Sperm issues are a major cause of male infertility. Semen analysis is a great tool for understanding the male side of the fertility equation, whether you’re trying for kids now or are planning to try in the future.
Male-factor infertility is responsible for infertility in 40-50% of cases, so there’s good reason for people with sperm to get tested. If sperm issues are identified through testing, it’s possible to get ahead of them.
In this post, we’ll walk through the most important things to know about semen analysis, the factors that are included in a semen analysis, and what to do with your results.
Here are the key takeaways:
- Semen analysis alone can’t confirm fertility or infertility.
- The fertility factors included in your semen analysis can vary. Some of the most important factors are volume, concentration, motility, sperm count, total motile sperm, and morphology.
- If your results are all normal, that’s a good sign that (as far as the parameters included in your semen analysis go) there aren’t red flags that could interfere with conception.
- If your results are low, share them with your doctor. Typically, your doctor will recommend a second semen analysis to confirm the first (because there can be some variation between samples). If your retest confirms the abnormal result, your doctor will walk you through your options, including further testing, treatment, fertility preservation, or assisted reproductive technologies, like in vitro fertilization (IVF).
- Semen analysis can be done in a lab, or using an at-home collection kit.
At a glance: what counts as “normal” semen analysis results?
We’ll dig into each of these factors in the sections below, but if you’re looking for a quick reference for understanding your results, here it is:
What is a semen analysis?
Semen analysis gives you a snapshot of sperm quality and quantity. There are a number of different factors that can be measured to understand how well sperm is able to do its job — which is to navigate through the uterus and fallopian tubes and fertilize an egg.
The “factors” (i.e., what’s tested) included in a semen analysis vary. The most basic tests only include sperm count, but there are many other factors that tie into the overall health of sperm.
Depending on the factors included in a test, semen analysis can help you answer the following Q’s:
- How much sperm is being produced?
- Of the sperm being produced, how many of them are likely able to navigate to the egg?
- Is more testing needed to investigate male-factor fertility issues?
- Are there any lifestyle adjustments that could improve sperm?
Here’s how getting a semen analysis works:
- The person being tested provides a sample via masturbation (either in a clinic or using an at-home test kit)
- The sample is sent to a lab for analysis
- A report is returned that breaks down the different factors — more on each of these below!
What to do with your results
Overall, a normal semen analysis is a sign that (as far as the parameters included in the semen analysis go) there aren’t any red flags that are expected to interfere with conception. A normal semen analysis isn’t a guarantee that there won’t be any issues with conception (because fertility is complex, and there are both male and female factors at play). Similarly, an abnormal semen analysis isn’t a guarantee that there will be issues.
If your results are all normal and you’re currently trying to conceive:
- The recommendation is to wait to retest until you meet the clinical definition of infertility (not achieving a pregnancy after 12 months of unprotected sex if your female partner is <35 and 6 months if your partner is 35 or older).
If your results are all normal and you’re not currently trying to conceive:
- If you just received your results and are not currently trying to conceive, the recommendation is to perform another semen analysis test prior to trying to conceive, especially if it’s been more than 12 months since your last result.
If one or more results is abnormal:
- The current standard of care for out-of-range results is to do a second semen analysis since there is natural variation from sample to sample. If your first test was an at-home test, the repeat analysis should be performed in a lab and analyzed within 60 minutes. In addition, your lifestyle leading up to collection can impact results (for example, using a hot tub frequently before testing).
- If you’re implementing lifestyle changes with the desire to see the effect on semen parameters, wait three months between the initiation of lifestyle changes and the subsequent semen analysis (that’s because it takes about three months to replace your sperm).
What fertility factors are included in a semen analysis?
The factors included in a semen analysis can vary. Below, we’ll break down what you should know about some of the most common factors, what they mean for fertility, and what (if anything) can be done to improve them.
Before digging into each factor, keep in mind that individual factors won’t give you the full picture — it’s important to look at results holistically. For example: If you have an extremely high sperm count, that doesn’t mean much if very few of those sperm are moving. Similarly, a lower sperm count may be less concerning if you have good motility.
Here are two examples:
Person One: Sperm count of 45M * 90% motility = 40.5M total motile sperm
Sperm count may initially look low, but with a high percentage of motile cells, there are plenty of moving sperm in the sample.
Person Two: Sperm count 110M * 10% motility = 11M total motile sperm
At first glance, sperm count seems very high. But since there is a lower percentile of motile cells, this person has few sperm that are moving.
It’s important to understand how the idea of “normal” vs. “low” parameters came about. The World Health Organization (WHO) puts out a manual on how to measure and interpret the results of a semen analysis test. In 2021 they put out their newest edition, the 6th edition, with updated values for what is considered “normal.”
