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Trying to get an overall look at your fertility? A semen analysis is the initial male fertility test that gives you insights into your sperm health and ability to conceive.
Since male factor infertility contributes to almost half of all cases of infertility in couples, a semen test provides invaluable information. A semen analysis is performed in a laboratory and provides important sperm measures like:
- Semen volume
- Concentration
- Shape
- Movement
- Viability
Paired with a look at your medical history and a physical exam, a semen analysis can give you a good idea of your male reproductive health.
Key takeaways
- Understanding your sperm health usually begins with a semen analysis and physical exam.
- A semen analysis can tell you: semen volume, sperm count, motility (movement), morphology (sperm shape), vitality (alive or dead), and more.
- Any abnormalities seen on a semen analysis could point to male fertility challenges. Or they could show a need for further testing.
- More advanced tests can be used to evaluate sperm function and underlying barriers like DNA damage, oxidative stress, and immune factors.
- If there are abnormalities with your sperm health, it may still be possible to conceive. But additional measures like lifestyle changes or fertility treatment may be necessary.
What semen analysis terms should you know?
Before we dive deeper into understanding semen tests, see below for all the lingo to know!
Parameter | What it tells you |
Semen volume | How much seminal fluid was produced |
Sperm concentration | The amount of sperm per milliliter (mL) of semen |
Total sperm count | Total number of sperm in the full ejaculate |
Motility | The amount of sperm that are moving |
Progressive motility | The number of sperm that are moving forward |
Morphology | The percentage of sperm with a normal structure and shape |
Vitality | The percentage of sperm that are actually alive |
pH and appearance | Clues about the accessory glands and possible infection/inflammation |
Liquefaction and viscosity | Whether semen becomes fluid normally and allows sperm to move properly |
White blood cells | Can suggest inflammation or infection in some cases |
Total Motile Sperm Count (TMSC) | Measures the number of active, swimming sperm in a single ejaculate |
One of the most important sperm parameters to know is your total motile sperm count. Here’s how you figure out this number:
TMSC = Semen Volume (mL) x Sperm Concentration (million/mL) x Total Motility (%)
How is sperm collected for a semen analysis?
If you’re preparing for a semen analysis, it’s a pretty straightforward process!
(But first, a reminder that sperm and semen are not the same thing. Semen is the collection of fluids that gets released when you ejaculate. It contains sperm as well as other fluids from the male reproductive glands.)
Here’s a glimpse at what you’ll need to do to provide your semen sample:
- You’ll (likely) be directed to abstain from ejaculation for a period of 3 – 7 days before providing your sperm sample. (This helps ensure a higher sperm count for examination.)
- You’ll ejaculate into a collection cup (either at home or near a laboratory). The cup will be a wide-mouthed container that’s not toxic to sperm.
- If you’re at home, you’ll want to keep the container with the sample around room temperature.
- You should provide the laboratory with your sample within an hour of collection. This helps make sure the sperm quality isn’t impacted by factors like temperature changes.
- Follow any other directions from your physician or laboratory. For example, you’ll need to report if any part of the sample didn’t make it into the collection cup.
That’s pretty much it in most cases! But, if you’re having trouble or you’re unable to produce enough of a sample through masturbation, there may be alternatives. For instance, a nontoxic condom can be worn during intercourse as a collection method. (It’s important to stay clear of latex condoms as these can impact sperm motility and viability.)
It’s also important to realize that you may need to provide additional samples down the road. This is because male semen can change quite a bit in its composition from day to day. Often, 2 or 3 semen samples may be required in order to give the most accurate picture of sperm health.
Know more: Does Ejaculating Multiple Times Reduce Sperm Count? – Inito
You may be thinking to yourself: Okay, I provided my semen sample. Now what? In the next section, we’ll go over what happens with your semen sample after collection!
How is a semen sample tested?
When you get a semen analysis, there are a few major steps taken to determine the health of your sperm and ejaculate (seminal fluid). Here’s a quick overview of how your semen sample is inspected:
Step 1: Specimen liquefaction
During this step, your semen sample is put in an incubator (kept at 37°C ) or a laboratory bench. Here, it undergoes liquefaction (the process of becoming more liquid and uniform). The main purpose of this process is to allow sperm to move more freely by decreasing the thickness of the fluid. Liquefaction can start as soon as 5 minutes and can take up to 60 minutes.
