A semen analysis (SA) is one of the first tests done when evaluating male fertility. It's simple, non-invasive, and provides valuable information about sperm quantity and quality. But the report can be confusing if you don't know what you're looking at.
Let's break down each parameter so you can understand exactly what your results mean.
WHO Reference Values: What's "Normal"?
The World Health Organization (WHO) publishes reference values based on studies of fertile men. These are the minimum values found in the lowest 5th percentile of men who achieved pregnancy within 12 months—meaning 95% of fertile men had values above these thresholds.
| Parameter | WHO 2021 Reference | What It Measures |
|---|---|---|
| Volume | ≥1.4 mL | Amount of ejaculate |
| Concentration | ≥16 million/mL | Sperm per milliliter |
| Total Count | ≥39 million | Total sperm in sample |
| Total Motility | ≥42% | % of sperm moving |
| Progressive Motility | ≥30% | % swimming forward |
| Morphology | ≥4% | % with normal shape |
| Vitality | ≥54% | % of live sperm |
These are minimum reference values, not optimal values. Being above the threshold doesn't guarantee fertility, and being slightly below doesn't mean you can't conceive naturally. These numbers are just one piece of the puzzle.
The Key Parameters Explained
How many sperm are present per milliliter of semen. This is often what people mean when they talk about "sperm count." More sperm means more chances for one to successfully fertilize the egg.
The percentage of sperm that are moving at all (any movement counts). Sperm need to swim to reach the egg, so motility is crucial for natural conception.
The percentage of sperm swimming forward in a straight line or large circles (not just twitching in place). Progressive movement is what actually gets sperm to the egg.
The percentage of sperm with normal shape—proper head, midpiece, and tail. Abnormally shaped sperm may have trouble penetrating the egg. Note: Even fertile men have mostly abnormal sperm; 4% normal is actually the threshold.
Other Parameters on Your Report
Total amount of ejaculate. Low volume could indicate incomplete collection, retrograde ejaculation (semen going into bladder), or issues with seminal vesicles/prostate. Very high volume can dilute sperm concentration.
Acidity/alkalinity of semen. Normal semen is slightly alkaline, which helps protect sperm from the acidic vaginal environment. Abnormal pH can indicate infection or gland problems.
Semen is gel-like at ejaculation and should liquefy within 15-30 minutes (up to 60 is normal). Delayed liquefaction can trap sperm and impair their ability to swim toward the egg.
Elevated white blood cells (leukocytospermia) may indicate infection or inflammation in the reproductive tract, which can damage sperm. May warrant further investigation.
Medical Terms You Might See
What If My Results Are Abnormal?
Sperm parameters vary significantly from day to day based on recent illness, stress, heat exposure, ejaculation frequency, and more. A single abnormal result should always be confirmed with a repeat test 2-4 weeks later before drawing conclusions.
If abnormal results are confirmed, next steps typically include:
Lifestyle optimization: Many cases of mild abnormalities improve with lifestyle changes—quitting smoking, limiting alcohol, maintaining healthy weight, avoiding heat, and taking supplements. Give it 3 months (one full sperm production cycle).
Further testing: Depending on results, your doctor may recommend hormone testing (testosterone, FSH, LH), genetic testing, scrotal ultrasound, or other evaluations.
Specialist referral: A reproductive urologist can evaluate for treatable conditions like varicocele (enlarged veins in the scrotum, found in ~40% of infertile men and often correctable).
Treatment options: Depending on severity, options range from lifestyle changes and supplements to IUI (which concentrates sperm), IVF, or ICSI (injecting a single sperm directly into an egg).
Can You Improve Your Numbers?
Yes! Unlike women's eggs, sperm are constantly being produced. What you do today affects the sperm that will be ready in 2-3 months. Evidence-based strategies:
- Quit smoking—smokers have 23% lower concentration on average
- Limit alcohol—heavy drinking impairs production
- Maintain healthy weight—obesity lowers count and quality
- Avoid heat—hot tubs, saunas, tight underwear, laptop on lap
- Supplement wisely—CoQ10, zinc, and L-carnitine have evidence
- Reduce stress—chronic stress impairs sperm production
- Get adequate sleep—testosterone is produced during sleep
At-Home Sperm Tests: Are They Accurate?
At-home sperm tests have improved but still have limitations:
What they measure: Most only measure concentration (count). Some newer ones also measure motility. None measure morphology accurately at home.
Accuracy: Generally good for detecting whether sperm are present and whether count is very low vs. normal range. Less accurate for borderline cases.
Best use: Screening before investing in a full lab analysis, or monitoring progress if making lifestyle changes. Not a replacement for a comprehensive lab analysis when actually trying to conceive.
If you're actively TTC and haven't conceived after 6-12 months, get a proper lab analysis done—don't rely solely on at-home tests.
Where Are You in Your Fertility Journey?
Our quiz can help you understand your situation and point you toward the right resources.
Take the Fertility Quiz →The Bottom Line
A semen analysis provides valuable information but isn't the final word on male fertility. Key takeaways:
- WHO reference values are minimums, not targets—being above them doesn't guarantee fertility
- One test isn't enough—always confirm abnormal results with a retest
- Parameters vary naturally—stress, illness, heat, and other factors cause day-to-day fluctuation
- Improvement is possible—lifestyle changes affect sperm produced 2-3 months later
- Context matters—your partner's fertility, your age, how long you've been trying all factor in
If results are concerning, don't lose hope. Many men with "abnormal" semen analyses father children naturally or with minimal intervention. Work with a specialist to understand your specific situation and options.