Semen analysis is an important fertility test for infertile couples, and the test should be done before any treatments (even “just Clomid”) are prescribed. Also referred to as sperm count testing, semen analysis includes more information than just a sperm count. It’s key to know how to read a sperm analysis report so that you understand any sperm-related fertility issues that may be at play, including sperm count and motility. Many people with sperm experience anxiety over the test—and later, over the results. Here’s what to expect during a semen analysis, 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 World Health Organization (WHO), a semen sample should be taken no less than two days after sexual intercourse, and no more than seven days. The testicles are outside the body in the scrotum because sperm are sensitive to temperature. This is why you’ll want to avoid high heat exposure in the two to three months before your test, which includes activities such as sitting in a hot tub, using car seat warmers, and high-heat exposure in the workplace. A high fever can also affect your sperm counts. If you have been exposed to high heat or experienced a high fever, it can take several weeks for your sperm counts to return to normal. Make sure to let your doctor know if these factors are relevant to you so that your test can be timed properly. Some experts recommend that you avoid smoking, drinking alcohol, caffeine, and recreational drugs the week before your semen analysis. There’s a possibility that lifestyle habits can negatively impact your sperm count, but it’s unlikely that giving them up for a week will make a difference in your test results. The process of sperm creation takes place over two to three months. If you want to try to improve your fertility, consider giving up these habits for the longterm. Some prescription drugs can also negatively impact sperm counts. The following medications may affect sperm count:
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 Certain antibiotics Chemotherapy Cimetidine (also known as Tagamet) Colchicine, an anti-inflammatory drug used to treat gout Ketoconazole, an anti-fungal drug (if taken in pill form) Long-term steroid use Spironolactone and nifedipine for high blood pressure Sulfasalazine, a drug used to treat rheumatoid arthritis and ulcerative colitis Testosterone supplements or replacement therapy
If you’re taking any of these medications, your semen analysis results might be affected. Always tell your healthcare provider if you are taking any prescription medications, over-the-counter medications, vitamins, and supplements. Your doctor might 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 (masturbation) into a sterile container. 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 you might want to bring a magazine or your smartphone. Ask your doctor about the specialized lubricants that have been approved for use for fertility testing and treatment. If obtaining a sample via masturbation is difficult, you might be able to collect a sample via intercourse using a specialized condom at home. However, do not use any condom—the chemicals in regular condoms can damage the sperm sample, skewing the results. Ask your doctor about how to obtain a specialized, sperm-safe condom. You might be able to produce the sample at home via self-stimulation. Keep in mind that a semen sample should be evaluated within a particular time frame (generally two hours). If you live far away from the fertility clinic, your doctor might deem it necessary for you to give a sample at the office. It’s common to feel uneasy about any medical testing. You may be nervous about providing the sample and anxious to receive the results of a semen analysis. If you are having trouble ejaculating to produce the sample, you’re not alone. Ask your doctor about the 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 be hesitant about semen analysis testing or even refuse it. 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. If you have concerns or fears about the test, talk to your healthcare provider. It’s important that you undergo the test to determine if there is a sperm-related cause for the infertility challenges you are experiencing. If there is a problem, it might be able to be fixed—but you won’t know for sure without the testing.
World Health Organization Guidelines for Normal Semen Analysis
You may wonder how to read a sperm analysis report. Your doctor will explain your results to you. Different labs and physicians sometimes use different normal value ranges. Keep in mind that what your doctor considers to be normal or abnormal for you might differ from the values listed here. In general, these are the semen health factors that are evaluated in a semen analysis, the normal values according to the WHO guidelines, and what abnormal results could mean. The WHO 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 the group (less than 5% of the men who fathered a child in the past year had semen parameter measurements below these cutoffs).
