How do I interpret basic semen analysis results?

Male infertility is responsible for approximately 20% of the infertile couples seeking fertility treatment. It also contributes to the other causes of infertility in another 30% of couples.

The initial test requested is a basic semen analysis. Before producing a sperm sample, the man should abstain for two to five days before the test. You can produce the sample at a London IVF clinic or Andrology laboratory.

If producing a sample at home, you should use a specimen bottle provided. Any other container may have some materials or chemicals that are toxic to sperm. This will negatively affect your test result. While producing a sperm sample at home, the sample should be presented to the lab within an hour.

Almost 10-20% of the semen analysis results are outside the normal range. It is not uncommon to have results outside the normal range. Therefore, your fertility specialist may ask you to repeat the test in 8-12 weeks. The report will comment on the following common sperm parameters:

  • Semen volume

    A typical ejaculate sample is 1.5-4ml. A low volume of less than 1.5ml suggests an incomplete collection. Low semen volume is also called hypospermia or oligospermia. Other reasons may be:

    -an obstruction retrograde

    -retrograde ejaculation

    -problems with accessory glands that line the ducts.

  • Sperm count or sperm concentration

    A normal specimen should contain 20 million sperm/ml, or more. Most low sperm counts (oligozoospermia) go unexplained. Sometimes this could mean a fertility problem that needs further testing.

    Very low sperm counts (severe oligozoospermia) of less than 5 million per ml could be from certain medical and genetic causes and should be tested by a fertility specialist. When abstaining for less than two days when producing the test sample, fewer sperms may be noted, but with better motility.

  • Sperm motility (sperm movement)

    This is expressed as a percentage of live sperm. Different IVF or Andrology laboratories may express motility in different formats. We generally expect about 50% of the sperm to be swimming and at least 32% should have forward movement pattern.

    Good sperm motility is essential for the sperms to make their way in the female tract or cervix to reach the egg. If you do not ejaculate for long periods of time, sperm may begin to die and the motility declines. There are also other causes of low motility.

  • Sperm morphology (sperm shape)

    This refers to the shape of the sperm. By the WHO guidelines, normal sperm morphology of less than 4 percent is abnormal. If that is the case, your specialist may suggest fertility treatments such as Intracytoplasmic sperm insemination or ICSI.

  • White blood cells or leukocytes

    The presence of white cells in significant numbers would need confirmation of infection. White cells more than one million cells per ml generally suggest an acute or a silent infection.

    It is important, that the white cells are differentiated from the immature sperms. Treatment with suitable antibiotics will clear the infection and may restore male fertility.

  • Sperm Agglutination (‘Sticky Sperm’) mixed agglutination reaction or MAR test

    This is a test to check for sperm agglutination or ‘stickiness’. The MAR value of over 50% is abnormal.

To understand the pitfalls of basic semen analysis, check out our upcoming blog post: ‘Limitations of Basic Semen Analysis’.