Reading a semen analysis report

Why it's done

Male factors are involved in many couples' difficulty conceiving, either alone or alongside other factors. A semen analysis is simple, non-invasive and often one of the first tests. Guidelines suggest testing both partners from the start, so that one person isn't tested for months while the other waits.

This guide explains what a report usually contains. It can't interpret your own result: that needs a doctor who knows your history.

Preparing for the test

• Avoid ejaculation for 2 to 7 days beforehand, or as the laboratory advises.
• Collect the whole sample into the container provided, ideally at the lab. The first part of the sample holds many of the sperm, so tell the lab if any was spilled.
• Don't use lubricants, saliva or ordinary condoms, as they can harm sperm.
• If you are allowed to collect at home, ask how quickly the sample must reach the lab, usually within about an hour, and keep it close to body temperature on the way.
• Mention any recent fever or illness, and any medicines: they can lower results for weeks afterwards.

The main measures and WHO values

Laboratories usually compare results with World Health Organization (WHO) reference values from its 2021 manual. These come from men whose partners conceived within a year: 95 in 100 of them had results at or above these levels. Results below them are a reason to look further, not a diagnosis, and many men with lower results still father children.

Measure	What it means	WHO lower reference limit
Volume	Amount of semen	1.4 mL
Sperm concentration	Sperm per millilitre	16 million per mL
Total sperm number	Sperm in the whole sample	39 million
Total motility	Sperm that are moving	42%
Progressive motility	Sperm moving forward	30%
Vitality	Sperm that are alive	54%
Morphology	Sperm with a typical shape	4%

Some laboratories still use older WHO values or their own ranges. Use the range printed on your report.

Other things you may see

Reports often include a few more items:

• Appearance and liquefaction. Semen is thick at first and becomes more liquid within about an hour. Slow liquefaction is noted because it can affect the other measurements.
• pH. How acidic or alkaline the semen is. Labs give their own range.
• Round cells or white blood cells. A high number may suggest inflammation or infection, and usually needs a further test to tell what the cells are.
• Agglutination. Sperm sticking to each other. It is noted, but on its own it doesn't diagnose a cause.

Words you may see on the report

Term	Plain meaning
Normozoospermia	All main measures at or above the reference values
Oligozoospermia	Lower sperm number
Asthenozoospermia	Lower sperm movement
Teratozoospermia	Fewer sperm with a typical shape
Cryptozoospermia	Very few sperm, found only after spinning the sample
Azoospermia	No sperm found in the sample

These words describe the sample, not the person, and they don't tell you the cause. A result showing no sperm is covered in its own guide on azoospermia.

A note on shape (morphology)

Laboratories use strict rules to decide whether a sperm has a "typical" shape. By these rules, most sperm even in fertile men count as atypical, which is why the reference value is only 4%. A low morphology result on its own rarely decides what happens next.

Good to know. Results can vary a lot between samples. Sperm take around two to three months to develop, so illness, heat or some medicines in that period can affect a result.

If a result is unusual

Doctors usually repeat the test, often after about three months, unless the result is very low. Depending on the findings, the next steps might include a physical examination, hormone tests, or a referral to a urologist or andrologist. Causes and lifestyle factors are covered in separate guides, on what causes male infertility and male fertility and lifestyle.

Some laboratories offer extra tests, such as sperm DNA fragmentation. Their value is still debated, and they are not part of routine first tests. If one is suggested, ask what the result would change.

What you can do

• Stop smoking, and keep alcohol low.
• Avoid anabolic steroids and testosterone supplements, which can stop sperm production.
• Keep the testes cool: avoid long hot baths and laptops on the lap.
• Don't stop a prescribed medicine without talking to your doctor first.

When to see a doctor

• You have a report you are unsure about. Ask a doctor to go through it with you.
• A result was below the reference values, or showed no sperm.
• You notice a lump or swelling in the testes, blood in the semen that keeps coming back, or problems with erection or ejaculation.

Sudden, severe pain in a testicle needs emergency care, as it can be a sign of a twisted testicle: call 112 or go to the nearest hospital.