Male Fertility Testing: What to Expect From a Semen Analysis and How to Get One

What does a semen analysis measure?

A semen analysis examines a semen sample across several parameters defined by the WHO Laboratory Manual for the Examination and Processing of Human Semen (6th edition, 2021) 1Ref 1Björndahl L, Kirkman Brown J, and WHO Laboratory Manual Editorial Board (2022).The sixth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen: ensuring quality and standardization in basic examination of human ejaculates.WHO 2021 reference ranges for semen parameters including concentration, motility, morphology, volume, and abstinence interval recommendations:

• Sperm concentration — how many sperm are present per milliliter
• Total sperm count — concentration multiplied by total ejaculate volume
• Motility — the percentage of sperm that are moving, and whether their movement is forward-directed (progressive motility)
• Morphology — the percentage with normally shaped heads, midpieces, and tails (assessed by Kruger strict criteria)
• Semen volume, pH, and liquefaction time — additional markers of overall sample quality

One abnormal result does not mean infertility; parameters fluctuate with illness, stress, and timing. One normal result does not guarantee fertility. The analysis starts a diagnostic conversation, not a verdict.

How do you arrange a semen analysis?

The most common paths are:

• Through a primary care clinician — they write a lab order, and many standard reference labs accept semen samples
• Through a urologist specializing in male reproductive health
• Through a fertility clinic if you and your partner are already working with a reproductive endocrinologist

The AUA/ASRM guideline on male infertility recommends that initial evaluation of the male partner should include one or more semen analyses 2Ref 2Schlegel PN, Sigman M, Collura B, De Jonge CJ, Eisenberg ML, Lamb DJ, Mulhall JP, Niederberger C, Sandlow JI, Sokol RZ, Spandorfer SD, Tanrikut C, Treadwell JR, Oristaglio JT, Zini A (2021).Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline Part I.Recommendation for semen analysis as first-line male infertility evaluation, hormonal panel for abnormal results, and treatment approach including varicocele repair. Some clinics offer at-home collection kits that ship the sample to a lab — convenient, but worth confirming quality-control equivalence with your clinician before choosing that route.

How should you prepare for the test?

Sample quality is affected by how long you have abstained from ejaculation before collection. Most labs — and the WHO reference methodology — recommend 2 to 7 days of abstinence 1Ref 1Björndahl L, Kirkman Brown J, and WHO Laboratory Manual Editorial Board (2022).The sixth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen: ensuring quality and standardization in basic examination of human ejaculates.WHO 2021 reference ranges for semen parameters including concentration, motility, morphology, volume, and abstinence interval recommendations. Too short an interval underestimates count; too long an interval accumulates older, less motile sperm. Your clinician or the lab will provide specific instructions.

Avoid significant alcohol, cannabis, and heat exposure (hot tubs, saunas) in the weeks before the test if possible, as these affect sperm production and function. Collection is done either at the lab in a private room, or at home with immediate delivery — typically within 30 to 60 minutes. Follow transport instructions carefully.

What do the results mean?

Results are compared against WHO 2021 lower reference limits 1Ref 1Björndahl L, Kirkman Brown J, and WHO Laboratory Manual Editorial Board (2022).The sixth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen: ensuring quality and standardization in basic examination of human ejaculates.WHO 2021 reference ranges for semen parameters including concentration, motility, morphology, volume, and abstinence interval recommendations. Abnormal findings may include:

• Oligozoospermia — sperm count below the reference threshold
• Asthenozoospermia — reduced motility
• Teratozoospermia — a high proportion of abnormally shaped sperm
• Azoospermia — complete absence of sperm, which requires further investigation into whether sperm are not being produced (non-obstructive) or are blocked from reaching the ejaculate (obstructive)

Abnormal results do not mean conception is impossible. Many people with below-average parameters conceive, and treatment options exist for most causes 2Ref 2Schlegel PN, Sigman M, Collura B, De Jonge CJ, Eisenberg ML, Lamb DJ, Mulhall JP, Niederberger C, Sandlow JI, Sokol RZ, Spandorfer SD, Tanrikut C, Treadwell JR, Oristaglio JT, Zini A (2021).Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline Part I.Recommendation for semen analysis as first-line male infertility evaluation, hormonal panel for abnormal results, and treatment approach including varicocele repair. A single abnormal result should typically be confirmed with a repeat analysis, as parameters vary naturally over time.

What happens if the analysis is abnormal?

The next step is usually evaluation by a urologist or reproductive urologist to look for a treatable underlying cause. The AUA/ASRM guideline recommends hormonal evaluation — including FSH, LH, and testosterone — for men with oligozoospermia or azoospermia 2Ref 2Schlegel PN, Sigman M, Collura B, De Jonge CJ, Eisenberg ML, Lamb DJ, Mulhall JP, Niederberger C, Sandlow JI, Sokol RZ, Spandorfer SD, Tanrikut C, Treadwell JR, Oristaglio JT, Zini A (2021).Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline Part I.Recommendation for semen analysis as first-line male infertility evaluation, hormonal panel for abnormal results, and treatment approach including varicocele repair. Common identifiable causes include:

• Varicocele (enlarged veins in the scrotum) — the most common correctable cause of male infertility 3Ref 3American Urological Association / American Society for Reproductive Medicine (2022).Report on Varicocele and Infertility: A Committee Opinion.Varicocele as the most common correctable cause of male infertility, affecting 35-40% of men with primary infertility
• Hormonal imbalances (low testosterone, elevated FSH or prolactin)
• Prior infections (orchitis, chlamydia)
• Anatomical blockages of the vas deferens or epididymis
• Genetic factors (Y chromosome microdeletions, Klinefelter syndrome)

Many causes have effective treatments. A thorough workup — not just the semen analysis alone — is needed to find the right path forward.

Factors that affect sperm quality day to day

Sperm take approximately 72 to 90 days to mature. Factors that affect results include:

• Fever or serious illness in the preceding 3 months — even a brief high fever can suppress sperm production temporarily
• Anabolic steroids and exogenous testosterone — these suppress the pituitary signal that drives sperm production, often dramatically reducing or eliminating sperm from the ejaculate; always disclose this at evaluation
• Certain medications — chemotherapy, sulfasalazine, and some antifungals affect spermatogenesis
• Heat exposure — prolonged hot tub or sauna use in the weeks before collection

If an initial result is unexpectedly abnormal in someone who has recently been ill or exposed to gonadotoxins, a repeat analysis after several months may give a more representative picture.