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 work-up. 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 and unexplained infertility.

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

Unfortunately, the sperm count test is often forgotten, especially if a fertility specialist isn’t evaluating the couple. This basic male fertility test may not be offered if the woman sees her gynecologist for an infertility evaluation (possibly because gynecologists tend to focus on the woman’s health), and fertility testing for the male partner may be overlooked if the woman has already been diagnosed with an infertility problem.

However, making sure to have a semen analysis done early on during fertility testing may save you much heartbreak (and dollars) later. If you treat just the woman, but male factors are involved, any fertility treatments are likely to fail.

For more information on why this test is important, be sure to read this article on the importance of sperm count analysis:

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, a semen sample should be taken no less than two to three days after sexual intercourse, and no more than seven days.

The American Society of Reproductive Medicine 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 either.)

However, 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 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.

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, and if that method would be better for you.

You may also be able to do the test at home, placing the sperm into a sterile container provided by the doctor.

A semen sample should be evaluated within a particular number of hours (within two hours is generally recommended) for best results. If you live very 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 they may have suggestions that could help.

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, check out this article:

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.

More on the male side of infertility:

Sources:

Patient’s Fact Sheet: Diagnostic Testing for Male Factor Infertility. American Society of Reproductive Medicine. Accessed May 29, 2008. http://asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/Testing_Male-Fact.pdf

A Basic Guide to Male Infertility: How to Find Out What’s Wrong. American Urologic Association. Accessed November 20, 2013. https://urology2008-2012.ucsf.edu/patientGuides/pdf/maleInf/A%20Basic%20Guide%20to%20Male%20Infertility.pdf

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