So how does WHO define normal? Well, they looked at semen analysis results from people with sperm who had successfully gotten their partner pregnant within 12 months of trying. Then, they found the 5th percentile for each parameter. Anything below that number, they considered “low.” But remember, this was a study of people who successfully conceived, so having a low parameter doesn’t mean it’s impossible to get a partner pregnant. Rather, it means that, on average, there may be a higher likelihood of fertility issues.
What is semen volume?
Semen is made up of both sperm cells and seminal fluid. Semen volume is pretty straightforward — it refers to the total volume of an ejaculate. It’s reported in milliliters and the normal reference range goes from 1.4–6.2 mL. A result below 1.4 mL is typically considered a low volume.
How is semen volume related to fertility?
Semen volume is less impactful when it comes to fertility compared to the other semen parameters. In fact, semen volume naturally declines as men age.
Even if volume has a limited effect on fertility, a low semen volume may suggest underlying issues (more on this below). High semen volumes also don’t typically affect fertility unless concentration is quite low.
Can you improve semen volume?
There are a few reasons for low semen volume.
- The most common reasons are “artifactual” (aka, related to the sample collection). These include not getting the entire sample in the collection cup during the collection, or not abstaining from ejaculating for enough time before the collection. These can be addressed by correcting sample collection technique or by meeting the abstinence period before the next collection.
- Low semen volume can also be caused by a few conditions, such as retrograde ejaculation. With this condition, semen enters the bladder instead of being ejaculated. If semen volume is low, a second analysis should be performed. If both results are low (and there were no issues with sample collection), follow up with a doctor to rule out conditions that may cause low volume.
- Other common causes include diabetes, some medications (like alpha-blockers), past surgery, or trauma.
- Lastly, psychological issues can also play a role, such as performance anxiety.
What is concentration?
Concentration refers to the number of sperm cells per mL of semen and is sometimes referred to as sperm count. Because there are so many sperm in a single milliliter of semen, it’s reported in units of millions per mL (M/mL) and the normal reference range is from 16–208 M/mL.
Fun fact: Men make an average of 1,500 sperm per second. That’s roughly 129,600,000 sperm made over the course of a day.
How is concentration related to fertility?
In general, there is a wide range of concentrations among healthy, fertile men. However, when sperm concentration drops below approximately 16 M/mL, that’s when it can be a sign of subfertility. It’s been shown that the impact of concentration on fertility is a continuum. This means that the chance of conceiving increases as concentration increases up to about 40–55 M/mL. After that, there’s no additional benefit to higher concentration.
Keep in mind that a single low sperm concentration does not mean it’s impossible to conceive with your partner. However, it’s important to discuss the result with your doctor. If concentration is low, a repeat semen analysis is typically recommended (in the case of extremely low concentrations, a doctor may not order another semen analysis test but may proceed to ordering additional tests and performing a physical examination to determine the cause). If concentration is consistently low, it may take longer for couples to conceive naturally since there are fewer sperm to fertilize the egg.
Can you improve concentration?
There are a number of different reasons that concentration may be low. They include genetics, general health, sexually transmitted infections, environment, and past surgeries that might have affected the testes.
Some of the main things that impact concentration:
- Anabolic steroids and testosterone supplementation can have a major impact on sperm production and can cause low concentration.
- Smoking cigarettes (and even e-cigarettes) can affect sperm concentration. It’s a good idea to stop smoking around three months before trying to conceive (because it takes about 90 days to make new sperm). There’s limited evidence that marijuana can impact concentration. That being said, the general clinical recommendation is to stop marijuanna usage.
- Weight is associated with sperm concentration — higher BMIs can lead to lower sperm concentration. In those cases, it’s a good idea to talk to your healthcare provider to see if they recommend losing weight.
- Heavy alcohol use has been shown to impact concentration.
- If low count is due to varicocele (an enlargement of the veins in the scrotum), then surgery may help improve concentration.
- For people who experience chronic heat exposure (such as firefighters), reducing exposure to heat may help.
What is motility?
Sperm motility refers to the ability of sperm to move. Sperm have to be able to move through the uterus and fallopian tubes in order for natural conception to occur. Motility is typically reported as a percentage and refers to the percent of sperm that are moving. Motility is often broken down into two types: progressive motility (where the sperm is moving forward) and non-progressive (where the sperm is continuing to move but is not moving forward). Add these two together and you get total motility.
For each type of motility, there are ranges that are considered normal.
- Progressive motility: normal reference range is from 30–77% with <30 considered low
- Non-progressive motility: normal reference range is from 1–32% with <1 considered low
- Total motility: normal reference range is from 42–90% with <42 considered low
Given that motility can be reported in many different ways, it’s important to understand which result you are getting.
Fun fact: Recent research has found that sperm swim like a playful otter or corkscrew, upending 350 years of assumptions.
How is motility related to fertility?