Step 2: Volume measurement
After liquefaction, a trained lab professional will check for the following measurements:
- Total semen volume and pH.
- Motility (normal movement)
- Whether or not the sperm stick together. (If this happens, it may mean there are anti-sperm antibodies present–aka antibodies that kill sperm.)
Step 3: Vitality assessment
This step isn’t always necessary if the first two parts of the semen analysis are generally normal. But in cases where there’s low sperm count or poor motility, a vitality assessment is performed. This helps determine:
- Whether the sperm are dead or alive (aka viable)
- An accurate sperm count (by diluting the semen even more)
- The presence of anti-sperm antibodies
- The presence of peroxidase-positive cells (cells that contain infection)
- Sperm morphology (this shows how the shape and structure of sperm hold up after 4 hours)
Additional biochemical tests may be performed depending on the initial findings as well. This may seem like a complicated process. So let’s take a look at the major parameters you should know that indicate your sperm health. Keep reading!
What are normal sperm parameters?
As with other health markers, there are certain standards for what’s considered “normal” when it comes to male sperm. Below are reference limits that show the lowest acceptable limits (the 5th percentile) for “normal” sperm parameters. (These are based on limits set by the World Health Organization).
Parameter | What’s “normal?” |
Semen volume | >1.5 mL |
pH of semen | > 7.2 |
Total sperm number | 39 million sperm per ejaculate or more |
Sperm morphology | > 4% normal forms (using the Tygerberg method) |
Sperm vitality | > 58% of sperm are alive |
Sperm progressive motility | > 32% |
Total (progressive and nonprogressive motility) | > 40% |
Sperm agglutination | None |
Viscoscity | < 2 cm after liquefaction |
The parameters above represent the most foundational semen health findings. Based on what these initial parameters look like, additional tests may be performed.
Here are what some of those additional standards look like:
- Mixed antiglobulin reaction test: < 50% motile spermatozoa with bound particles. (This helps to see if antibodies are attached to the moving sperm)
- Immunobead test: < 50% motile spermatozoa with bound beads (This test also checks to see if antibodies are clinging to sperm)
- Seminal fructose: > 13 mcmol per ejaculate
- Seminal zinc: > 2.4 mcmol per ejaculate
If your initial semen analysis is considered abnormal, you may need to do another one. Typically, this is done after a period of 3 months. Why 3 months? That’s the amount of time it takes to collect a sample from a new sperm production cycle.
Let’s say one or more of your semen parameters is deemed to be abnormal. What does that mean as far as a male infertility diagnosis? We’ll cover this next.
What are abnormal sperm analysis findings?
If there’s something abnormal with your semen results, here are some of the potential terms you may hear:
Finding | Meaning |
Azoospermia | Absence of sperm in semen |
Oligozoospermia | Low sperm concentration |
Asthenozoospermia | Reduced sperm movement |
Teratozoospermia | Lower percentage of sperm with normal shape and structure |
Necrozoospermia | High proportion of sperm that isn’t viable |
Cryptozoospermia | Extremely rare sperm, sometimes found only after centrifuging the sample |
Leukocytospermia | Increased white blood cells in semen |
Take a closer look below at some of these common infertility markers and what they mean:
Semen volume
A semen volume that’s less than < 1.5 mL is considered low or abnormal. If the volume is < 1 mL, then a urine sample will be collected immediately after ejaculation and examined for sperm. This is because the presence of sperm in your urine can confirm retrograde ejaculation. This is when instead of flowing out through the penis, your semen travels backward into the bladder.
What are possible causes of low semen volume?
- Retrograde ejaculation (can be caused by underlying conditions like diabetes, spinal cord injury, nerve conditions, prostate surgery, and more)
- Loss of part of the semen sample during collection. This is considered an incomplete collection and a new collection is necessary.
- Testosterone deficiency
- An obstruction in the tubes that carry semen
- A congenital bilateral absence of the vas deferens (CBAVD) (this is the absence of sperm-carrying tubes)
Know more : How to Increase Semen Volume: A Comprehensive Guide
Low sperm count (oligozoospermia)
If you have a sperm count that’s less than <10 million/mL, it could indicate sexual dysfunction or certain hormonal disorders. In this case, your doctor may order labs for you to get your hormone levels checked. If an initial hormone test shows a low total testosterone (less than 300 ng/mL), additional tests may be necessary. These other tests can look at your levels of:
- Total and free testosterone
- Serum luteinizing hormone (LH)
- Prolactin
As with a semen analysis, any results that are right on the cusp warrant a second round of testing.
