Semen analysis results explained
A semen analysis is usually the first fertility test a man has. Here is what each line of the report means — and why one abnormal result is never the final word.
When a couple has difficulty conceiving, a problem on the male side may be involved in around half of cases, and the semen analysis is the main first test. This guide explains what each measurement means, how to give a representative sample, why a single abnormal result is never the final word, and what happens next.
What does a semen analysis measure?
A semen analysis measures semen volume and the number, movement and shape of sperm, and often whether sperm are alive and white blood cells are present.
Each line answers a different question:
- Volume — how much semen was produced, and its appearance. A low volume can simply mean part of the sample was lost.
- Concentration — the number of sperm per millilitre of semen, reported in millions.
- Total sperm count — the number of sperm in the whole sample, which is the concentration multiplied by the volume. BAUS gives the typical total count as more than 39 million.
- Motility — the percentage of sperm that are moving. Progressive motility is the percentage swimming forwards in one direction rather than round in circles, and it is the most useful single measure for predicting the success of fertility treatment.
- Morphology — the percentage of sperm that are normally shaped.
- Vitality — the proportion of sperm that are alive, which is not the same as the proportion that are moving.
- White blood cells — large numbers can point to infection. Where your history also suggests infection, urine or semen cultures are arranged.
Compare each result with the reference values your laboratory uses, and remember that a result outside them is a prompt for further assessment, not a verdict. The NHS is clear that with a low sperm count it may still be possible to conceive naturally.
What do the terms on my semen analysis report mean?
The terms say which measurement is outside the reference range: “oligo” refers to concentration, “astheno” to movement and “terato” to shape, while azoospermia means no sperm.
- Oligozoospermia (or oligospermia) — a low sperm concentration
- Asthenozoospermia — too few sperm moving, or moving forwards
- Teratozoospermia — too few normally shaped sperm
- Oligoasthenoteratozoospermia (OAT) — all three together
- Azoospermia — semen containing no sperm
- Aspermia — no semen produced
- Necrospermia — all the sperm are dead
- Leucospermia (or pyospermia) — a large number of white blood cells in the semen, often associated with infection
These words describe the sample, not the cause. A low concentration can result from a varicocele, a hormone problem, testosterone or anabolic steroid use, a blockage on one side, or a genetic condition, and the treatment is different for each.
Azoospermia needs particular care. It should be confirmed on at least two samples that have been spun down (centrifuged) and examined carefully by an experienced andrology laboratory, because very small numbers of sperm can be missed — and finding them changes management entirely. If it is confirmed, the key question is whether a blockage or a production problem is the cause; my page on azoospermia explains why that matters.
How should I prepare for a semen analysis?
Abstain from ejaculation for 3 to 7 days, collect the whole sample by masturbation into the container provided, and deliver it within an hour at body temperature.
BAUS patient guidance sets out the essentials:
- Abstinence. No ejaculation, by intercourse or masturbation, for at least 3 days and no more than 7. Write the number of days since your last ejaculation on the request form; the laboratory needs it to interpret the result.
- Collection. Produce the sample by masturbation, with a clean, washed hand, into the sterile container provided. Do not use a condom or lubricant, as they may affect sample quality.
- The whole sample. If you think any of it was lost, tell the laboratory when you hand it in.
- Labelling. Mark the container with your name and date of birth and record the time of production; laboratories reject samples with incomplete details.
- Delivery. Get it to the laboratory within 1 hour, kept warm in an inside pocket. Excessive heating or chilling affects the sample and can give inaccurate results. If you cannot reach the laboratory within the hour, ask about producing the sample on site.
- Timing. Most laboratories only accept samples during normal working hours, and some ask you to book a drop-off slot.
Tell whoever requests the test about any medication, testosterone, anabolic steroids or gym supplements: testosterone and anabolic steroids suppress sperm production, and BAUS warns that many protein shakes are likely to contain hidden chemicals not listed in the ingredients. If you are my patient, my team will tell you which laboratory to use, because the right one depends on the test needed; see my Canary Wharf clinic page.
