The Life Plus Hospital

What is checked in a semen analysis?

A semen analysis will check for a number of things, including:

• Semen volume (the amount that you ejaculate)
• Sperm concentration (also known as sperm count, meaning the number of sperm per milliliter of semen)
• Total sperm number
• Sperm motility (the number of moving sperm compared to non-moving sperm)
• Sperm vitality (the number of ‘alive’ sperm)
• The number of ideally shaped sperm (normal sperm) compared to oddly shaped sperm (abnormal sperm)
• White blood cells (which can be a sign of infection)
• Semen pH (to see if you’re semen is acidic or alkaline; it should be slightly alkaline)
• Sperm antibodies (a protein that fights sperm).

How is semen collected for testing?

Semen testing should be done with a fresh semen sample ejaculated within one hour of examination. A semen sample is best collected in a specimen jar and produced by masturbation. You usually do this in a private room at the testing laboratory. When you collect semen at home, you have to keep the sample warm and take it to the laboratory very quickly – within one hour if possible. If this method of collecting semen is too difficult, you can talk to your doctor about alternatives.

You need to make sure that you don’t lose any of the semen sample. As sperm are mostly in the first part of the ejaculate, losing the first part can falsely lower the sperm concentration. It’s important that you don’t ejaculate for at least two days before the sample is collected, but it’s equally important that it’s not been longer than seven days since you last ejaculated.

World Health Organization Guidelines for Normal Semen Analysis

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 might differ from the values listed here.

WHO lower reference values for semen characteristics

These semen parameters are only guidelines to consider when investigating what could be causing your infertility. Having better or worse numbers than what is listed here does not necessarily mean that you will or won’t be able to father a child.

What do the results of a semen analysis mean?

A semen analysis doesn’t guarantee that you’re fertile, because there can be other reasons for infertility.

If you have a very low sperm concentration, you might still be able to get pregnant naturally.

Many factors can affect a couple’s chance of getting pregnant, including the couple’s frequency and timing of sex, the length of time the couple has tried to get pregnant, and the age and fertility of the female partner. Your semen analysis needs to be looked at together with other clinical information by your doctor.

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 1.5 milliliters to 6 milliliters of fluid (about one-third 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.

An abnormally high volume could be caused by inflammation of the reproductive glands.

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% of the sperm should be moving, and at least 32% 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. 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 58% 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 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.

Ask your doctor about fertility-approved lubricants and specialty condoms that are available for the collection of semen samples.

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 has 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.⁴ 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.

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

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 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 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.

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 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) may indicate an infection. Bacterospermia is when excessive levels of bacteria are found in semen.

Anywhere from 5% to 20% of men tested may be found to have leukocytospermia.

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.¹ 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.