In roughly half of couples who have difficulty conceiving, a male factor contributes. Yet the semen analysis — the one simple, inexpensive test that reveals it — is often done late, done badly, or misread. Men are handed a sheet of numbers with asterisks and told they are "weak" or "fine" with little explanation. This article is about how the test should be done, what each line of the report means, and what an abnormal result does and does not tell you. For what to do about an abnormal result, see our companion article on male factor infertility.

When should it be done?

Early. If a couple has been trying for a year — or six months when the woman is over 35 — both partners should be assessed at the same time. There is no logic in a woman undergoing scans and dye tests while her partner has not had a semen analysis. It should also be done before any treatment such as ovulation induction or IUI is planned.

How to prepare — it matters more than you think

  • Abstinence of 2–7 days (ideally 2–3). Shorter and the volume and count fall; longer and motility falls as sperm age.
  • Produce the sample by masturbation into the sterile container provided — not a condom (most contain spermicide) and not by withdrawal.
  • Collect the whole sample; the first portion is the most sperm-rich, and losing it distorts the result. Tell the laboratory if any was lost.
  • If produced at home, keep it at body temperature (an inside pocket) and deliver it within one hour.
  • Avoid fever, sauna or heavy illness in the preceding weeks — tell the laboratory if you have had one, since a fever can depress the count for two to three months.
  • Mention any medicines or supplements, especially testosterone or anabolic steroids, which can switch sperm production off almost completely.

Reading the report

Modern laboratories report against the World Health Organization's 2021 reference values. These are not "pass marks"; they are the fifth centile of men who fathered a child within a year. Being below a value makes conception less likely, not impossible, and being above all of them does not guarantee fertility.

  • Volume — normal 1.4 ml or more. Low volume may mean an incomplete collection, a short abstinence, or occasionally a blockage or retrograde ejaculation.
  • Concentration — 16 million per ml or more. Below this is oligozoospermia; no sperm at all is azoospermia, which always needs specialist assessment — it does not always mean none are being produced.
  • Total sperm number — 39 million per ejaculate or more. This (concentration × volume) is more meaningful than concentration alone.
  • Total motility — 42% or more moving; progressive motility (swimming forward) 30% or more. Low motility is asthenozoospermia.
  • Morphology — 4% or more normal forms by strict criteria. This figure alarms men more than any other: 4% is normal. Morphology is the least reproducible measurement and, on its own, a poor predictor.
  • Vitality — 54% or more alive; mainly relevant when motility is very low.
  • pH, white cells, agglutination — pointers to infection or antibodies if abnormal.

The phrase teratozoospermia or OAT (oligoasthenoteratozoospermia) on a report simply strings these terms together; it describes the pattern, not the cause.

One abnormal result is not a diagnosis

Sperm production takes about 74 days, and results vary considerably from sample to sample in the same man — illness, stress, abstinence time and even the laboratory's technique all move the numbers. For that reason an abnormal result should always be repeated after about three months, ideally in a laboratory that follows WHO methods, before any conclusion is drawn. A mildly low count on one sample is very often normal on the next. Only a severely abnormal result (for example azoospermia) should be acted on without waiting.

What causes abnormal results?

In many men no cause is found. Recognised causes include varicocele (dilated veins around the testis), previous infection or mumps, undescended testes in childhood, hormonal problems, genetic conditions, obstruction, and lifestyle factors — smoking, heavy alcohol, obesity, anabolic steroids, and regular heat exposure to the testes. Some medicines and chemotherapy also suppress production. A clinical examination, a hormone profile (FSH, LH, testosterone) and in some cases a scrotal ultrasound or genetic tests follow a confirmed abnormal result.

What the result means for treatment

  • Mild reduction in count or motility — lifestyle changes, treating any cause, and timed intercourse or IUI are reasonable; many couples conceive naturally.
  • Moderate reduction — IUI if the washed motile count is adequate; otherwise IVF.
  • Severe reduction (very few motile sperm) — IVF with ICSI, where one sperm is injected into each egg.
  • Azoospermia — depends on whether it is obstructive (production normal, delivery blocked) or non-obstructive; in both, sperm can often be retrieved surgically for ICSI.

Treatment plans should be based on the couple as a whole: the woman's age and ovarian reserve weigh at least as heavily as the semen result in deciding how fast to move.

Can you improve the numbers?

Stopping smoking and anabolic steroids, keeping alcohol modest, losing excess weight, avoiding prolonged heat (laptops on the lap, hot baths, tight synthetic underwear) and treating infections all help, and the effect appears after about three months. The evidence for antioxidant supplements is weak: a large Cochrane review found no clear improvement in live births. They are not harmful at sensible doses, but they are not a treatment.

The bottom line

  • Both partners should be tested from the start; the semen analysis is cheap, simple and essential.
  • Prepare properly — 2–7 days' abstinence, the whole sample, delivered within an hour.
  • WHO 2021 values are reference points, not pass marks; 4% normal morphology is normal.
  • Repeat any abnormal result after three months before drawing conclusions.
  • Even severe results have treatments — including ICSI with surgically retrieved sperm.

If you have a semen analysis report you do not understand, bring it with you — you can consult us at Sugabi Clinic Ragama or book a video consultation.

References

  1. World Health Organization. WHO laboratory manual for the examination and processing of human semen. 6th ed. Geneva: WHO; 2021 [cited 2026 Oct 5]. Available from: who.int
  2. National Institute for Health and Care Excellence. Fertility problems: assessment and treatment (CG156) [Internet]. London: NICE; 2013 [updated 2017 Sep 6; cited 2026 Oct 5]. Available from: nice.org.uk/guidance/cg156
  3. NHS. Infertility — diagnosis [Internet]. London: NHS; [cited 2026 Oct 5]. Available from: nhs.uk
  4. Björndahl L, Kirkman Brown J; other Editorial Board Members of the WHO Laboratory Manual. The sixth edition of the WHO Laboratory manual for the examination and processing of human semen: ensuring quality and standardization in basic examination of human ejaculates. Fertil Steril. 2022;117(2):246–51. doi:10.1016/j.fertnstert.2021.12.012
  5. Campbell MJ, Lotti F, Baldi E, Schlatt S, Festin MPR, Björndahl L, et al. Distribution of semen examination results 2020 — a follow up of data collated for the WHO semen analysis manual 2010. Andrology. 2021;9(3):817–22. doi:10.1111/andr.12983
  6. Minhas S, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz NC, et al. European Association of Urology guidelines on male sexual and reproductive health: 2021 update on male infertility. Eur Urol. 2021;80(5):603–20. doi:10.1016/j.eururo.2021.08.014
  7. de Ligny W, Smits RM, Mackenzie-Proctor R, Jordan V, Fleischer K, de Bruin JP, et al. Antioxidants for male subfertility. Cochrane Database Syst Rev. 2022;(5):CD007411. doi:10.1002/14651858.CD007411.pub5