A semen analysis is an important step in determining male fertility. Learn about what a semen analysis is, what test results mean, and what the next steps are after receiving the test results.
Infertility, or the inability to conceive a child after one year of regular unprotected sex during the fertile window, impacts around one in six couples worldwide. The World Health Organization (WHO) estimates that in around 50% of these cases, male infertility is a contributing or responsible factor.
For couples trying to conceive, a semen analysis is an important step in determining male fertility. It provides essential information about sperm health and functioning. The test results can help couples understand the likelihood of conceiving and determine the next steps.
In this article, we discuss what a semen analysis is and what it measures, what do test results mean, and what are the next steps after receiving the test results.
What is a semen analysis?
Also called a sperm count test, a semen analysis is a male fertility test that primarily evaluates sperm production and health. Produced in the testicles, sperm is the male sex cell that fertilises a mature female egg (ovum) and provides half the genetic material for a new baby. The ability of your sperm to develop, live, and fertilise is measured through three parameters:
- Sperm count refers to the number of sperm cells in ejaculate (also known as semen, a white, thick fluid that carries sperm cells out of the penis at ejaculation).
- Sperm motility refers to the direction and speed that sperm move. Ideally, sperm cells have linear forward movement.
- Sperm morphology refers to the shape and size of sperm cells.
In addition to sperm parameters, a semen analysis measures the quantity and quality of your semen and provides information about whether your reproductive organs are properly functioning. Often confused with sperm, semen (also called seminal fluid) is produced by three glands in the male reproductive system. In addition to transporting sperm cells, semen contains substances that help with sperm viability and may contribute to fertility.
While a semen analysis is important for identifying potential factors impacting fertility, it does not assess the ability of sperm to fertilise an egg. For this reason, it cannot be considered a direct measurement of male infertility.
How is a semen analysis conducted?
A semen analysis test involves collecting a semen sample through masturbation. Collecting your semen sample may be done by
- ejaculating into a small sterile container provided by your fertility clinic. You may do this at the fertility clinic or at your home.
- ejaculating into a non-toxic condom during intercourse. This is a natural latex condom that is made without harmful chemicals.
To get a complete picture, your fertility specialist will often conduct two or three semen analyses.
A common cause of poor semen and sperm parameters is improper sperm sample collection. To avoid this, the sample should be carefully collected at the right time. Your fertility specialist will instruct you to avoid both ejaculating for 2–7 days before giving a sample and using lubricants during the sample, as they can impact your sperm motility.
If you are collecting your sample at home, you should bring it to your fertility clinic within 30 minutes. During this time, the sample should be kept between room and body temperature (20–37 degrees Celsius).
What is the purpose of a semen analysis report?
A semen analysis report provides you and your fertility specialist with an understanding of your sperm health and vitality. In addition to functioning as a sperm analysis, this report provides insight into additional causes of male factor infertility (infertility that arises from or involves issues with the male), such as whether you have abnormal semen or are experiencing dysfunction in your reproductive tract.
What are the major lab values that are measured in a semen analysis report?
Sperm count
Sperm count indicates your sperm production and whether your sperm is being released when you ejaculate. Having a sufficient sperm count is important because it improves the number of opportunities you have to fertilise a female’s mature egg (ovum).
Your sperm count is measured as either sperm concentration or the total number of sperm. If your sperm concentration is less than 15 million/mL, you are considered to have a low sperm count (a condition known as oligospermia).
It is also possible to have no sperm in your ejaculate (a condition known as azoospermia). Azoospermia may arise due to various issues, including blockages in your reproductive tract and hormonal disorders.
Sperm motility
A semen analysis evaluates your total motility, which is the number of sperm that are moving in general. Total motility includes two categories: progressive motility and non-progressive motility. While progressive motility refers to sperm moving forward in a straight line or large circle, non-progressive motility refers to sperm cells that are not moving linearly or are swimming in tight circles.
Having progressively motile sperm is important because it means that it is more likely that your sperm will be able to make it through the female reproductive tract to fertilise an egg.
