Semen analysis: what the measures mean

A semen analysis is a laboratory test that evaluates various characteristics of semen and the sperm it contains. It's typically the first test performed when investigating male fertility.

Why it's important:

• Male factors contribute to 40-50% of fertility issues
• It's simple, non-invasive, and relatively inexpensive
• Results provide valuable information quickly
• Can identify issues that are often treatable

What the test examines:

The analysis evaluates several parameters:

• Volume of semen produced
• Concentration (count) of sperm
• Motility (how well sperm swim)
• Morphology (shape and structure of sperm)
• Other factors like pH, liquefaction, and presence of white blood cells

When it's recommended:

• Early in any fertility investigation
• If a couple has been trying to conceive for 6-12 months
• Before fertility treatments
• To assess fertility potential before trying
• To check recovery after varicocele surgery or treatment

Important to know:

• Sperm parameters naturally vary between samples
• A single abnormal result doesn't necessarily indicate a problem
• Two analyses, typically 2-4 weeks apart, provide a more accurate picture
• Results should be interpreted in the context of overall health

Proper preparation ensures the most accurate results:

Abstinence period:

• Abstain from ejaculation for 2-5 days before the test
• Less than 2 days may result in lower count and volume
• More than 5-7 days may result in reduced motility and older sperm

Collection methods:

At the clinic/laboratory:

• Most accurate method
• Private room is provided
• Sample is analysed quickly

At home:

• May be offered if you live close to the lab
• Must be kept warm (body temperature) during transport
• Must reach the lab within 30-60 minutes

Collection tips:

• Collect the sample through masturbation into a sterile container provided by the lab
• Avoid lubricants (they can damage sperm) - use fertility-friendly lubricant if necessary
• Collect the entire ejaculate, especially the first portion
• Don't use a regular condom (they contain spermicide)

Before your test:

• Avoid illness in the weeks before (fever can temporarily affect sperm)
• Continue normal lifestyle (don't change dramatically just before the test)
• Inform the lab of any medications you're taking
• Note if you were unwell recently

Emotional considerations:

Many men feel awkward about providing a sample. This is completely normal:

• Take your time
• The lab staff are professionals and handle this daily
• If you struggle, discuss alternatives with your doctor

Semen analysis results include several parameters. Here's what they mean:

Semen volume:

• Normal: ≥1.5 mL
• Low volume may indicate: incomplete collection, ejaculatory duct obstruction, retrograde ejaculation, or hormonal issues

Sperm concentration (count):

• Normal: ≥15 million per mL
• Lower is termed oligospermia
• Zero sperm is azoospermia
• Higher isn't necessarily better beyond normal range

Total sperm number:

• Normal: ≥39 million per ejaculate
• Volume × concentration
• Gives overall production picture

Total motility:

• Normal: ≥40% moving
• Includes all types of movement

Progressive motility:

• Normal: ≥32%
• Sperm moving forward (most important for reaching the egg)

Morphology (shape):

• Normal (WHO/strict criteria): ≥4% normal forms
• Don't be alarmed by low percentages - only a small proportion need to be normal
• Strict criteria are very rigorous

Other parameters:

• pH: Normal 7.2-8.0
• Liquefaction: Semen should liquefy within 30 minutes
• White blood cells: High levels may indicate infection
• Vitality: Proportion of live sperm

Terminology:

• Normozoospermia: All parameters normal
• Oligozoospermia: Low sperm count
• Asthenozoospermia: Poor motility
• Teratozoospermia: Abnormal morphology
• Oligoasthenoteratozoospermia (OAT): Combination of the above

If your results show abnormalities, here's what you should know:

Don't panic:

• One abnormal result doesn't define your fertility
• Many men with "abnormal" results conceive naturally
• Most issues are treatable
• A repeat test is usually recommended

Low sperm count (oligozoospermia):

Possible causes:

• Varicocele
• Hormonal imbalances
• Heat exposure
• Lifestyle factors
• Certain medications
• Genetic factors

Next steps: Hormone testing, ultrasound, lifestyle modifications

No sperm (azoospermia):

Can be:

• Obstructive: Sperm are produced but blocked
• Non-obstructive: Production problem

Evaluation includes: Hormone testing, genetic testing, and potentially testicular biopsy. Sperm may still be retrieved surgically.

Poor motility (asthenozoospermia):

Possible causes:

• Varicocele
• Antisperm antibodies
• Infection
• Lifestyle factors
• Genetic factors

Often responds to lifestyle changes or treatment of underlying cause.

Abnormal morphology (teratozoospermia):

• Remember that only 4% normal is required
• Morphology is highly variable
• Isolated abnormal morphology with normal count/motility may not significantly impact fertility
• High abnormal morphology may affect fertilisation ability

Multiple abnormalities:

When several parameters are abnormal:

• More comprehensive evaluation is needed
• IVF with ICSI may be recommended
• Treatment success is still often good

Based on your results, here's what typically happens next:

If results are normal:

• The focus shifts to female factor evaluation
• Continue lifestyle optimisation
• Keep trying naturally if no female issues
• Results confirm male fertility is not likely the issue

If results are mildly abnormal:

• Repeat test in 2-4 weeks to confirm
• Implement lifestyle changes (can take 3 months to see effect)
• Consider supplements (with doctor guidance)
• May proceed with IUI if other factors are favourable

If results are significantly abnormal:

Additional testing may include:

• Hormone panel (FSH, LH, testosterone, prolactin)
• Scrotal ultrasound
• Genetic testing (for very low counts or azoospermia)
• Antisperm antibody testing
• Post-ejaculatory urinalysis (for retrograde ejaculation)

Treatment options:

• Lifestyle modifications (always recommended)
• Hormonal treatment (if indicated)
• Surgery (e.g., varicocele repair)
• Assisted reproduction (IUI, IVF, ICSI)

If azoospermia (no sperm):

• Full evaluation to determine cause
• Surgical sperm retrieval may be possible
• Donor sperm is an option
• Genetic counselling if genetic causes

Working with your doctor:

Bring your results to a urologist or reproductive endocrinologist who can:

• Interpret results in context
• Recommend appropriate next steps
• Discuss treatment options
• Provide prognosis based on your specific situation