Why does one abnormal semen analysis need repeating?
Results vary considerably from one sample to the next, so an abnormal result is repeated, usually about three months later, before any conclusions are drawn.
Part of the reason is practical: the length of abstinence, an incomplete collection, or a sample chilled or delayed on the way can all affect the result. Part is biology. BAUS advises that the two tests should be at least three months apart so that they reflect two different cycles of sperm production, each of which normally takes about 74 days. The NHS likewise describes a repeat test around three months after an abnormal first result.
The same timescale applies to change: the effect of stopping smoking, losing weight, coming off anabolic steroids or varicocele repair takes three months or more to show, so repeat testing is usually done at three months.
One exception: if you notice a lump or swelling in a testicle, see a doctor promptly rather than waiting for a repeat test. A semen abnormality is occasionally the first sign of a more significant medical problem, including testicular cancer, which needs picking up regardless of your fertility plans.
One result is not a diagnosis
A single abnormal semen analysis tells you that something needs looking at — not what it is, and not whether you can father a child. Confirm it with a second test at least three months later. If the repeat is also abnormal, the next step is finding the cause, and in many men that cause is treatable.
What happens after an abnormal semen analysis?
If a repeat test confirms the problem, the next step is a specialist assessment to find the cause: examination, hormone tests and, where needed, ultrasound or genetic testing.
The NHS describes referral to a specialist after a second abnormal test, and BAUS notes that this is usually to an andrologist, a male infertility specialist. My guide on andrologists and urologists explains what that means in the UK. In my clinic the assessment usually involves:
History and examination
Your medical, surgical, sexual and family history, medication and occupation, then an examination, which is essential: it is where varicoceles, an absent vas deferens and testicular abnormalities are found.
Hormone tests
Testosterone, FSH, LH and prolactin. Testosterone should be measured on a fasting sample taken before 10am, because levels follow a daily rhythm and an afternoon sample can look falsely low. FSH matters most when no sperm are seen: it is the single most useful test for telling a blockage from a problem with production.
Scrotal ultrasound
An ultrasound scan of the scrotum can show a varicocele, including small ones visible only on a scan, and check the testicles for other abnormalities. A transrectal scan is added where a blockage of the ejaculatory ducts is suspected.
Genetic tests
Where the count is very low or no sperm are seen, I check the chromosomes (karyotype) and look for Y chromosome microdeletions, and test for cystic fibrosis gene mutations where the vas deferens is absent. Some of these conditions can be passed on to a son conceived through ICSI, so genetic counselling is arranged where a cause is found.
Other tests
A urine test after ejaculation where semen may be passing backwards into the bladder (retrograde ejaculation), and urine or semen culture if infection is suspected. If sperm may need to be stored or used in IVF, the laboratory also needs viral screening, including hepatitis B, hepatitis C and HIV.
Do I need a sperm DNA fragmentation test?
Not routinely. I use sperm DNA fragmentation testing in selected cases, in keeping with the latest evidence-based medicine and international guidelines — for example after recurrent miscarriage or failed IVF cycles.
The test looks at damage to the DNA carried inside sperm, one of the problems a standard semen analysis cannot identify. It is usually done in a dedicated laboratory. A raised result can change management: it is one of the findings that can support repairing a palpable varicocele, and it can inform the choice between IVF and ICSI. What I would not do is order it for every man as a screening test.
Can an abnormal semen analysis be treated?
Often, yes: once the cause is known, treatment ranges from stopping a medication or repairing a varicocele to retrieving sperm surgically for ICSI, depending on what is found.
My page on male infertility covers the causes in more detail. The main routes are:
- Varicocele repair — I generally recommend microsurgical varicocele repair for fertility where all of these apply: the varicocele can be felt on examination, not just seen on a scan; the semen is abnormal or DNA fragmentation is raised; the couple has documented infertility; and the female partner has normal fertility or a treatable cause. Most men with a varicocele are fertile, and a varicocele seen only on a scan should not usually be repaired.
