Semen Analysis – What It Is, Recommendations and Useful Information

The semen analysis (spermiogram) is the only method officially recognised by the World Health Organization (WHO) for assessing male fertility. It evaluates the concentration, structure and motility of sperm within the seminal fluid.

In practice, it is the only recognised way for a couple who are not achieving a pregnancy to find out whether the semen is the cause – and why. Abnormal results do not, however, represent a permanent verdict of infertility – they may point to a medical condition or a temporary problem, which means a semen analysis can be the first step towards treatment and improved fertility.

There are other situations in which a doctor may recommend a semen analysis, such as after a vasectomy or following a vasectomy reversal. Read on to discover everything every man should know about semen analysis and how to prepare for providing a sample.

What is a semen analysis?

A semen analysis, also known as a spermiogram, is a test that measures the characteristics of the semen and the sperm – both quantitatively and qualitatively. The result of a semen analysis reflects the quality of the seminal fluid, the number of sperm and their ability to fertilise an egg.

Although the semen analysis is also known as the “male fertility test”, because it can indeed detect whether sperm are entirely absent and the man is therefore infertile, abnormal test results do not automatically mean infertility. They can, however, confirm that the semen is part of the reason why a couple is not achieving a pregnancy.

When is a semen analysis recommended? 

As a general rule, a semen analysis is recommended for couples who have not achieved a pregnancy despite regular, unprotected intercourse over the course of a year. In these cases, the semen analysis can shed light on the quality of the semen and whether it is a contributing factor.

The result may indicate infertility, but not only that – it can reveal a low sperm count in the seminal fluid, their complete absence, the structure or viscosity of the fluid, as well as an infection or another temporary problem that is treatable and does not affect fertility in the long term.

The most common situations in which a semen analysis is recommended include:

• To determine whether a man is infertile
• After a vasectomy, to check that it has been effective
• After a vasectomy reversal, to check that it has been effective
• To diagnose haematospermia (when blood is present in the semen)
• To assess the possible effects of mumps on the sperm-producing tissue and of a varicocele on spermatogenesis

Preparing to provide a sample 

For a semen analysis, a sample must first be obtained. The process is not difficult, but there are certain preparations and recommendations a man should follow so that the result of the semen analysis is as accurate as possible:

The sample is obtained by masturbation.

Sexual abstinence of 2–7 days before providing the sample is recommended.

The sample is collected in a sterile, single-use container, not in a condom.

The entire ejaculate must be collected. If the patient is unable to collect all of the fluid, he must inform the doctor – even if only a very small amount is lost.

It is advisable to pass urine beforehand and wash the hands, so that no bacteria are transferred.

Using saliva or lubricants is not advisable, as these can impair semen quality.

Obtaining the sample by withdrawal is not recommended. However, there are solutions for those who wish to obtain the sample during intercourse with their partner: a special condom provided by the doctor can be used for sample collection.

Coffee, tobacco, alcohol and other substances should be avoided for at least 3 days before providing the sample.

If the sample is not produced at the laboratory, it must reach the laboratory in less than 30 minutes and be kept at around 37 ℃ during transport (ideally close to the body).

Depending on the situation, and where possible and permitted by the doctor, it is recommended that any medication be stopped in the week before providing the sample.

It is generally recommended that the semen analysis be repeated 2 to 3 times over the following weeks. The quality of the seminal fluid can vary from day to day, and repeating the test provides more accurate results.

Risks

There are no risks whatsoever associated with a semen analysis, and providing the semen sample causes no discomfort and carries no known risks.

If masturbation is problematic for a man for any reason, an alternative method of obtaining the sample can be agreed with the doctor.

Interpreting the results

A semen analysis involves a wide range of measurements describing the seminal fluid and the sperm. The results are therefore assessed according to the following criteria:

• Volume
  Normal values following ejaculation are between 2 and 5 ml. If the volume is lower, this is known as hypospermia or microspermia; the cause may be chronic inflammation of the prostate and seminal vesicles. If semen is entirely absent, this is known as aspermia.
• Colour
  A white, cloudy, slightly yellowish colour is considered normal.
• pH
  The normal pH of semen is between 7.12 and 8. A lower pH may be the result of genital inflammation and can adversely affect sperm motility.
• Liquefaction time
  Normally, liquefaction should take less than 30 minutes. Immediately after ejaculation, semen has a thicker consistency in order to restrict the free movement of the sperm. This viscosity is lost as specialised enzymes break down the colloidal substances, the semen liquefies and the sperm are released. If liquefaction takes longer than 30 minutes, this may indicate inflammation of the genital tract.
• Concentration
  Normal values are above 20 million sperm per millilitre, which corresponds to at least 40 million sperm per ejaculation. A lower concentration is known as oligozoospermia. While this does not automatically mean infertility, it is associated with an increased likelihood of infertility depending on its severity. The complete absence of sperm, known as azoospermia, is a sign of infertility and occurs when both testicles are affected.
• Morphology
  The normal structure of a sperm includes a rounded head and a straight, long, narrow tail.
• Motility
  Normal sperm movement is rapid and in a straight line, driven by the wave-like movements of the tail. There are 4 types of movement: type a (rapid tail movements and lateral head movements), type b (tail movements only, no head movements), type c (no forward movement, only movement on the spot through strong vibrations) and type d (no movement – the sperm are immotile and are often mistaken for dead sperm).

