What to Expect With Semen Analysis and Sperm Count Testing

Why It's Done, How It's Done, and What It Measures

Doctor discusses how to have a semen analysis with a man wearing a suit
If you have any questions about your semen analysis, just ask. It can be an emotionally uncomfortable test, but your doctor talks about it every day. Blend Images - Terry Vine / Brand X Pictures / Getty Images

Semen analysis should be part of every couple’s infertility workup. Sometimes referred to as sperm count testing, a real semen analysis includes much more than just a sperm count.

While one-third of infertility cases involves a problem with just the woman, one-third of infertility cases are a problem with just the man and another third involve problems on both sides or unexplained infertility.

This is why every infertile couple must make sure the male partner is tested.

Even if a fertility problem has been identified in the female partner, that doesn't mean the male partner's fertility is normal.

Semen analysis is sometimes overlooked, especially if a fertility specialist isn’t evaluating the couple. A gynecologist may not offered this very basic male fertility test (possibly because gynecologists tend to focus on the woman’s health.)

However, insisting that you have a semen analysis right from the start may save you much heartbreak (and dollars) later. For example, if only female infertility problems are treated, but male factor infertility is involved, any fertility treatments are likely to fail.

When Can the Test Be Done?

Your doctor will probably tell you that you need to abstain from intercourse for at least two to three days prior to taking the test.

According to the American Society of Reproductive Medicine (ASRM), a semen sample should be taken no less than two to three days after sexual intercourse, and no more than seven days.

ASRM also recommends that at least two samples are collected, taken about a month apart.

So, you may need to take the test twice.

Getting the Semen Sample

The semen sample is collected by self-stimulation, or masturbation, into a sterile container.

Because most lubricants contain chemicals that can harm sperm, your doctor will likely ask you to use a "dry rub" when producing the sample.

(Saliva can harm sperm, so don't use your own spit.) There are specialized lubricants that have been approved for use in fertility testing and treatment. Ask your doctor about using one.

The clinic should have a room set aside just for semen collection. They may or may not have materials to help "inspire" you for the collection, so if you know you will need something, bring a magazine or your smartphone along with you.

If obtaining a sample via masturbation is difficult for you, you may be able to collect a sample via intercourse using a specialized condom at home. Do not use just any condom, however! The chemicals in regular condoms can damage the sperm sample, skewing the results.

Ask your doctor about how to obtain the specialized condom.

You may also be able to produce the sample at home via self-stimulation. Talk to your doctor about this option. A semen sample should be evaluated within a particular time frame (within two hours is generally recommended) for best results. If you live far from the fertility clinic, it might be necessary to give the sample at the office.

It’s common to feel uneasy about any medical testing, and men are often nervous providing the sample and anxious to receive the results of a semen analysis.

If you are having trouble ejaculating to produce the sample, speak to your doctor. You're not alone, and there are steps you can take to help get the semen sample.

What the Test Measures

A semen analysis test looks at...

  • the total number of sperm
  • total volume of ejaculate
  • sperm concentration (in other words, how many sperm are in a particular volume of semen?)
  • the color of the semen and how it clumps and liquefies
  • the pH of the semen (how acidic or alkaline is it)
  • how many white blood cells are found in the semen (too many may indicate an infection)
  • how the sperm swim (also known as sperm motility)
  • how many of the sperm are alive and moving (known as sperm viability)
  • sperm shape and size (also known as sperm morphology)

If a sperm culture is being done, the test may also look for additional signs of infection.

According to the World Health Organization, a sperm concentration of 20 million per milliliter, and a total of at least 40 million per ejaculate, is needed for optimum fertility.

In some cases, the number of sperm may be normal, but other factors are less than ideal in the semen, and this is preventing pregnancy achievement.

For a much more detailed overview of what the test measures and why, read Understanding Semen Analysis Results: What's Normal, What's Abnormal, and Why.

What If the Results of the Semen Analysis Are Abnormal?

If abnormal results are obtained, the first step will be to schedule another semen analysis. One abnormal test result doesn't necessarily mean there is something wrong. If you had difficulty producing a sample via masturbation, your doctor may recommend doing the test via intercourse using a specialized collection condom.

Your doctor may also order additional testing. Depending on the results, your doctor may recommend medical treatment to correct the problem, lifestyle changes, or suggest fertility treatments.

Semen analysis results can be tricky to understand, as there are varying standards. Your sperm count results may fall under “normal” on one scale and “below normal” on another.

As always, speak to your doctor if you don’t understand the results.

What If I Don't Want the Test?

It's not uncommon for some men to refuse or be hesitant about semen analysis testing. Reasons men have for not wanting to do the test include fear of having their "manhood" judged, religious objections to collecting the sample, or embarrassment regarding the method of collection.

Discuss with your doctor any concerns or fears you have regarding the test. Skipping male fertility testing can lead to heartbreak and lost time, if later it's discovered male fertility factors were relevant.

Sources:

Patient’s Fact Sheet: Diagnostic Testing for Male Factor Infertility. American Society for Reproductive Medicine.

A Basic Guide to Male Infertility: How to Find Out What’s Wrong. American Urologic Association.

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