Male factors contribute to around half of couples’ difficulties conceiving, yet men are often tested last. A semen analysis is simple, painless and one of the most useful early fertility tests.
Imagine trying for a baby for over a year. Your partner has had blood tests and scans, and everything looks fine. Finally, someone suggests a semen analysis. You feel awkward about it, but the result changes the whole plan.
What a semen analysis measures
- Volume: how much semen is produced
- Concentration and total count: how many sperm there are
- Motility: what proportion of sperm are moving, and how well
- Morphology: what proportion have a normal shape
- Vitality: what proportion are alive
- Other factors: pH, white blood cells and how the semen liquefies
How to prepare
- Avoid ejaculation for about two to five days before the test, as advised by the laboratory
- Avoid alcohol and recreational drugs in the days before
- Tell the clinic about any recent fever or illness, which can lower sperm counts for up to three months
- Tell them about your medicines, including testosterone or anabolic steroids, which can severely reduce sperm production
Collecting the sample
The sample is usually collected by masturbation into a sterile container provided by the clinic, either in a private room at the clinic or at home. If at home, it must reach the laboratory quickly, often within an hour, and be kept at body temperature, for example in an inside pocket.,Do not use lubricants or ordinary condoms, which can harm sperm. Special collection condoms are available if needed for religious or personal reasons. Make sure the whole sample is collected, as the first part contains the most sperm.
WHO reference values
The World Health Organization laboratory manual (sixth edition, 2021) gives lower reference limits based on fertile men. These include a semen volume of about 1.4 mL, a sperm concentration of about 16 million per mL, a total sperm count of about 39 million per ejaculate, total motility of about 42% (progressive motility about 30%) and normal forms of about 4%.,These are not strict cut-offs for fertility. Many men with results below these limits father children naturally, and some men above them have difficulty. Results are interpreted alongside your partner’s fertility, how long you have been trying and your health history.
Why a repeat test is often needed
Sperm production takes about two to three months, and results can vary a lot from one sample to the next because of illness, stress, abstinence time and other factors. If your first result is abnormal, a repeat test is usually recommended, often about three months later.
Common terms on a report
- Oligozoospermia: low sperm concentration
- Asthenozoospermia: reduced motility
- Teratozoospermia: low proportion of normally shaped sperm
- Azoospermia: no sperm found, which needs specialist assessment
- Leukocytospermia: raised white blood cells, which may suggest infection or inflammation
Ways to support sperm health
- Stop smoking and avoid recreational drugs, including cannabis
- Keep alcohol within recommended limits
- Aim for a healthy weight
- Avoid anabolic steroids and testosterone supplements unless medically prescribed
- Avoid prolonged heat to the testicles, such as hot tubs, saunas and laptops on the lap
- Manage stress and get enough sleep
- Eat a balanced diet rich in fruit, vegetables and wholegrains
What happens next
Depending on your results, you may be referred to a fertility specialist or urologist for an examination, hormone blood tests, genetic tests or a scan. Treatment depends on the cause and may include treating infections or varicoceles, lifestyle changes, or assisted conception such as IUI, IVF or ICSI, where a single sperm is injected into an egg.
Talking about it
Many men feel embarrassed or that their masculinity is being questioned when fertility tests are discussed. Male infertility is common and is a medical issue, not a reflection of who you are. Talking with your partner, a counsellor or a support group can help.
Frequently asked questions
Does a low count mean I cannot have children?
Not necessarily. Many men with low counts conceive naturally or with treatment.
Can I produce the sample at home?
Often yes, if you can get it to the laboratory within the required time and kept warm.
How long do results take?
Usually a few days to two weeks.
But I feel fine. Why would there be a problem?
Most causes of male infertility cause no symptoms. Testing is the only way to know.
Your next step: If you have been trying to conceive for a year (six months if your partner is over 35), ask about a semen analysis alongside your partner’s tests.
Related: Infertility: supporting each other
Sources: World Health Organization laboratory manual for the examination and processing of human semen (6th edition, 2021), National Institute for Health and Care Excellence (CG156), British Fertility Society, American Society for Reproductive Medicine.
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