Semen Ejaculate Volume
What It Is: Semen is made up of more than just sperm. In fact, less than 5% of semen is made up of sperm. Healthy semen includes fluid from:
The bulbourethral glands (which contains mucus to help the semen swim)The prostate gland (which includes zinc-rich fluid to maintain DNA stability of the sperm)The seminal vesicles (which includes important nutrients for the sperm)The testes (where the sperm come from)
What Is Considered Normal: Normal semen ejaculate is between 2 milliliters to 5 milliliters of fluid (about one-half of a teaspoon to a little over a teaspoon). What Might Be Wrong If Results Are Abnormal: Low semen volume can 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 can also be caused by stress over the test. If you are anxious about the test, talk to your doctor about ways to reduce your anxiety.
Total Sperm Number
What It Is: The total number of sperm found in the provided semen sample. What Is Considered Normal: At least 20 million per milliliter (m/mL) sperm per ejaculate may be sufficient to achieve pregnancy, but normal range is considered 40 million to 300 million sperm per mL of fluid according to USC Fertility. Having a lower than normal count of sperm is sometimes called oligospermia. Azoospermia is when no sperm cells are found. What Might Be Wrong If Results Are Abnormal: Having a lower sperm count may indicate a number of problems, including:
Chronic or undiagnosed health problems (such as diabetes or celiac disease) Duct problems Ejaculation problems (such as retrograde ejaculation) Exposure to toxic substances Hormonal imbalances Infection Varicocele
Low sperm counts can also be caused by certain medications, a 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.
Sperm Concentration
What It Is: 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. It could also be related to an abnormally high ejaculate volume.
Motility
What It Is: 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 the forward movement in either a line or in a large circle. What Is Considered Normal: At least 40-50% of the sperm should be moving, and movement quality should be a 2 or higher on a scale of 0 to 4. 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. Often the cause is never found.
Viability or Vitality
What It Is: Sperm viability refers to the percentage of live sperm in the semen sample. This is especially important to measure if sperm motility is low, to differentiate between live non-motile sperm and dead sperm. What Is Considered Normal: At least 50% of the sperm cells should be viable. If more than half of sperms are immotile, further testing may be needed to evaluate viability. What Might Be Wrong If Results Are Abnormal: Necrozoospermia is the term used when all sperm in the semen sample is dead. There are a variety of causes for necrozoospermia, including many of the same things that can cause low sperm count. Using a non-fertility-safe lubricant or regular condom can kill sperm, even if they don’t contain spermicide. Make sure you tell your doctor if you used lubricant or a regular condom to produce your semen sample.
Morphology
What It Is: 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, midsection, 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 WHO’s 2010 guidelines encourage the use of Kruger’s Strict criteria, based on the research of Thinus Kruger and Roelof Menkveld. 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% 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 caused by the same things that can cause low sperm counts. 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.
Liquefaction
What It Is: 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 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 might want to follow up with a post-coital test (PCT). This fertility test evaluates a female partner’s cervical mucus after sexual intercourse. If sperm are found and moving normally, the delayed liquefaction is not considered a problem.
Semen pH
What It Is: 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. What Is Considered Normal: The semen should have a pH somewhere in the range of 7.2 to 7.8. 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 a 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 It Is: 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 (leukocytospermia or pyospermia) may have many causes. Bacterospermia is when excessive levels of bacteria are found in semen. Some men may have leukocytospermia and not have any active infection or male fertility impairment. There is a theory that a possible cause of bacterospermia is untreated dental infections, though this has not been proven.
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. There are some options for treatment. You might consider one or more of the following:
Hormone treatments. It is not very common, but in some cases, hormonal treatment may help improve sperm count. IUI. Intrauterine insemination 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. In IVF treatment, 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. Lifestyle change. If any poor health habits might be leading to lower sperm counts, those should be eliminated as soon as possible. Sperm donor. In some situations, it may be recommended to consider using a sperm donor. 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. Testicular sperm extraction. In cases of extremely low sperm count, zero sperm count, or no ejaculate, a 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. Treating any underlying medical conditions. Untreated celiac disease, diabetes, or a thyroid imbalance can all increase the risk of male infertility.
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