It is very common for some sperm to not be motile, but when the proportion of total moving sperm drops below 42% (or progressive drops below 30%) it may take longer to conceive. In the case that a result comes back below either of these thresholds, a second analysis is typically needed. If the second semen analysis confirms the first, talk with your doctor about potential treatment or next steps. Even if the first result is low and the second result is normal, it still may be worth a conversation with your doctor, especially if both samples were collected at a clinic (vs. at home).
Low motility can affect the amount of time it takes to conceive, but people with low motility can still achieve a pregnancy without assistance. Even in cases where motility is truly 0%, pregnancy may still be possible through in vitro fertilization (IVF).
It’s important to know that the percentage of motile sperm in a sample declines after a sample is collected. If you collect your sample using an at-home kit that is mailed in, the percentage of motile sperm will be lower than if you collected your sample in a clinic (where it would be tested sooner after collection).
Some at-home testing providers “correct” for the number of motile sperm that would have been in your sample at the time of collection, while others report the percentage that are in your sample at the time of testing. It’s important to know which result is being reported so that you can understand the results.
Can you improve motility?
The research on methods for improving sperm motility is somewhat limited. The exception to this is smoking, which has been shown to have adverse impacts on multiple semen parameters, including motility.
While the research on other factors isn’t as robust as smoking, there is some evidence that avoiding environmental toxins, and avoiding external heat sources (like hot tubs) while you’re trying to conceive (and for a few months before you start) can help motility. Eating a healthy diet and engaging in regular exercise may also help.
Varicocele (enlargement of the veins in the scrotum) has been associated with lower sperm motility (along with other parameters). Surgery may be able to help address this problem.
What is sperm count?
Sperm count refers to the total number of sperm in the ejaculate. Sperm count is determined by multiplying the concentration of a semen sample by its volume. Values for sperm count can range from 39M–701M. The threshold for low sperm count is 39M.
How is sperm count related to fertility?
The more sperm in the sample, the higher the chances that one of them makes it to the egg. Recent studies suggest that Total Motile Sperm Count might be a better measure of fertility than just motility or count alone (see next section).
Can you improve sperm count?
The same steps that can increase concentration also apply to improving sperm count. These include:
- Losing weight if BMI is above 25 or gaining weight if BMI is below 18.5
- Decreasing alcohol, drug, and tobacco use
- Decreasing stress
- Decreasing exposure to endocrine disrupting chemicals
- Not taking anabolic steroids or supplementing with testosterone
This last one might be surprising, but external testosterone can cause the body to stop producing natural testosterone which inhibits sperm production.
Total Motile Sperm Count
What is total motile sperm count?
Total motile sperm count (TMSC) refers to the total number of moving sperm in the ejaculate. Total motile sperm count is determined by multiplying the concentration of a semen sample by its volume and then factoring in the percent that are moving. Since it’s a composite of three different semen factors, it is thought to give a better overall picture of sperm quality.
It’s been the subject of lots of research but has yet to make it into the list of commonly reported factors. Because of that, there isn’t a well accepted range of what is considered normal or low. The best estimate for determining low total motile sperm count, using the low threshold for the other parameters, is around 15M–16M.
How is total motile sperm related to fertility?
Total motile sperm count is often only an issue when the number is very low. It is often very low when average motility and/or sperm count is also very low.
If total motile sperm count is low (<15M–16M), you should discuss your results with a doctor. A repeat analysis will typically be recommended. If both results are low, your doctor can discuss the best approach. In these cases, conceiving without intervention is still possible but chances decrease as TMSC decreases. At total motile sperm counts of <5M, it may still be possible to conceive without intervention, but your doctor may recommend treatments like intrauterine insemination (IUI) or IVF. If total motile sperm count is below 1M, it may be even more strongly recommended. There’s no hard and fast rule here so advice may vary.
Can you improve total motile sperm?
The same steps that can increase average motility and count also apply to improving total motile sperm, since total motile sperm is a composite of them.
What is morphology?
Morphology refers to the overall shape and structure of individual sperm cells.
How is morphology related to fertility?
Morphology is a bit controversial when it comes to its relationship with fertility. So far, studies have not demonstrated a clear link between abnormal morphology and the ability to conceive. The typical range of normal morphology is 4%–39%. However, having below 4% normal sperm is considered low. That’s right, having as low as 5% or more total sperm that look normal is the norm.
Can you improve morphology?
The current research shows that lifestyle changes may not improve sperm morphology specifically. There may be some benefit to reducing drinking, especially if morphology is low. Some evidence suggests smoking may be related to worse morphology. Research on cannabis use is more limited and inconsistent, but stopping may be beneficial. Overall, following a healthy lifestyle is the best course of action.
The bottom line
Doing a semen analysis is one of the best ways to get insight into male fertility — but semen analysis alone can’t tell you if you’re fertile or infertile.
Semen analysis gives you a snapshot of your sperm, but can’t tell you *why* you have the parameters you do. For example, if you have low sperm concentration, additional testing with your doctor may be necessary to find out why.
When it comes to fertility, the more info you have, the more options you have.