What Is a Semen Analysis?

The semen analysis is one of the most important tools we have to understand male fertility. I get questions all the time about what this test means, how to prepare, and what factors can impact it. So let’s break it all down together.

Why the Semen Analysis Matters

A semen analysis is the first-line functional test to evaluate how well things are working on the male side. It gives us real, measurable insight into sperm health and reproductive potential.

This test provides valuable information about hormones, anatomy, and lifestyle factors — all in one simple sample.

Preparing for a Semen Analysis

Before giving a sample, it’s important to follow these steps:

• Abstain from ejaculation for 2–3 days. This ensures enough volume for accurate results.

• Check your clinic’s process. Some offices have on-site collection rooms, while others (like ours) require drop-off within about an hour after collection at home.

• No need to keep it warm. Room temperature is perfectly fine.

• Bring ID. Clinics need to verify identity to maintain proper chain of custody.

And please, don’t be embarrassed! Fertility clinics handle these samples every single day. You’re not alone in this process.

What the Test Measures

Your semen analysis will evaluate several key parameters:

1. Volume and pH

Volume reflects how much semen is produced, while pH helps us understand the chemical environment.

• Low volume may mean spillage during collection or an issue with the seminal vesicles.

• Acidic (low pH) and low volume can indicate a condition called Congenital Bilateral Absence of the Vas Deferens (CBAVD) — often seen in men who are carriers of cystic fibrosis genes.

This condition doesn’t mean you can’t have biological children, but conception may require sperm extraction and IVF.

2. Sperm Concentration

This tells us how many sperm are present per milliliter of semen.

• Normal: ≥15 million sperm/mL (though 40–50 million is ideal).

• Low count: “Oligospermia.”

• No sperm: “Azoospermia.”

Sperm concentration reflects how well the testes and brain are communicating. For instance, testosterone therapy can actually shut down sperm production by signaling the brain to stop releasing FSH and LH. If you’re trying to conceive, talk to your doctor about safer alternatives like Clomid or HCG.

Also remember: sperm health reflects the past 90 days. Illness, fever, or even COVID can temporarily affect counts, so timing matters!

3. Motility

Motility measures how well sperm move forward.

• Normal: At least 40% motile (60% is ideal).

• Total Motile Sperm Count (TMSC): Volume × concentration × motility.

Even though “it only takes one sperm,” in reality, you need an army of strong, swimming sperm to reach and fertilize the egg. For procedures like IUI, we aim for at least 10 million motile sperm after the sample is processed.

4. Morphology (Shape)

Structure equals function. Abnormal shape (like two heads or tails) can make it harder for sperm to fertilize an egg.

We use two main grading systems:

• WHO criteria: ≥15% normal forms.

• Kruger strict criteria: ≥4% normal forms.

If morphology is poor, ICSI (Intracytoplasmic Sperm Injection) may help during IVF, where a single healthy sperm is directly injected into the egg.

Lifestyle matters here too — heat (like saunas or hot tubs), smoking, processed foods, and sugar can negatively impact morphology. A diet rich in antioxidants, fruits, and vegetables can help improve sperm quality over time.

5. Round Cells

Sometimes we see “round cells” in the sample. These can be immature sperm, white blood cells, or red blood cells. If infection or inflammation is suspected, a short course of antibiotics or anti-inflammatories may be recommended before repeating the test.

Think of it like clearing traffic — removing these “stalled cars” lets healthy sperm move more freely.

What Happens Next

If your semen analysis is normal, that’s great news!

If it’s abnormal, your fertility team will look deeper into:

• Lifestyle factors: heat exposure, diet, stress, toxins.

• Hormones: checking FSH, LH, testosterone, and prolactin.

• Genetics or anatomy: chromosome testing, ultrasound, or sperm extraction when needed.

Treatment options depend on the results — from optimizing health and timing to procedures like IUI, IVF, or ICSI.

The Bottom Line

A semen analysis is simple, affordable, and incredibly informative. Whether you’ve conceived before or not, it’s always worth checking if you’re having trouble getting pregnant. Fertility is dynamic, and sperm health changes over time.