What to Expect During a Semen Analysis and What the Results Mean

What's Normal, What's Abnormal, and Why

Fenugreek and radish sprouts as metaphor for sperm / semen
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Semen analysis is an important fertility test for infertile couples, and the test should be done before any treatments (even "just clomid") are prescribed. Sometimes referred to as sperm count testing, a real semen analysis includes much more than just a sperm count. 

While one-third of infertility cases involves a problem with just the woman, one-third of infertility cases are a problem with just the man and another third involve problems on both sides or unexplained infertility.

This is why every infertile couple must make sure the male partner is tested. Even if a fertility problem has been identified in the female partner, that doesn't mean the male partner's fertility is normal.

Many men experience anxiety over the test—and later, over the results. Here's what to expect during a semen analysis, what having the test is like, what the results mean, and what happens if they are abnormal. 

Preparing for a Semen Analysis

Your doctor will probably tell you that you need to abstain from intercourse for at least two to three days prior to taking the test. According to the American Society of Reproductive Medicine (ASRM), a semen sample should be taken no less than two to three days after sexual intercourse, and no more than seven days.

ASRM also recommends that at least two samples are collected, taken about a month apart. You may be asked to take the test twice, especially if the first results are abnormal or borderline abnormal.

Also, you'll want to avoid you'll want to avoid high heat exposure in the two to three months before your test. This includes things like frequent hot tubbing, using car seat warmers, or possibly high-heat exposure in the work place. A high fever can also impact your sperm counts. The testicles are outside the body in the scrotum because sperm are so sensitive to temperature.

Unfortunately, if you have been exposed to high heat, or experienced a high fever, it may take several weeks for your sperm counts to return to their normal. Mention this to your doctor if you know it may be an issue, so the test can be timed properly. 

Some recommend that you should avoid smoking, drinking alcohol, caffeine, and recreational drugs the week before your semen analysis. While there is a possibility that these lifestyle habits can negatively impact your sperm count, it's unlikely that giving them up for a week will make a big difference in your test. This is because the process of creating sperm takes places over months. If you really want to ensure better results—and better fertility—you should give up the unhealthy habits for the long term. 

There are prescription drugs that can also negatively impact sperm counts, including

  • testosterone supplements or replacement therapy
  • chemotherapy
  • long-term steroid use
  • the anti-fugal drug ketoconazole (if taken in pill form)
  • some antibiotics
  • the high blood pressure drugs spironolactone and nifedipine
  • the heartburn medication cimetidine (also known as Tagamet)
  • sulfasalazine, a drug used to treat rheumatoid arthritis and ulcerative colitis
  • colchicine, an anti-inflammatory drug used to treat gout 
  • 5-alpha-reductase inhibitors, drugs used to treat enlarged prostate and hair loss
  • alpha blockers, like silodosin, tamsulosin, and alfuzosin, drugs used to treat enlarged prostate

If you're taking any of these medications, your semen analysis results may be impacted. 

Always let your doctor know the medications you are currently taking. They may 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 doctor.

Getting the Semen Sample

The semen sample is collected by self-stimulation, or masturbation, into a sterile container.

Because most lubricants contain chemicals that can harm sperm, your doctor will likely ask you to use a "dry rub" when producing the sample. (Saliva can harm sperm, so don't use your own spit.) There are specialized lubricants that have been approved for use in fertility testing and treatment. Ask your doctor about using one.

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 if you know you will need something, bring a magazine or your smartphone along with you.

If obtaining a sample via masturbation is difficult for you, you may be able to collect a sample via intercourse using a specialized condom at home. Do not use just any condom, however! The chemicals in regular condoms can damage the sperm sample, skewing the results. Ask your doctor about how to obtain the specialized condom.

You may also be able to produce the sample at home via self-stimulation. Talk to your doctor about this option. A semen sample should be evaluated within a particular time frame (within two hours is generally recommended) for best results. If you live far from the fertility clinic, it might be necessary to give the sample at the office.

It’s common to feel uneasy about any medical testing, and men are often nervous providing the sample and anxious to receive the results of a semen analysis. If you are having trouble ejaculating to produce the sample, speak to your doctor. You're not alone, and there are steps you can take to help get the semen sample.

What If I Don't Want the Test?

It's not uncommon for some men to refuse or be hesitant about semen analysis testing. Reasons men 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.

