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A semen analysis, which usually includes a sperm-count test, looks at the health and viability of a man’s sperm.
If a couple is struggling to get pregnant, a semen analysis may reveal whether part or all of the difficulty stems from a man’s sperm or semen. A semen analysis can also help a man’s healthcare provider figure out how best to treat or get around the problem (research shows that male infertility is the cause of about 20–30% of infertility cases and is a factor in about half of all cases) (Agarwal, 2015).
Here’s everything you need to know about this common fertility test—including how it’s done and how to interpret its results.
What is a semen analysis?
Semen is a mixture of spermatozoa (sperm) and fluids that help transport the sperm out of your reproductive tract via ejaculation through your penis. A semen analysis is a laboratory test that examines your semen to determine your fertility (Sunder, 2021).
A semen analysis looks at many different aspects of your semen, including:
- Total number of sperm (sperm count)
- Sperm concentration (the number of sperm per milliliter of semen)
- Sperm viability (how healthy are they)
- Sperm motility (how well do they move)
- Volume of ejaculated fluid
- Composition of ejaculated fluid
Each of these characteristics plays a part in the overall health of your semen and, therefore, your fertility (Sunder, 2021).
Reasons for semen analysis
Two common situations call for a semen analysis: testing for male infertility and testing after a vasectomy.
Male fertility testing
Experts usually define infertility as an inability to conceive after 12 months of regular, unprotected sex (Leslie, 2020).
Male factor infertility—meaning fertility problems related to a man’s semen health or sexual functioning—causes or contributes to a couple’s infertility in up to half of all cases. For this reason, whenever a couple is experiencing fertility challenges, it’s common for their care team to perform a semen analysis (Vander Borght, 2018).
A semen analysis can also help determine how to overcome any fertility challenges. For example, men with abnormal sperm morphology (shape of the sperm) may be good candidates for a type of assisted reproduction technology (ART) where a fertility specialist inserts the man’s sperm directly into their partner’s egg (Sunder, 2021).
Men who have had a vasectomy often undergo a semen analysis to ensure that the procedure was successful. A vasectomy is a procedure that cuts and seals the tubes that send sperm to the penis and is common among men who no longer want to have children.
While vasectomies are usually effective, there is a small risk that a man may still be able to conceive afterward. That’s especially true in the days and weeks immediately following the procedure.
For this reason, healthcare providers recommend that men undergo a semen analysis following a vasectomy to ensure that they are no longer fertile (Diederichs, 2019).
Signs of infertility in men and women
How does a semen analysis work?
For a semen analysis, you’ll need to provide a sample of your semen.
Masturbation is the preferred way to collect a semen sample. You will masturbate and ejaculate into a special container, which you’ll get from your healthcare provider or testing company. They may ask you to do this at a lab or clinic, but you may be able to do it at home (Sunder, 2021).
Once you provide a sperm sample—or in some cases, multiple samples—your clinic or testing service examines your ejaculate to assess things like your semen volume, sperm concentration, and other factors that may affect your fertility (Sunder, 2021).
Are home test sperm tests accurate?
An at-home sperm test can be accurate and provide reliable information on male fertility depending on the type of service you’re using and what measures are being looked at.
Some at-home tests only report whether sperm are present or absent and do not provide the comprehensive analysis that conventional testing at a fertility clinic offers.
For example, some at-home tests provide you with rough figures like whether your sperm concentration falls above or below the standard “normal” threshold—but they do not give you your exact concentration (Yu, 2018).
The problem here is that this is not enough info to determine if you’re fertile or not. Sperm count is only one factor in male fertility. For example, even if you have 100 million sperm, you still won’t conceive naturally if none of them are moving.
Some companies offer more complete semen analysis results, often in the form of at-home sperm collection kits. With these kinds of “at-home” tests, “at-home” just means that you collect your semen sample in the comfort of your own home, but a lab still evaluates your semen.
The company will send you everything you need to collect your sample and will arrange at-home pickup or provide you with a shipping label for delivery to a lab. Once the lab receives your sperm sample, they will evaluate it for sperm count and other measures, such as concentration and motility.
When using an at-home sperm collection kit, it’s important to remember that a semen analysis alone cannot predict fertility. Proper male fertility testing should always include an evaluation by a healthcare professional who can explain your semen analysis and discuss next steps.
What is semen retention and are there benefits?
Preparing for a semen analysis
There’s not much you have to do to prepare before collecting your semen sample. However, for the most accurate results, a healthcare provider or at-home-testing service will likely instruct you to avoid ejaculation for at least three full days before you collect your semen sample (Sunder, 2021).
It’s also very important that you follow your healthcare provider’s instructions—like remembering to wash your hands and penis—the day of your collection to avoid contaminating your sample (WHO, 2010).