Sperm morphology
A semen analysis evaluates how many of your sperm have a normal shape and size. While the term ‘normal’ is typically used, a more accurate term may be ideal, since only 4–10% of spermatozoa typically fit these requirements. The role of sperm morphology in fertility is relatively unclear, although defects in the shape of sperm are associated with lower fertilising potential and abnormal sperm DNA.
According to the WHO, normal sperm have a smooth oval head and a slender midpiece (which joins the head and tail). They also have a tail that is thinner than the midpiece and around ten times the length of the head. The sperm head should be 40–70% covered by a membrane structure called the acrosome, which secretes enzymes that help the sperm cell penetrate the egg cell at fertilisation.
Sperm viability
Sperm viability (also known as sperm vitality) refers to the amount of sperm that are alive in a semen sample. Sperm viability is measured as a percentage. It is typically tested when sperm motility is between 5–10%, meaning that a great deal of sperm are not moving (nonmotile). This value helps determine whether nonmotile sperm are still alive (and thus has fertilising potential).
By determining the viability of sperm, it is possible to identify whether certain fertility procedures can be used to increase the chances of pregnancy for men with abnormal sperm motility. One such example is an intracytoplasmic sperm injection (ICSI).
Semen volume
Around 95% of semen is made up of components from four male sex organs: the seminal vesicles, the prostate, the bulbourethral glands and the urethral glands. The remaining 5% is sperm and trace fluids from the testicles, where the sperm remains until ejaculation.
Measuring your volume of semen is one way to determine if you have a condition, such as
- an obstruction in your reproductive tract
- a testosterone deficiency (also known as male hypogonadism)
- ejaculatory dysfunction
- prostate issues
- genetic abnormalities
Semen pH
Seminal fluid is the surrounding environment for sperm cells following ejaculation. During this time, semen provides nutrients to the sperm cells, assists with sperm motility, and provides a constant pH for sperm during the fertilisation process.
The measurement of semen pH aims to determine whether semen is within the normal value range of 7.2–8.0. Since a neutral pH is 7.0, semen may be considered slightly basic. By measuring semen pH, it is possible to detect potential issues with fertility. For example, if semen is too acidic (low pH), it may be an indication that there is a blockage in the seminal vesicles. These organs secrete a more basic fluid. If semen is too basic (high pH), it may indicate an infection.
Semen liquefaction
Semen liquefaction refers to the process where ejaculated semen changes consistency from a sticky gel-like fluid to a thinner liquid. Liquefaction is important because it facilitates sperm movement through the female reproductive tract. A semen analysis measures how long it takes for liquefaction to occur.
According to one review on semen hyperviscosity, which is a condition where semen remains thick, having impaired semen liquefaction is associated with sperm abnormalities and infertility. Impaired semen liquefaction may be caused by various things, including improper functioning of the glands that produce seminal fluid, infection, high levels of white blood cells in semen, and genetic factors.
White blood cell count
The white blood cell count is a measurement of the number of white blood cells (also known as leukocytes) per millilitre of ejaculate.
The presence of too many white blood cells in the male reproductive tract indicates an infection in the male genital tract (MGT). MGT infections are strongly associated with male infertility. The infection may directly damage sperm cells or the surrounding environment.
What are normal values for semen analysis?
Although there are values that are used in a clinical setting to evaluate sperm health and additional parameters, there is a widespread understanding that such numbers generally cannot be used to diagnose infertility. Rather, having results within a certain range may indicate that you have a better chance of conceiving a child without intervention.
With this in mind, it can still be useful to have an idea of how to interpret your results. In one study for semen assessment values that was supported by the WHO, the following values were recognised as within a normal range:
- Sperm concentration: ≥ 15 million sperm per millilitre of semen
- Sperm count (total number in ejaculate): ≥ 33 million sperm
- Total motility (progressive motility + non-progressive motility): ≥ 40% of sperm
- Progressive motility: ≥ 26% of sperm
- Non-progressive motility: 1–40% of sperm
- Sperm morphology: 3–34% of sperm have a normal form
- Sperm viability: ≥ 54% live sperm cells
- Semen volume: 1.3–6 millilitres semen per ejaculation
Additional semen analysis values that have been marked as normal in other studies include:
- Semen pH: 7.2–8.0
- Liquefaction: 15–20 mins (although up to 2 hours is possible before it may be considered a problem)
- White blood cell count: < 1 million white blood cells per millilitre of semen
If you have values that do not correspond with the suggested range, it does not necessarily mean that you cannot have children. By considering these values together with additional tests, your medical history, and your lifestyle, your fertility specialist can help you plan the best approach to getting pregnant.
