How to read a semen analysis result

A semen analysis result is made of several columns of numbers, and next to some of them is an asterisk or the word “low.” Getting a result like this is hard for many men, because it suddenly turns a personal matter into numbers. This article aims to help you read it more calmly: what each number measures, why one result is not enough, and what is done afterwards.

What is this test for?

MedlinePlus describes a semen analysis as a test that measures the quantity and quality of semen and sperm, most often requested after a year of trying for a pregnancy without success. According to the EAU and WHO, infertility means no pregnancy after 12 months of regular unprotected intercourse. WHO calls infertility a disease of the male or female reproductive system and says one in six people of reproductive age experience it. The EAU writes that in about half of infertile couples a male factor is found too. So this test is one half of the puzzle and should be read alongside the assessment of the partner, as the EAU recommends.

What does each number say?

MedlinePlus and the EAU list these:

• Volume: the total amount of semen. The WHO (2021) lower limit quoted by the EAU is 1.4 mL.
• Total count: the number of sperm in the whole ejaculate, with a lower limit of 39 million.
• Concentration: the number of sperm per millilitre, with a lower limit of 16 million.
• Motility: the share of sperm that move well. Total motility 42 percent and progressive motility 30 percent.
• Shape: the share of sperm with a normal shape, with a lower limit of 4 percent.
• Vitality: 54 percent.
• pH and white blood cells: MedlinePlus says a pH of 7.2 to 8 and fewer than one million white cells per millilitre are normal; more white cells may be a sign of infection.

MedlinePlus numbers differ slightly from WHO (2021) (for example a concentration above 15 million or a volume of 1.5 to 7.6). The reason is that references and editions differ. The EAU says the analysis should follow the sixth edition of the WHO manual. So always interpret your result against the reference on the same report.

Does “lower limit” mean the line for infertility?

No. The EAU stresses that these limits (the fifth percentile of the reference population) are not the boundary between fertile and infertile men. A man with a slightly lower number may still father a child. On the other hand, the EAU says that in 20 to 30 percent of couples, infertility occurs even with a normal analysis and a normal assessment of the partner. MedlinePlus also writes that an abnormal result does not mean permanent infertility and only shows that sperm may be playing a part in making pregnancy harder.

Why is one analysis not enough?

MedlinePlus says sperm counts vary from day to day, which is why several samples are sometimes taken over one to two weeks. The EAU states the rule more clearly: if one analysis is normal, that single test is enough. If the first result is abnormal, at least two analyses in a row are needed, and if it is abnormal twice, a more specialised male (andrological) assessment begins.

Things that change the result: the time since last ejaculation (MedlinePlus says 2 to 7 days of abstinence), the way the sample is collected, and how long it takes to reach the lab. According to MedlinePlus, a home collection kit must get the sample to the lab within one hour at room temperature. The details are in the test preparation guide.

What happens if the result is abnormal?

The EAU says that if the sperm count is low or no sperm are seen, testosterone and the hormones FSH and LH are measured, and if the count is very low, genetic testing and genetic counselling are suggested. If a blockage is suspected, a transrectal ultrasound helps. MedlinePlus lists smoking, varicocele (widened veins of the testicle), a genetic or hormonal disorder, diabetes and cystic fibrosis among the possible causes. WHO also mentions blockage, hormonal disorders, chemotherapy, anabolic steroids and lifestyle factors.

A varicocele is seen in about 15 percent of normal men and 35 to 40 percent of infertile men (EAU), and treatment is not always needed; the details are on the male infertility page. The NHS says obesity, smoking and heavy alcohol use affect fertility and semen quality. The EAU also says the effect of antioxidant supplements has not yet been confirmed by randomised trials, so do not start a supplement without your doctor.

Treatment and the way forward

Treatment depends on the cause. The EAU says the partner’s fertility must be assessed at the same time. The NHS describes assisted reproduction methods such as intrauterine insemination and IVF. The decision about each method and its availability in Iran is for your doctor. MedlinePlus says referral to a fertility specialist may be needed too.

One sentence for yourself

WHO writes that in many places the woman is considered infertile regardless of her actual condition, and infertility brings pressure and shame to both people. If your result was not what you hoped for, you are not alone. Embarrassment does not change the result and only delays treatment. Share the result with your partner and your doctor, and do not forget the repeat before deciding.

A reminder

This article is for general information. One test result is not a diagnosis; your doctor interprets it with your history, examination and other tests.