Semen Analysis – All You Need To Know

woman checking pregnancy and a man thinking about male fertility test

For a lot of men, providing a semen analysis and understanding the results can be a challenge. If you're trying to have a baby, conventionally or with IVF (In Vitro Fertilisation) a semen analysis is essential. So here’s everything you need to know about your semen analysis. And what the results actually mean.

Your Feelings About it are Totally Normal

There are many parameters to take into account in a semen analysis, which can be divided into those that can be evaluated with the naked eye (macroscopic examination) and those that cannot be evaluated with the naked eye (microscopic examination). Below, we show the requirements that a semen sample must meet in order to be catalogued as normal (Normozoospermia).

So here’s everything you need to know about your semen analysis. And what the results actually mean.

The best conditions to provide a semen analysis are abstaining from ejaculation for two to three days beforehand, maximising motility and count. Abstinence may raise your libido levels, making it easier to produce a sample.

Your semen analysis will get underway 30 minutes or so after you’ve left the clinic. That gives the sample time to liquefy (when your sperm will swim towards the uterus after sex). A few days later, you’ll get your semen analysis results. These are usually contained in a document breakdown with terms such as ‘volume’, ‘liquefaction’, ‘PH’, ‘motility’ and ‘morphology’. There should be a summary at the bottom of the report. You’re looking for the word ‘normal’ as a result.

These terms can be quite confusing to the average person, so what exactly do they mean and what is their relevance to pregnancy chances and fertility? We will go over these key terms in your semen analysis results.

1. Volume

Volume in a semen analysis is the amount you produced in the sample. The standard reference range is 1.5 to 6.5 ml. Less than 1.5 ml may mean your abstinence wasn’t long enough. Or that part of your ejaculate may not have reached the specimen pot (situations like this can happen, aim can be for a lack of a better term, unpredictable). Or you may have sexual-gland issues, such as a prostate problem or a blockage of the seminal vesicles. The latter means no sperm due to an obstructive a medical condition called azoopermia – a common condition after vasectomies or vasectomy reversals. Conversely, big volume doesn’t mean great sperm. Anything over 6.5 ml might also indicate a current or past infection.

2. Concentration

Concentration in a semen analysis is also known as count, or density. It’s the concentration of sperm within the whole sample, not the actual number of sperm. A score of 15 to 200 million/ml is normal if the total number of sperm is more than 39 million. Anything less than 15 million/ml is an indication of low sperm count (oligozoospermia). Any score between 20 and 40 million/ml is perfectly acceptable.

3. Motility

Your motility score within a sperm analysis is the percentage of sperm that are moving. If more than 50 per cent are moving, that’s a positive result. Anything over 32 per cent is fine. Less than 32 per cent means reduced motility (asthenozoospermia).

4. Progressive motility

Progressive motility fine tunes your motility score. This is the number your doctor, or embryologist, wants to see. It’s the percentage of your sperm that swim rapidly, in a straight line. Progressive means impressive. Look out for a further refinement in your semen analysis: motile sperm concentration (MSC). That’s the number of sperm with progressive motility, measured in millions/ml.

5. Morphology

Morphology means shape. Sperm come in all shapes and sizes. Less than 20 per cent of normal forms is a reduced score (teratozoospermia). But four per cent, or even less, can still lead to a successful Intracytoplasmic Sperm Injection (ICSI) intervention. 20 to 30 per cent is normal. Above 30 is highly encouraging. Ask to see functional sperm concentration (FSC): that’s the number of progressive sperm that are shaped normally.

So What’s The Outlook?

In 2010, the World Health Organization (WHO) released a new set of guidelines for a normal sperm analysis; in order to be considered fertile, semen should have at least 15 million sperm per milliliter, a motility of 40% or more, and a morphology of 4% or more. Dr. Trolice warns patients to take these guidelines with a grain of salt, though.

“It’s important to know that just because your numbers are below the cutoff, that doesn’t mean you can’t father a child or will definitely need to do IVF,” he says. In some cases, a patient might be referred to a urologist or possibly considered for hormone therapy or surgery if the problem can be corrected.

There are many factors that can affect your sperm count, including lifestyle choices or underlying medical conditions. If you have a low sperm count, your doctor may recommend options for you to raise your sperm count, or they may refer you to a urologist or fertility specialist, if needed.

If you have a low sperm count and are hoping to conceive a child, there are many fertility options available today, including a range of treatments like intrauterine insemination (IUI), In Vitro Fertilization (IVF), IVF with intracytoplasmic sperm injection (ICSI).

Talk to your doctor about your concerns and options.

It should be mentioned that a semen analysis can be different after two consecutive tests, even at the same clinic. If you’re worried about your sperm quality, small changes make a big difference. Stop smoking. Reduce alcohol. Eat a better diet, rich in green vegetables and fruit. Stay active. Reduce stress. And take a vitamin and mineral supplement. Zinc and selenium are important.

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