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Understanding Semen Analysis

Male fertility plays a part in nearly half of all infertility cases and can affect approximately 7% of all men. A semen analysis is one of the tests that should be offered to help determine if there is an underlying cause of difficulties conceiving. It’s an important test to check the quality and quantity of the sperm to help investigate if there are any issues. Sperm analysis will usually check the following things: sperm count, sperm morphology, sperm motility, sperm concentration and semen volume. These tests can also help determine what treatment type (if any) may be most suitable. Here we’ll explain why you may have an analysis performed and what the results could mean. 

What is semen?

Semen is the thick cloudy, white fluid that comes from a man’s penis when they ejaculate1. It contains seminal fluid which carries sperm cells out of a man’s body during ejaculation so they can fertilise an egg.

What is a semen analysis? 

A semen analysis is a test performed to evaluate semen and sperm cells2. The semen is collected by masturbation into a sterile pot, usually in a fertility clinic. The test will analyse the volume of semen produced, sperm count, sperm concentration, how the sperm are moving (motility) and how they are shaped (morphology).  

Why have a semen analysis?

If you and your partner are having trouble getting pregnant, one of the first tests your doctor will likely ask for is a semen analysis. The aim of the test is to identify if semen is a factor affecting your fertility. While problems with fertility can affect both men and women3, issues with male fertility can play a part in as many as half of all infertility cases4.

What do the results mean? 

The World Health Organisation has guidance on how to interpret semen analysis which your doctor may refer to.2. The results are often presented in a report and should include:

  • Volume – i.e how much semen there is in samples measured in milliliters (ml). Ideally it should be 1.5ml or higher. Volumes between 2-5ml would be considered normal.  A low sperm volume could be due to dehydration, low testosterone or a testicular obstruction. 
  • Sperm concentration – The sperm concentration is the number of sperm in 1ml of semen. 15 million or more sperm per ml of semen is considered normal. There are a number of potential causes of a low concentration including, hormone imbalances, genetic or structural problems and lifestyle factors such as smoking and excessive drinking can have an impact.
  • Sperm count/Total sperm number – This is the total number of sperm found in the entire sample or ejaculate. 39 million sperm or more would be considered normal. A low sperm count could be due to similar reasons affecting the volume or concentration. 
  • Motility – Motility measures the percentage of sperm that are moving. 40% or more moving sperm in the sample would be considered normal. Low motility can be caused by certain medications, nutritional deficiencies or similar reasons that affect the concentration.
  • Morphology – Morphology analyses how the sperm look based on the shape of the head, the midpiece and the tail. 4% or more normal forms is considered normal. Low sperm morphology could be the result of whatever factor is also affecting the semen concentration.

If the results are within the reference range you may be encouraged to try to conceive through intercourse for a total of 2 years (depending on if there are any other factors affecting fertility, including your age). If the results demonstrate a low sperm count or that the sperm quality is low it’s still possible to conceive you and your partner should continue to have regular, unprotected intercourse.5. You may be referred for additional tests or a repeat semen analysis as results can vary between ejaculates. You may be referred for in vitro fertilisation (IVF) funded by the NHS after you have been trying for a total of 1-2 years, determined by the area you live in6. In some cases you may not be eligible for funded treatment and would be advised of any adjustments you could make or if you should consider private treatment. You may also choose to have and pay for treatment privately at a fertility clinic of your choice.

How to access a semen analysis

Your GP should refer you for a semen analysis if you’ve been trying to conceive for 1 year. You may be referred earlier if there’s a reason to think the sperm count may be low. Alternatively you could pay for a private semen analysis. If the results are not normal, the test should be repeated. This will usually be performed after 3 months6

Lifestyle factors that affect semen quality

There are some lifestyle factors that are known to reduce sperm quality. Smoking, recreational drug use and excessive alcohol consumption can negatively affect the number of healthy sperm that are being produced. Read more on lifestyle changes for optimal sperm health here.  

Learn more

We know that sperm testing, semen analysis, fertility treatment can be a challenging experience for men. A 2017 survey from the Fertility Network UK found that most respondents felt it affected their mental wellbeing, self-esteem and relationships7. Visit HIMFertility for more information and support. 

References

  1. WHO laboratory manual for the examination and processing of human semen 
  2. Quality statement 4: Semen analysis | Fertility problems 
  3. Causes of infertility – NHS 
  4. Trends of male factor infertility, an important cause of infertility: A review of literature 
  5. Treatments for men | Information for the public | Fertility problems: assessment and treatment | Guidance | NICE 
  6. Low sperm count – NHS
  7. ​​Men’s experiences of infertility: Findings from a qualitative questionnaire study