How to Read a Semen Analysis (Sperm Test) Result

For couples trying to have a baby, the man’s assessment usually starts with a semen analysis. The numbers and terms on the report can, however, be confusing at first glance. In this article we explain how a semen analysis is done, how to read the results and which steps follow an abnormal result.

What is a semen analysis, and who needs one?

A semen analysis (spermiogram) is a laboratory examination of semen. It assesses the volume of semen, the number of sperm in it, and the movement and shape of the sperm.

For couples where no pregnancy has occurred within a year despite regular, unprotected sex, it is recommended that the man is assessed together with the woman. If the female partner is over 35, or if there are known risk factors such as a varicocele or a history of an undescended testicle, the assessment can be started earlier.

How should you prepare for a semen analysis?

Giving the sample in the right way is very important for an accurate result:

• Avoid ejaculation for 2–7 days before giving the sample.
• The sample should be collected by masturbation into the sterile container provided by the laboratory. Lubricants and ordinary condoms should not be used, as they can harm sperm.
• All of the semen should go into the container. Losing the first part can significantly affect the result; if this happens, the laboratory should be told.
• If the sample is collected at home, it should be kept close to body temperature and brought to the laboratory within 1 hour at the latest.

How do you read a semen analysis result?

The results are compared with the reference values published by the World Health Organization (WHO) in 2021. These values represent the lowest 5% of men whose partners became pregnant within a year:

Parameter	WHO 2021 lower reference value
Semen volume	1.4 mL
Sperm concentration	16 million/mL
Total sperm count	39 million (per ejaculate)
Total motility	42%
Progressive motility	30%
Vitality (live sperm)	54%
Normal forms (morphology)	4%

Important note: These values are not strict cut-offs that separate “fertile” from “infertile”. Just as there are men below the reference values who father children naturally, there are also men with normal values who are unable to have children. The result should be interpreted together with the couple’s overall situation.

The report also includes the pH of the semen, the liquefaction time, viscosity and the white blood cell (leucocyte) count. A high leucocyte count may suggest infection or inflammation.

What do the terms on a semen analysis report mean?

• Normozoospermia: All values are within the reference range.
• Oligozoospermia: The sperm count is below the reference value.
• Asthenozoospermia: The proportion of motile sperm is low.
• Teratozoospermia: The proportion of normally shaped sperm is low.
• Oligoasthenoteratozoospermia (OAT): Count, motility and shape are all low.
• Cryptozoospermia: Sperm are seen only in very small numbers in a centrifuged sample.
• Azoospermia: No sperm are found in the semen, even after centrifugation.
• Necrozoospermia: The proportion of live sperm is very low.
• Aspermia: No semen comes out during ejaculation.

Why is a single test not enough?

Sperm values can fluctuate markedly over time, even in the same person. The abstinence period, a recent illness with fever, stress, medicines and an incomplete sample can all affect the result.

For this reason, an abnormal result should be confirmed with a second test. Azoospermia is confirmed by examining centrifuged semen in at least two separate samples.

The main factors that can temporarily affect the result are:

• A very short (less than 2 days) or very long (more than 7 days) abstinence period
• An illness with a high fever or an operation within the last three months
• Use of testosterone, anabolic steroids and certain medicines
• Part of the sample not being collected in the container
• The sample reaching the laboratory late or being kept somewhere cold

It takes about three months for sperm to be produced and mature. For this reason, the effect on sperm values of a feverish illness, a change in medication or treatments such as varicocele surgery can be assessed at the earliest after this period.

What are the next steps if the result is abnormal?

After an abnormal semen analysis, a urologist carries out a detailed assessment:

1. History: Past illnesses (mumps, undescended testicle), operations, medicines, smoking, alcohol, weight and exposure to heat or chemicals at work are asked about.
2. Physical examination: Testicular volume, any varicocele and the presence of the sperm ducts are assessed.
3. Hormone tests: The hormonal balance is checked, mainly FSH, LH and testosterone.
4. Scrotal ultrasound: Varicocele and the structure of the testicles are assessed.
5. Genetic tests: These may be requested for a severely low sperm count or azoospermia.

If treatable causes such as a varicocele, infection or a hormonal disorder are found, these are treated first. Where necessary, assisted reproduction is planned. For details, see the male infertility page.

What can you do to support sperm quality?

• Stop smoking and limit alcohol.
• Try to lose excess weight and exercise regularly.
• Avoid habits that heat the testicles, such as saunas, hot tubs and using a laptop on your lap for long periods.
• Do not use testosterone or anabolic steroids without talking to your doctor; they can suppress sperm production.

When should you seek help without waiting?

A semen analysis is not an urgent test; however, if during the assessment you notice sudden, severe pain in a testicle, a new hard lump, or a lot of blood in the semen, seek help without waiting. For sudden testicular pain, see our article on the causes of testicular pain.

When should you see a urologist?

It is advisable to see a urologist if no pregnancy has occurred after trying for a year, if your semen analysis shows values below the reference range, if you have swelling or a feeling of heaviness in a testicle, or if you have a history of an undescended testicle, mumps or testicular surgery.

Op. Dr. Mücahit Kabar sees patients in Bursa (Nilüfer), Turkey, at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) and Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). Appointments are booked through the hospitals’ online booking pages or appointment lines. Consultations are held in English or Turkish and are confidential; the hospitals’ international patient departments can arrange interpreters for other languages. If you are travelling from abroad, you can send your questions and previous semen analysis reports by WhatsApp to +90 541 622 54 82 before your visit. See the contact and appointment information for details.