but it may be the only option for people with very low sperm count.Lifestyle changes: Healthy diet and exercise are helpful for semen quality. Additionally, antioxidant vitamins (such as L-carnitine) can be considered in cases with lower semen parameters to create a more "hospitable" environment for sperm and to potentially improve quality and offset negative effects of risk factors. When there is increased inflammation due to chronic illness or environmental risks (obesity or cigarette smoking for example), there can be increased sperm damage (sperm DNA fragmentation). This can be evaluated with specific testing that would be considered in certain cases with persistent issues following standard semen analysis.Treating any underlying medical conditions: Untreated celiac disease, diabetes, or a thyroid imbalance can all increase the risk of male infertility, so treating these conditions may increase fertility.Sperm donor: In some situations, it may be recommended to consider using a sperm donor.Surgical treatments for male infertilityVaricocele: If there is a varicocele (varicose vein in the scrotum or testicle), microsurgical varicocelectomy (disrupting, ligating, or removing it) may improve sperm counts by reducing heat surrounding the testisVasectomy: Micro-surgical reconstruction may be considered in some cases of male infertility, especially if it's a vasectomy reversal. Testicular sperm extraction: In cases of extremely low sperm count, zero sperm count, or no ejaculate, a testicular sperm extraction is an option. This is when mature or immature sperm cells are extracted via a needle or microsurgical approach from the testicles. In addition microsurgical epididymal sperm aspiration can be completed in cases of blockage as alternative to vasectomy reversal. IVF-ICSI is required if this procedure is done. For more Parents news, make sure to sign up for our newsletter! Read the original article on Parents.
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