- Stopping what is suppressing production — testosterone replacement and anabolic steroids switch off the brain’s signal to make sperm; stopping prescribed testosterone is planned with the doctor who prescribed it. In most men production recovers after stopping, but this can take many months and is occasionally incomplete.
- Hormone treatment where a pituitary cause is found.
- Reconstruction where a blockage can be bypassed, including vasectomy reversal.
- Surgical sperm retrieval — where no sperm reach the ejaculate, sperm can often be retrieved from the testicle and used for ICSI. BAUS puts the chance of finding sperm close to 100% where the cause is a blockage; where the problem is production, microTESE finds sperm in around half of men.
- Assisted conception — where IVF or ICSI is needed, it is still worth optimising the male side first, working jointly with the fertility unit.
Lifestyle changes may help too: stop smoking, drink less alcohol, lose weight if you are overweight, avoid recreational drugs and anabolic steroids, wear loose underwear, and keep heat away from the testicles — no laptops on the lap, long hot baths, saunas or heated car seats.
How much does a male fertility test cost in London?
The semen analysis is charged by the laboratory or hospital, separately from my consultation fee, and you are told the cost before the test is booked.
The same applies to hormone blood tests, ultrasound and sperm DNA fragmentation testing: each is billed by the hospital or laboratory that performs it, which is why I do not quote a single price for “a fertility test”. My own fees are £350 for an in-person initial consultation, £300 for a video or telephone consultation, and £250 for a follow-up.
If you are insured, check your policy before booking: some policies limit cover for fertility investigation and treatment. Self-funding patients do not need a GP referral. Full details are on my fees and insurance page, and you can contact my team to arrange an appointment.
On the NHS, your GP can arrange a semen analysis and other fertility tests, with referral to a specialist if a repeat test is also abnormal. What is available locally varies between NHS areas, and your GP can advise on local funding policy for fertility treatment.
Sources and further reading
Frequently asked
Can I collect the sample at home?
Yes, as long as you can get it to the laboratory within an hour of producing it. Keep it warm on the way, at body temperature, in an inside pocket, because excessive heat or cold affects the sample and can give an inaccurate result. If the journey will take longer than an hour, ask the laboratory whether you can produce the sample on site instead.
Can I use a condom or collect the sample during sex?
No. Condoms and lubricants may affect the quality of the sample, so it should be produced by masturbation, with a clean, washed hand, directly into the sterile container the laboratory provides. If producing a sample this way is difficult for you, for whatever reason, tell the clinic before the test so that it can be discussed in advance rather than on the day.
I have fathered a child before. Do I still need a semen analysis?
Yes. A previous pregnancy is reassuring, but problems with sperm production can develop in the time since, so a semen analysis is still recommended for any couple seeking help with fertility. It is a simple test, and checking both partners at the same time avoids months of investigation focused on only one of you.
Do I need a semen analysis after a vasectomy reversal?
Yes. A semen analysis is arranged around three months after the operation and repeated periodically. Sperm can take several months to reappear after a straightforward reconnection, and sometimes twelve months or more after a bypass to the epididymis, so a single early result with no sperm does not mean the operation has failed.
Does a normal semen analysis mean I am fertile?
Not necessarily. Some sperm problems, such as DNA damage, cannot be identified by a standard semen analysis, so a normal result does not guarantee fertility. It is reassuring, but both partners should still be investigated. Where a normal result sits alongside recurrent miscarriage or failed IVF cycles, further testing in selected cases may be worthwhile.
Should my semen analysis be done in a specialist andrology laboratory?
Ideally, yes. I ask for semen analyses performed to WHO standards in an accredited andrology laboratory. This matters most when very few or no sperm are reported, because a less rigorous laboratory may not look hard enough to find very small numbers of sperm — and finding them changes the options for treatment entirely.
Speak to my team
Appointments at The Shard and Canary Wharf are arranged by my PA, Jeanette Bush. Tell us briefly what the problem is and we will find the right clinic slot for you.