Know more: Tips for Getting Pregnant with Low Sperm Count
Low sperm motility (asthenozoospermia)
If you have low sperm motility, it may not affect your chances of conception all that much unless the majority of sperm are immotile. If there are barely any motile sperm, then ART methods like intracytoplasmic sperm injection (ICSI) may be an option.
Know more: Sperm Motility and Fertility: How To Boost Pregnancy Chance
Sperm vitality
Sperm vitality refers to the proportion of sperm that are living (living sperm are viable; dead sperm are not). If you have a higher-than-normal amount of dead sperm and immotile sperm, it could be a sign of epididymal disease. The epididymis is the tube that stores sperm as they mature.
If you have a lot of sperm with poor motility but they’re alive, that could point to structural abnormalities in the flagellum (the sperm tail).
Sperm morphology
If you have abnormal sperm morphology (shape), it could mean there’s an underlying issue with your sperm production (aka spermatogenesis). This is another case where ICSI may be needed in order for pregnancy to be possible.
Cells in the ejaculate
When there are round cells present in a semen sample, further testing is needed to see if they are leukocytes (aka white blood cells). Having greater than a million leukocytes per mL semen is called pyospermia. And it can be a sign of infection or inflammation within the reproductive tract. More testing is often necessary if this is the case.
Know more: Semen Health: How To Produce More Sperm?
Having one of these atypical results come up on your semen test may make you feel defeated at first. But the silver lining is that an abnormal sperm test isn’t necessarily the end of a fertility journey. In many cases, there are ways you can improve your sperm health. And depending on your diagnosis, there may be fertility treatments that can help as well. More on this next!
How to manage male infertility?
If your sperm health isn’t optimal, here are some potential actions you can take to boost your overall fertility:
- Adopting healthy lifestyle habits like staying physically active and eating a healthy diet.
- Limit alcohol and avoid smoking.
- Discuss with your doctor healthy ways to reach your target BMI (if you’re overweight).
- Stay away from lubricants that harm sperm, excessive heat, and other sperm killers. (Know more : 9 Sperm Killers to Avoid When You’re Trying to Conceive)
- Opt for genetic counseling (if genetic irregularities are suspected).
- Ask a fertility specialist for information on assisted reproductive techniques (ART) such in vitro fertilization (IVF) or ICSI.
Keep in mind that management for infertility will look different depending on your sperm health and your diagnosis. By looking at your semen analysis, physical exam results, and overall health history, a healthcare provider can give you more guidance on next steps.
For example, this could mean surgery if you suffer from ejaculatory duct obstruction. Or if you have hypogonadotropic hypogonadism, gonadotropin therapy is an option. The management method is all dependent on the underlying fertility issue.
Know more : How Much Sperm Does it Take to Get Pregnant?
Whether you think you may have a fertility challenge or you’re just proactively looking at your health, here’s the bottom line: Getting a semen analysis and physical exam is the starting point for better understanding your health. And you’re not alone in this journey!
FAQs
The number of tests depends on the irregularity and length of your cycles. For someone with an average cycle length of 30 days, 12-15 tests may be required to track and confirm ovulation.
The number of tests depends on the irregularity and length of your cycles. For someone with an average cycle length of 30 days, 12-15 tests may be required to track and confirm ovulation.
The number of tests depends on the irregularity and length of your cycles. For someone with an average cycle length of 30 days, 12-15 tests may be required to track and confirm ovulation.
The number of tests depends on the irregularity and length of your cycles. For someone with an average cycle length of 30 days, 12-15 tests may be required to track and confirm ovulation.
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- Semen Analysis – StatPearls – NCBI Bookshelf
- WHO laboratory manual for the – examination and processing of human semen
- Sperm function tests in clinical practice – PMC
- Semen analysis and sperm function tests How much to test?
- Clinical assessment of the male fertility
- Sperm DNA Fragmentation: A New Guideline for Clinicians – PMC
- Sperm DNA fragmentation in male infertility: From bench to bedside – PMC
