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Semen Analysis Results: What the Numbers Mean

A semen analysis measures five parameters: ejaculate volume, total sperm count, concentration, motility (percentage moving), and morphology (percentage normally shaped), compared against WHO 6th edition reference ranges [1]. One abnormal result does not confirm permanent infertility — sperm renew roughly every 74 days, and a repeat test is always needed [2].

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What does each measurement on a semen analysis report mean?

Volume The total amount of fluid in the ejaculate. WHO 6th edition reference: 1.4 mL or more. Very low volume can suggest a problem with the seminal vesicles or prostate, or retrograde ejaculation (semen entering the bladder). Very high volume can dilute sperm concentration.

Total sperm count The total number of sperm in the whole ejaculate. WHO reference: 39 million or more per ejaculate. This combines volume and concentration.

Sperm concentration The number of sperm per milliliter of ejaculate. WHO reference: 16 million per mL or more.

Motility The percentage of sperm that are moving. WHO reference: 42% or more total motility. Motility is further broken down: - *Progressive motility* — sperm moving in a roughly straight or large-circle path (WHO reference: 30% or more) - *Non-progressive motility* — sperm moving but in tight circles or minimal displacement - *Immotile* — not moving at all

Morphology The percentage of sperm that have a normal shape under microscopic examination (using Kruger strict criteria). WHO reference: 4% or more. Morphology is often the most confusing number — even in fertile men, most sperm have abnormal shapes, which is why the threshold is low. 1

What does it mean if my results are below the reference range?

A result below the WHO reference value is called *oligospermia* (low concentration), *asthenospermia* (low motility), or *teratospermia* (low morphology). Many men have results below reference on one or more parameters and still father children; the reference ranges define the lower fifth percentile of fertile men, not a sharp cutoff between fertile and infertile. 1

Degree matters: - Mildly below reference: may have minimal clinical impact; a repeat test in two to three months and lifestyle adjustments may be the first step 2 - Moderately below reference: warrants further evaluation by a urologist or male fertility specialist - Severely below reference (very few sperm, or no sperm — called azoospermia): requires specialist evaluation to determine whether it is obstructive or non-obstructive in cause, as treatment differs

A single abnormal semen analysis should always be repeated before any conclusions are drawn. Sperm parameters vary considerably from sample to sample and are affected by recent illness, fever, stress, alcohol use, and abstinence duration before the test. 2

What are the most common reasons for an abnormal semen analysis?

Common contributing factors include:

  • Varicocele: An enlarged vein in the scrotum that increases testicular temperature — the most common surgically correctable male-factor diagnosis. Found in roughly 40% of men evaluated for infertility. 2
  • Hormonal imbalances: Low testosterone, high FSH (a sign the testes are struggling), elevated prolactin, or thyroid abnormalities
  • Obstruction: Prior infection (epididymitis, STI), vasectomy, or anatomical block preventing sperm from reaching the ejaculate
  • Genetic factors: Y-chromosome microdeletions or chromosomal abnormalities (such as Klinefelter syndrome) affecting sperm production
  • Lifestyle factors: Tobacco use, significant heat exposure (frequent hot tubs, tight underwear, laptop on the lap), anabolic steroid use, and some medications reduce sperm quality
  • Recent illness or fever: Can temporarily reduce sperm quality — an illness within the past three months can affect current results 2

What happens after an abnormal result?

An abnormal semen analysis is the beginning of an evaluation, not the end of it. A urologist with expertise in male fertility is the right specialist for a comprehensive workup. 2 This typically includes:

  • Repeat semen analysis in two to three months (one complete sperm cycle)
  • Hormonal blood tests: FSH, LH, total testosterone, prolactin
  • Physical examination: looking for varicocele, anatomical abnormalities
  • Genetic testing if indicated (Y-chromosome microdeletion panel, karyotype)

Many causes of abnormal semen analysis are treatable or manageable. Varicocele repair, hormonal correction, and treatment of infections can improve parameters. IUI or IVF with intracytoplasmic sperm injection (ICSI) — where a single sperm is injected directly into an egg — is highly effective even with significantly reduced sperm counts or quality.

Common questions

My morphology was only 2% — does that mean I cannot have children?

Not necessarily. Morphology below 4% (the WHO threshold) is called teratospermia and can affect fertility, but many men with low morphology conceive naturally or with assisted reproduction. Morphology alone is not a definitive predictor — it is interpreted alongside count and motility, and ICSI is highly effective even with poor morphology.

What is a 'normal' abstinence period before the test?

The WHO recommends two to seven days of abstinence before a semen analysis for standardized results. Abstaining too briefly can reduce volume and count; abstaining too long can reduce motility. Follow the instructions from your laboratory.

Can lifestyle changes improve semen analysis results?

Yes, to a meaningful degree. Quitting smoking, reducing alcohol, avoiding anabolic steroids, maintaining a healthy weight, managing heat exposure, and controlling any underlying health conditions can all improve sperm parameters over two to three months — one complete sperm production cycle.

What is azoospermia, and is it treatable?

Azoospermia means no sperm are found in the ejaculate. It is either obstructive (a blockage prevents sperm from being expelled, but the testes are producing them) or non-obstructive (the testes are not producing sperm or are producing very few). Both types require specialist evaluation. Obstructive azoospermia is often correctable surgically; non-obstructive may still allow sperm retrieval for IVF with ICSI.

Should we wait to try naturally, or see a specialist now?

If the semen analysis shows a mild abnormality and you have been trying for less than a year, lifestyle adjustments and a repeat test in two to three months is often the first step. If the results are significantly abnormal, or you have been trying for a year without success, seeing a urologist with male fertility expertise and a reproductive endocrinologist together is the most efficient path.

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When an abnormal semen analysis warrants prompt specialist evaluation

  • —Azoospermia (no sperm found) — always requires urological evaluation
  • —Severely low count or motility on a repeat test — do not wait another year
  • —Blood in the ejaculate — unrelated to fertility but warrants urological evaluation
  • —Pain or swelling in the testes — may indicate varicocele or other treatable condition

This article is general health education and is not a substitute for personalized interpretation of your semen analysis results by a licensed clinician. A urologist with male fertility expertise and a reproductive endocrinologist are the right specialists for evaluation and treatment planning.

References

  1. 1.Björndahl L, Kirkman Brown J, et al. (on behalf of the WHO 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. Fertility and Sterility. doi:10.1016/j.fertnstert.2021.12.012 ✓WHO 6th edition semen analysis reference limits: volume ≥1.4 mL, concentration ≥16 million/mL, total count ≥39 million, total motility ≥42%, progressive motility ≥30%, morphology ≥4% — and the caveat that these are 5th-percentile values of fertile men, not a binary fertile/infertile cutoff
  2. 2.Schlegel 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. Journal of Urology. doi:10.1097/JU.0000000000001521 ✓AUA/ASRM guideline on male infertility: evaluation pathway, repeat testing rationale, varicocele prevalence and treatment, hormonal workup, lifestyle factors, and indications for genetic testing

2 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.