What If Your Semen Analysis Results Are Abnormal?

Additional Testing and Treatment Options

Concerned man with doctor
If your semen analysis testing comes back abnormal, your doctor will likely order another test to be sure.. Jupiterimages / Getty Images

You've had a semen analysis, and your results are considered abnormal. Maybe your sperm count is low, or maybe your test results have found poor sperm motility or morphology. What does this mean? What's next?

One Abnormal Result Doesn't Mean Male Infertility

The most important thing to know is that one poor result doesn't necessarily mean you're infertile. Your semen analysis can be affected by recent illness, anxiety over the exam and other various factors.

Your doctor will likely order one or two follow-up tests to confirm the results, to see if the abnormal results repeat.

It's also important to remember that the semen analysis results need to be considered together. In other words, if the only abnormal result is a high white blood cell count, but other semen parameters are normal and there are no other signs of infection, then your results may, in fact, be considered normal.

Semen Analysis Results and Potential Fertility

Semen analysis normal and abnormal ranges are based on percentiles — in other words, what percentage of men had this particular result and went on to father a child within a year. Your semen health may be considered subpar, but you may still be able to conceive with those subpar numbers. In fact, normal results on a basic semen analysis don't necessarily guarantee fertility.

Semen analysis is not a test of fertility, but a tool used to investigate possible causes for infertility.

Low sperm count, for example, is not a diagnosis itself, but a symptom that can be only discovered through semen analysis. There are a variety of causes for low sperm count, and sometimes, a cause is never found. If your semen analysis shows low sperm count, your doctor's next goal will be to investigate why this may be occurring, and what can be done to help you and your partner have a baby.

Further Male Fertility Testing

As stated above, your doctor will want to repeat the semen analysis again. If you had trouble producing a sample, your doctor may suggest doing so via intercourse, using a specialized condom meant for the collection of semen samples. (Don't use a regular condom! It can kill sperm, even without added spermicide.)

Beyond the basic semen analysis, depending on testing results, your doctor may also order:

  • A general exam by a urologist.
  • Blood work, specifically to check hormone levels including follicle stimulating hormone (FSH), testosterone, luteinizing hormone (LH), estradiol, and prolactin.
  • More advanced semen analysis testing, which may include Computer Assisted Semen Analysis (CASE), anti-sperm antibodies testing, sperm DNA testing, hypo-osmotic swelling testing, and others.
  • Post-coital testing (PCT), a test that evaluates the woman's cervical mucus after intercourse, to check for live, moving sperm.
  • Genetic testing, to check for chromosomal disorders that can cause male infertility

What If Poor Results Repeat

After additional testing, your doctor may recommend treatment to improve your semen health. This may include lifestyle changes, medications, or surgery. Your doctor may also recommend fertility treatments, like IVF or IVF with ICSI. Another possibility is that your doctor will recommend considering a sperm donor.

It's also possible that your doctor will recommend trying one thing, and if that doesn't work, recommend something else. Treatment is not always as straightforward and quick as we'd like. Your partner's fertility will also be taken into account when devising a treatment plan.

If you'll be trying out medication, lifestyle changes, or surgery, it's important to know that your semen health will take time to improve. While sperm may seem to be produced at the moment of ejaculation, in actuality it takes weeks for sperm to develop within the male reproductive system. This is why your doctor may recommend a follow-up semen analysis three to four months after a treatment plan has been put into action.

Speak to your doctor about his recommended treatment plans. Don't be afraid to ask questions. The more you know, the easier it will be for you and your partner to make informed decisions on moving forward.

More on male infertility:


Infertility: An Overview. American Society of Reproductive Medicine. Accessed April 23, 2009. http://asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/infertility_overview.pdf

Patient's Fact Sheet: Diagnostic Testing for Male Factor Infertility. American Society of Reproductive Medicine. Accessed April 23, 2009. http://asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/Testing_Male-Fact.pdf

Sandro C Esteves, Ricardo Miyaoka, and Ashok Agarwal. "An update on the clinical assessment of the infertile male." Clinics (Sao Paulo). 2011 April; 66(4): 691-700. doi: 10.1590/S1807-59322011000400026.

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