Discuss with your doctor any concerns or fears you have regarding the test. Skipping male fertility testing can lead to heartbreak and lost time, if later it's discovered male fertility factors were relevant.

World Health Organization Guidelines for Normal Semen Analysis

Your doctor will explain your results to you, and because different labs and doctors may use different normal value ranges, what your doctor considers normal or abnormal may differ from what you find in this article and elsewhere on the internet.

With that said, here are the semen health factors typically evaluated in a semen analysis, their normal values according to the World Health Organization's 2010 guidelines, and what abnormal results may mean.

The World Health Organization guidelines are based on percentiles, which are based on a group of men who fathered children in a year or less. The lower acceptable numbers represent the 5th percentile of this group. In other words, less than 5 percent of the men who fathered a child in the past year had semen parameter measurements below these cutoffs.

ParameterLower Reference Limits
WHO lower reference values for semen characteristics
Semen volume (ml)1.5 (1.4 to 1.7)
Total sperm count (10^6)39 (33 to 46)
Sperm concentration (10^6 / ml)15 (12 to 16)
Total motility (percent)40 (38 to 42)
Progressive motility (percent)32 (31 to 34)
Vitality (percent)58 (55 to 63)
Sperm morphology (percent)4 (3 to 4)

What this means is that having better or worse numbers doesn't necessarily mean you will or won't be able to father a child. The semen parameters are just guidelines to consider when investigating what may be causing infertility.

Semen Ejaculate Volume

What Is It: Semen is made up of more than just sperm. In fact, less than 5 percent of semen is made up of sperm.

Healthy semen includes fluid from the testes (which is where the sperm come from), from the seminal vesicles (which includes important nutrients for the sperm), from the prostate gland (which includes zinc-rich fluid to maintain DNA stability of the sperm), and from the bulbourethral glands (which contains a mucus to help the semen swim).

What Is Considered Normal: Normal semen ejaculate is between 1.5 milliliters to 6 milliliters of fluid. This is about one-third of a teaspoon to a little over a teaspoon.

What Might Be Wrong if Results Are Abnormal: Low semen volume may 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 may also be caused by stress over the test. (Speak to your doctor if this is true for you.) An abnormally high volume may be caused by inflammation of the reproductive glands.

Total Sperm Number

What Is It: This is the total number of sperm found in provided semen sample.

What Is Considered Normal: About 39,000,000 (or 39 x 10^6) sperm per ejaculate is considered the lower acceptable limit. Having a lower than normal count of sperm is sometimes called oligospermia. If no sperm cells are found, this is called azoospermia.

What Might Be Wrong if Results Are Abnormal: Having a lower sperm count may indicate a number of problems, including varicocele, infection, chronic or undiagnosed health problems like diabetes or celiac disease, problems with ejaculation like retrograde ejaculation, duct problems, hormonal imbalances, and exposure to toxic substances.

Abnormally low sperm counts can also be caused by certain medications, recent illness accompanied by high fever, and exposure of the scrotum to heat (as in a hot tub). Smoking, obesity, and excess alcohol intake has been linked to low sperm count. Often, the cause for low sperm count is never found.

Azoospermia may be caused by a duct problem, a hormonal imbalance, or a problem with the testes.

Sperm Concentration

What Is It: Sperm concentration is the number of sperm found in one milliliter of semen.

What Is Considered Normal: There should be at least 15,000,000 (or 15 x 10^6) sperm per millimeter.

What Might Be Wrong if Results Are Abnormal: Low sperm concentration may be part of an overall low sperm count, or it could be related to an abnormally high ejaculate volume. See above for more on these two issues.

Motility

What Is It: Motility is the percentage of sperm who move. For fertilization to occur, sperm must swim up the female reproductive tract to meet the egg. Being able to swim to their destination is essential. Total motility refers to any movement, while progressive motility refers to forward movement in either a line or in a large circle.

What Is Considered Normal: At least 40 percent of the sperm should be moving, and at least 32 percent should swim in a forward movement or in large circles.

What Might Be Wrong 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 poor health habits like smoking. Many of the causes of low sperm count can also cause poor motility. (See above.) Often the cause is never found.

Viability or Vitality

What Is It: Sperm viability refers to the percentage of live sperm in the semen sample. This is especially important to measure if sperm motility is low, so differentiate between live non-motile sperm and dead sperm.

What Is Considered Normal: At least 58 percent of the sperm cells should be viable.

