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Understanding Your Semen Analysis Results

The semen analysis is the first step in evaluating the male factor for couples undergoing an infertility evaluation.  It is important to evaluate the male so the female does not go through more invasive testing or treatments unnecessarily.

The semen analysis report contains several pieces of data.  The most important values are volume, count, motility, and morphology.  Here is a brief description of these factors and their relevance:

Volume:  This measures the total volume of the ejaculate. Human semen is produced in relatively small amounts.  Most men produce 1-4ml.  While normal values are given on the report, there are no known causes of infertility associated with abnormal semen volume.  However, too little or too much semen may interfere with proper delivery of the semen to the female during intercourse.  Although this has never been proven, a short course of artificial insemination would theoretically deal with this possible problem.  Some clinicians believe that high volumes are associated with infections of the prostate.  This can be confirmed by semen cultures.

Count:  The sperm count is given in concentration (sperm/ml) and total count.  (Concentration multiplied by volume).  Low sperm counts are usually assumed to be related to infertility.  This is not perfect, as there are men with low counts who have children.  Low sperm counts can be due to anatomical or hormonal issues, but most go unexplained.

Motility:  This is usually expressed as percentage of moving sperm.  Some labs will “rate” the quality of the motility by a grading system.  This can be subjective.  Also, some men with high counts and lower motility may still have normal amounts of moving sperm.  In general, 10 million sperm with good motility per ml is probably acceptable.  Possible causes of low motility include varicocoeles, infection, and sperm antibodies.

Morphology:  Normally shaped sperm.  This can be reported by the older World Health Organization (WHO) standard, or the newer “Kruger or strict criteria.”  Most fertility centers do not use the WHO standard because it does not correlate well with IVF results.  In contrast, the strict criteria has been shown to predict fertilization rates with IVF.  This test is performed by a licensed technician who looks at the sperm through a microscope, so there is variation between labs.  Morphology does not correlate well with natural fertility.  It is best used to determine how to treat sperm for couples undergoing IVF.  Most centers decide what level might require intracytoplasmic sperm injection (ICSI).

Men with low counts and/or motility may benefit from seeing a urologist to rule out varicocoeles or other problems in the genital tract.  Hormone and sperm antibody testing may be indicated in some men.

Men with an abnormal semen analysis should consult with a reproductive endocrinologist.  A urology consult may be indicated in some cases.  Most men with an abnormal semen analysis can father children with appropriate treatment.