Male fertility test results 101

The 5 things you need to know to understand your semen analysis results.

When making your fertility to-do list, you may want to consider getting a semen analysis done before the female workup because it’s cheaper, faster and easier–both logistically and physically.  The analysis results can also immediately eliminate a long list of possible diagnoses (like asking about facial hair in a game of Guess Who?, so you can take your next steps with confidence.  Plus, all men should include at least two semen analyses in their fertility workup, so you might as well get the first out of the way early on.

Although a semen analysis interpretation looks at many different parameters of semen, urologist and male infertility specialist Dr. Matthew Wosnitzer tells us there are five main factors.  He outlines the criteria for each below with the benchmark reference values defined by the World Health Organization as the minimum “normal” values (i.e., 95 percent of men have results equal or better).

1. Sperm count/concentration

What it is:  Sperm count is the total number of sperm in the whole ejaculate.  Sperm concentration is how many millions of sperm per milliliter.

WHO benchmark:  At least 39 million sperm per ejaculate with a concentration of 15 million sperm per milliliter
Diagnosis:  Low sperm count (oligospermia) or no sperm (azoospermia)

Next steps:  Oligospermia could be a result of multiple causes including varicoceles, genetic or hormone abnormalities, medications, or systemic diseases such as cancer.  Have your urologist confirm sperm count with a follow-up analysis and then conduct further appropriate investigation based on findings of decreased sperm count.

2.  Volume

What it is:  The most straightforward parameter of the test, semen volume refers to the total amount of male ejaculate.

WHO benchmark:  1.5 milliliters or more semen per ejaculation
Diagnosis:  Low volume (hypospermia)

Next steps:  If the volume of ejaculate is low, it could be a inadequate collection of the semen sample or it could be an obstruction in the male reproductive tract (blocked plumbing system, like an ejaculatory duct obstruction).  Have a repeat semen analysis to confirm the collection was seamless, and then see a urologist to discuss possible causes.

3.  Motility

What it is:  Motility refers to the sperm’s ability to move in a straight line and/or large circle.  Healthy movement enables the sperm to navigate the female reproductive tract and ultimately unite with the egg.

WHO benchmark:  At least 40 percent of the sperm have healthy movement
Diagnosis:  Decreased motility (asthenozoospermia) or no motility at all (complete asthenozoospermia)

Next steps:  Moving sperm are alive and healthy.  If they are moving slowly, in an abnormal pattern or not at all, there may be an engine problem (e.g., insufficient energy production or overall health).  Decreased sperm motility can occur because of varicoceles, medications, systemic illness or anti-sperm antibodies.  See a urologist who specializes in male infertility to identify what factors may be causing the issue.

4.  Morphology

What it is:  Morphology refers to the size and shape of the sperm head, mid-piece and tail, each of which is judged by a variety of scoring systems.  In general, healthy sperm have an oval head and a long tail.  Sperm with severe morphological defects may have a more difficult time fertilizing an egg.

WHO benchmark:  Minimum 4 percent of sperm have regular size/shape
Diagnosis:  Poor morphology (teratospermia)

Next steps:  The health of the sperm should be evaluated further.  Abnormal sperm shape and/or size may be a response to heat or other environmental influences (such as a varicocele), or it could reflect a larger problem (such as a genetic issue like DNA fragmentation).  Although the relationship between poor sperm morphology and pregnancy remains unclear, there is recent research indicating that abnormally low morphology does not impact IUI or IVF/ICSI results (American Urological Association Annual Meeting, 2014).  See a urologist who specializes in male infertility and has experience treating men with abnormal sperm shape, in particular.

5.  pH

What it is:  pH refers to the acidity level of the semen.  Healthy semen is basic (low acidity, higher pH).

WHO benchmark: Higher than or equal to 7.2 pH
Diagnosis:  Acidic semen (low pH) may be caused by obstructed ejaculatory ducts or congenital bilateral absence of the vas deferens (CBAVD, which can occur with cystic fibrosis)

Next steps:  About 50 to 70 percent of the seminal fluid in humans is basic and originates from the seminal vesicles.  When those are blocked, the ejaculate becomes acidic.  The female reproductive tract is slightly acidic, so the basic pH of the seminal vesicle secretion balances this environment.  If the semen is too acidic, have a urologist analyze semen pH abnormalities and other seminal parameters.