What are normal semen analysis results?
After the lab receives your sample, you can expect results in as little as one day to up to one week. Whether your results are “normal” will depend on why you had a semen analysis done.
For example, after a vasectomy, you want your results to show that your semen lacks sperm. For fertility testing, the analysis is a bit more complex. The World Health Organization has established the following as the “lower reference limits,” or minimums, when it comes to “normal” semen health (Cooper, 2010):
- Total volume of semen: 1.5 milliliters or more
- Sperm concentration: ≥15 million sperm per milliliter of semen
- Total sperm count: 39 million or more
- Sperm motility (percentage of sperm in the sample that are able to move ): 40% or more
- Sperm morphology (percentage of sperm in the sample with a normal shape): 4% or higher
If your numbers come in at or above these minimums, they are considered normal results. However, research on male sperm health shows that you may still be able to conceive even if your semen doesn’t meet all of these minimums (Cooper, 2010).
What do abnormal results mean?
While abnormal test results can raise your risk for fertility challenges, experts are still trying to figure out how each of these semen parameters affects a man’s ability to reproduce (Patel, 2017).
In some cases, abnormal results can help experts uncover specific problems that may be causing your infertility.
For example, a testosterone deficiency can, in some cases, cause low semen volume or low sperm count. And men with a high number of sperm with low sperm movement or motility may have problems related to their epididymis, a tube behind the testicles that stores and transports sperm.
This is why it’s important that you have a healthcare professional interpret the results of your analysis so that you can plan your next steps.
Ashwagandha and testosterone: the science behind the link
What happens after a semen analysis?
Your healthcare provider will consider your semen analysis results along with other information, like your medical and sexual history (ASRM, 2015).
Using all of this information, your provider can help you determine how best to move forward. In some cases, they may recommend lifestyle changes—such as exercising more or quitting smoking—to improve your sperm health.
In other cases, hormone therapy or assisted reproduction technologies like in vitro fertilization (IVF) may provide the best route to improved fertility (Leslie, 2022).
To sum up, a semen analysis is just one important part of assessing a man’s reproductive health. Its results matter, but they don’t tell the whole story.
- Agarwal, A., Majzoub, A., Parekh, N., & Henkel, R. (2020). A Schematic Overview of the Current Status of Male Infertility Practice. The World Journal of Men’s Health, 38(3), 308–322. doi: 10.5534/wjmh.190068. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308239/
- Cooper, T. G., Noonan, E., von Eckardstein, S., Auger, J., Baker, H. W., Behre, H. M., et al. (2010). World Health Organization reference values for human semen characteristics. Human Reproduction Update, 16(3), 231–245. doi: 10.1093/humupd/dmp048. Retrieved from https://www.who.int/reproductivehealth/topics/infertility/cooper_et_al_hru.pdf
- Diederichs, J., McMahon, P., Tomas, J., & Muller, A. J. (2019). Reasons for not completing postvasectomy semen analysis. Canadian Family Physician Medecin de Famille Canadien, 65(9), e391–e396. Retrieved from https://www.cfp.ca/content/cfp/65/9/e391.full.pdf
- Leslie, S. W., Siref, L. E., Soon-Sutton, T. L., & Khan, M. (2022). Male Infertility. [Updated Feb. 14, 2022]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK562258/
- Patel, A. S., Leong, J. Y., & Ramasamy, R. (2017). Prediction of male infertility by the World Health Organization laboratory manual for assessment of semen analysis: A systematic review. Arab Journal of Urology, 16(1), 96–102. doi: 10.1016/j.aju.2017.10.005. Retrieved from https://www.tandfonline.com/doi/pdf/10.1016/j.aju.2017.10.005
- Practice Committee of the American Society for Reproductive Medicine (ASRM). (2015). Diagnostic evaluation of the infertile male: a committee opinion. Fertility and Sterility, 103(3), e18–e25. doi: 10.1016/j.fertnstert.2014.12.103. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25597249/
- Sunder, M. & Leslie, S. W. (2021). Semen Analysis. [Updated Oct. 30, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK564369/
- Vander Borght, M. & Wyns, C. (2018). Fertility and infertility: Definition and epidemiology. Clinical Biochemistry, 62, 2–10. doi: 10.1016/j.clinbiochem.2018.03.012. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29555319/
- World Health Organization (WHO). (2021). WHO laboratory manual for the examination and processing of human semen. Retrieved March 10, 2022 from https://www.who.int/publications/i/item/9789240030787
- Yu, S., Rubin, M., Geevarughese, S., Pino, J. S., Rodriguez, H. F., & Asghar, W. (2018). Emerging technologies for home-based semen analysis. Andrology, 6(1), 10–19. doi: 10.1111/andr.12441. Retrieved from https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/andr.12441
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.