What Might Be Wrong if Results Are Abnormal: Necrozoospermia is the term used when all sperm in the semen sample are dead. There are a variety of causes for necrozoospermia, including many of the same things that can cause low sperm count. (See above.)

Using a non-fertility-safe lubricant or regular condom can kill sperm, even if they don't contain spermicide. Be sure to disclose to your doctor if you used lubricant or a regular condom to produce your semen sample. There are fertility-approved lubricants and specialty condoms available for the collection of semen samples. Ask your doctor for more information.

Morphology

What Is It: 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, mid-section and tail are evaluated, as well as the measurements and proportions between each.

Before 2010, the World Health Organization 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 2010 WHO guidelines encourage the use of Kruger's Strict criteria, based on the research of Dr. T.F. Kruger and Dr. R. Menkeveld. Speak to your doctor to find out if they are using the outdated WHO criteria or Kruger's criteria.

What Is Considered Normal: At least 4 percent should have a normal shape.

What Might Be Wrong if Results Are Abnormal: Teratozoospermia is the term used for poor sperm morphology. Poor sperm morphology may be cause by the same things that can cause low sperm counts. (See above.)

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. If sperm morphology alone is abnormal, but all the other semen parameters fall within normal limits, then male fertility may still be considered normal.

Liquefaction

What Is It: 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 Is Considered Normal: Semen should liquefy within 20 to 30 minutes of ejaculation.

What Might Be Wrong 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 may follow up with a post-coital test (PCT). This fertility test evaluates the woman's cervical mucus after sexual intercourse. If sperm are found and moving normally, the delayed liquefaction is not consider a problem.

Semen pH

What Is It: 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 in the semen.

Semen that is too acidic may kill the sperm or prevent fertilization.

What Is Considered Normal: The semen should have a pH greater than 7.2. 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.

What Might Be Wrong if Results Are Abnormal: Usually, low pH is accompanied by other abnormal measurements, including low volume of semen or low sperm counts. This may point to an obstruction or absence of the vas deferens.

White Blood Cells (WBC)

What Is It: White blood cells are the cells that fight infection in the body. All semen includes white blood cells.

What Is Considered Normal: The white blood cell count should be less than 1,000,000 per milliliter of semen, or 1.0 x 10^6 per ml.

What Might Be Wrong if Results Are Abnormal: A higher than normal white blood cell count is known as leukocytospermia, and it may indicate infection. Bacterospermia is when excessive levels of bacteria are found in semen. 

However, some men may have leukocytospermia and not have any active infection or male fertility impairment. Anywhere from 5 to 20 percent of men tested may be found to have leukocytospermia. There is a theory that one possible cause of bacterospermia is untreated dental infections, though this hasn't been proven yet.

If Your Results Are Abnormal

One abnormal semen analysis result is not necessarily a sign of impaired male fertility. Because so many factors can lead to a poor result, including recent illness or even stress over the test, your doctor will likely repeat the semen analysis in a few weeks.

Speak to your doctor about what to expect next. Be sure to disclose any possible causes for poor 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.)

If the poor results repeat, what treatments may be available? This depends on the cause of infertility as well as the female partner's fertility and age.

However, some options for treatment may include:

  • Lifestyle change: If any poor health habits might be leading to lower sperm counts, those should be eliminated as soon as possible.
  • Treating any underlying medical conditions: Untreated celiac disease, diabetes, or a thyroid imbalance can all increase the risk of male infertility. 
  • Hormone treatments: Not very common, but in some cases, hormonal treatment may help improve sperm count. 
  • Surgery: If there is a varicocele (a varicose vein in the scrotum or testicle), removing it may improve sperm counts. Micro-surgical repair may be considered in some cases of male infertility, especially if it's a vasectomy reversal
  • IUI (intrauterine insemination): This is a treatment where the man produces a semen sample, the sample goes through a special washing process, and then the specially washed semen is pushed through a catheter via the cervix into the woman's uterus. 
  • IVF or IVF with ICSI: IVF is when sperm and egg are put together in a lab, hopefully forming an embryo. Then, the embryo is transferred to the woman's 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 men with very low sperm count.
  • Testicular sperm extraction: In cases of extremely low sperm count, zero sperm count, or no ejaculate, testicular sperm extraction is an option. This is when mature or immature sperm cells are extracted via a needle from the testicles. IVF with ICSI is required if this procedure is done.
  • Sperm donor: In some situations, it may be recommended to consider using a sperm donor.
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