What do abnormal results indicate?
If the results of semen analyses are abnormal, it may suggest that there is a male factor impacting a couple’s ability to conceive. Results showing abnormal sperm or semen may indicate:
- a hormonal imbalance and/or improper functioning of hormone-producing organs (such as the hypothalamus or pituitary gland in the brain)
- improper functioning of reproductive organs (e.g. testicles)
- exposure to environmental factors, such as toxins or heat
- a genetic condition
- a medical condition or side effects from a medical treatment
- an error in the semen analysis test
What happens after I get my results?
After you receive your results, your fertility specialist will make a recommendation for the next steps.
What does it mean if I have abnormal results?
If you have abnormal semen analysis results, you may have a lower chance of getting your female partner pregnant.
Your fertility specialist will consult your results and make a recommendation for the next steps. This may involve performing additional fertility tests, such as hormonal blood tests, an ultrasound of the testes, genetic testing, or a testicular biopsy (a small surgical procedure where a piece of testicular tissue is removed for examination).
Options for Fertility Treatment
If your semen analysis reports show abnormal results, your fertility specialist may suggest various treatment options to increase your chances of conceiving a baby. Fertility treatment may also be recommended if you are experiencing infertility and there is no clear cause (also called idiopathic fertility). Since infertility may involve both male and female factors, it is a good idea for your female partner to also get checked.
Some of the most common treatments for male infertility are
- Surgery. Various surgeries may be done to improve sperm production and delivery, such as a varicocelectomy (a surgery to correct a varicocele).
- Antibiotics or non-steroidal anti-inflammatory medications. These may be prescribed to treat certain infections.
- Hormone treatments. Males with low testosterone levels may receive hormones to improve their sperm production.
- Intrauterine insemination (IUI). IUI is a form of artificial insemination where male sperm is inserted into the female uterus around the time of ovulation (when an egg is released from the ovaries).
Additionally, your fertility specialist may recommend assisted reproductive technologies (ARTs), such as
- In vitro fertilisation (IVF). IVF is a form of artificial insemination where a mature female egg (ovum) is removed from the ovaries and fertilised with male sperm in a test tube.
- Intracytoplasmic sperm injection (ICSI). ICSI is an in vitro fertilisation method where a mature female egg (ovum) is removed from the ovaries and fertilised with a single male sperm cell (spermatozoa) in a test tube.
We spoke to Professor Kelton Tremellen about what the best fertility test is for women, and this is what he had to say:
If you limit the test to just blood tests, the AMH assessment of ovarian reserve is, in my opinion, the most useful test. AMH is not a great test of natural fertility, but it is useful in helping decide on the speed to move to IVF (i.e., time trying for natural conception before moving to IVF), anticipated response to IVF stimulation, and if a low AMH results lower prognosis for IVF success. High AMH can also suggest a PCOS diagnosis. Not a perfect test, but AMH is my #1 blood test in female fertility assessment.
Takeaway
A semen analysis is an important indicator of male infertility. This test measures sperm and semen parameters, such as motility, morphology, count, vitality, and volume. When you receive your results, remember that there is a wide range of normal values. Your results will be used to evaluate your reproductive health and assess the best possible way to proceed, whether through additional testing, lifestyle changes, or fertility treatments and procedures.
While the test is an important diagnostic tool, a semen analysis is not an accurate measurement of fertility or the likelihood to become pregnant. For this reason, it's crucial to work closely with your specialist to understand your unique situation and develop a personalised plan for achieving your reproductive goals.
If you are interested in learning more about fertility testing or treatment options, reach out to the compassionate team at Cada for a free consultation.