Semen analysis – cost 

The cost of a semen analysis depends on the laboratory where the sample is provided and on the techniques used. The best-known analysis methods include CASA (computer-assisted sperm analysis), Leukoscreen and rapid tests. Semen analysis is available on the NHS through your GP as part of fertility testing; private clinics set their own prices, so ask for a costed quote.

The difference between a semen analysis and a semen culture

Both a semen analysis and a semen culture are methods of examining semen, but their purpose is different.

A semen analysis is used to assess characteristics such as the structure, motility and quantity of the sperm and the seminal fluid.

A semen culture aims to detect bacteria or other pathogens in the seminal fluid, in order to establish whether there is a urinary tract infection that may be causing infertility.

What does infertility mean?

Infertility is defined as the failure to achieve a pregnancy after a period of one year during which a couple has repeatedly tried to conceive through unprotected intercourse. The diagnosis is made after both partners have been examined, by means of:

• Genetic tests, hormone tests, semen analyses and biopsies in men.
• Ovulation tests, hysterosalpingography, assessment of ovarian reserve, as well as further hormone tests and imaging investigations in women.

In men, infertility is often the result of sperm disorders (problems with sperm production); in women, it is often due to problems with ovulation.

According to a study recently published by the World Health Organization, around 17.5% of the adult population is affected by infertility. Experts estimate that:

Around 30% of these cases are due solely to a problem in the man

Around 30% are due solely to a problem in the woman

In around 30% of cases, both partners have a problem contributing to the failure to conceive

In around 10% of cases, the cause of infertility is unknown

What does it mean if the semen analysis shows normal values?

If the semen analysis shows normal values, this means that the parameters assessed fall within the normal range and that no abnormalities were found to suggest that the infertility is caused by problems with the seminal fluid.

In this case, further investigations may be carried out to find the cause – including in the partner.

A semen analysis is not the only method of assessing male fertility. The doctor may recommend additional investigations, such as blood tests, imaging (e.g. scrotal ultrasound, transrectal ultrasound to assess the prostate), as well as hormone tests, genetic tests or a testicular biopsy.

How does sperm count affect fertility?

A low sperm count in the seminal fluid is a common reason why couples experience fertility problems.

This does not necessarily mean that the man is infertile – pregnancy is still possible even when a semen analysis shows oligozoospermia. However, the lower the sperm count and the more severe the oligozoospermia, the greater the risk that the partner will not conceive.

Possible treatments

If the result of the semen analysis shows a low sperm count or another problem with the semen, the doctor will investigate the cause and, depending on the findings, may recommend the following treatment options:

• Surgery: an operation may be recommended, for example, to correct a varicocele, that is, when the veins draining blood from the testicles become enlarged. This is one of the most common disorders causing male infertility.
• Antibiotics: for an infection of the genital or urinary tract; unfortunately, treating such an infection does not always restore fertility.
• Medication or counselling: when problems with intercourse, such as erectile dysfunction or premature ejaculation, are preventing pregnancy.
• Hormone treatments: when the infertility is caused by a hormonal imbalance

When should you see a fertility specialist?

Before you panic and consult a fertility specialist, bear in mind that it can take between 6 months and a year of repeated attempts for a woman to conceive. This is entirely normal and no cause for concern, provided neither partner has fertility problems.

A woman's body is at its most fertile – that is, has the greatest chance of conceiving – in the 5 days before ovulation, at the time of ovulation and on the day after. In practice, then, there are 7 days a month when the chances of conception are increased; on the remaining days, they fall significantly with unprotected intercourse. If you would like to read more about what the fertile window means and how to work it out, we have explained everything in the article HERE.

Age is also an important factor affecting fertility. The most common situations in which a consultation with a fertility specialist is recommended are therefore:

• When the female partner is under 35, you have repeated unprotected intercourse during the fertile window, and no pregnancy occurs over a period of more than a year.
• When the female partner is over 35 and you have been trying to conceive for more than 6 months.

The specialist can then recommend fertility investigations (for both partners), appropriate treatments depending on the results, or various planning methods such as the calendar method.

How is infertility treated? 

Treatment for infertility depends on the cause, which is identified through the investigations the doctor recommends for both partners. In some cases, treatment is needed for only one partner. In others, both partners need treatment in order to improve fertility and the chances of conception.

Fortunately, being infertile is not the same as being sterile, that is, having no possibility at all of conceiving a child. Of the couples facing infertility, statistics show that only 1–2% are sterile. And thanks to medical advances, most couples (over 50%) who seek professional help go on to have children following treatment:

Surgical treatment
Men may be offered varicocele surgery or a procedure to restore the passage of sperm. Women may be offered surgery to clear a blockage in a fallopian tube.

In vitro fertilisation (IVF)
This is the most effective assisted reproduction technique and involves artificially fertilising, in the laboratory, eggs that have been retrieved from the mother's body. These are collected from the ovaries under anaesthetic and fertilised with sperm from the partner or a donor. The resulting embryos are selected and transferred into the uterus in order to achieve a pregnancy.

Intracytoplasmic sperm injection (ICSI)
This is another assisted reproduction technique in which a single sperm is injected into the cytoplasm (the main body of the egg) when the woman is at her most fertile. The procedure is recommended when a couple's infertility is due to the man's diagnosis, particularly in severe cases where the sperm count in the semen is very low.

Artificial insemination
In vitro fertilisation and artificial insemination are the most effective and most widely used assisted reproduction technologies. In artificial, or intrauterine, insemination, sperm are placed directly into the uterus so that they are as close as possible to the egg, thereby increasing the chances of fertilisation. Unlike IVF, with artificial insemination the egg is fertilised naturally within the fallopian tubes.