Male Fertility Test No. 1 - The Semen Analysis and What it Means

OK, so let me set the scene: You and your partner have been trying to conceive for a while. Your GP has asked you to do a semen analysis. You follow through, and you’re told everything looks normal. Great news, right?

Well, yes - but what does ‘normal’ actually mean? And does this test tell you everything you need to know?

What Is a Semen Analysis or Sperm Test?

A semen analysis is a test that evaluates the health and viability of a man's sperm. It's an important first step in assessing male fertility and can help identify potential issues that might affect conception.

Some things to consider about the reference ranges in a semen analysis:

Reference values may vary slightly between labs, but the values I've provided below are defined by the W.H.O. (2021), Sixth Edition of the W.H.O. Manual for Human Semen Analysis (a bit of a mouthful, sorry). For this post, I am referring to these values as ‘normal’ rather than healthy, let me explain why:

These values represent the lowest acceptable range for natural conception; anything below these ranges suggests that IVF/ICSI is indicated. The values in a semen analysis have been taken from the lowest 5th percentile of fertile men. These reference ranges show the cut-off for the levels that suggest you should be able to conceive naturally. Ideally, you would want to exceed these ‘normal’ values for optimal fertility.

Understanding Your Semen Analysis

If you've recently had a semen analysis, you might be staring at a page full of numbers and unfamiliar terms. What does it all mean? I’ll break down the key markers and help you understand their meaning.

Key Markers in a Semen Analysis

Marker	Description	Normal Reference Range
Volume of Ejaculate	Measures the amount of semen produced.	> 1.4 ml
pH	Measures the acidity or alkalinity of the semen.	7.2 – 8.0
Sperm Concentration	Measures the number of sperm per milliliter of semen.	> 16 million/ml
Total Sperm Number	Total number of sperm in the entire ejaculate.	> 39 million
Motility	Percentage of sperm that are moving. Total motility should be high, with a portion showing progressive (forward) movement.	Total: > 42%; Progressive: > 30%
Morphology	Assesses the shape of the sperm. Indicates the percentage of sperm with a normal form. Does not assess quality or DNA damage.	> 4% normal forms
Agglutination and Aggregation	Refers to sperm clumping. Presence may indicate inflammation, infection, or prior surgery, and can interfere with analysis of concentration and motility.	Ideally none; presence may be clinically relevant
Sperm Antibodies	The presence of antibodies against sperm may impact fertility.	Ideally undetectable

Why These Markers Matter

Each of these markers plays a role in the health and function of your sperm.

Low sperm count (concentration) can reduce the number of sperm capable of reaching and fertilising an egg. In more severe cases, this may impact success even with Assisted Reproductive Technology (ART).

Poor motility affects the sperm's ability to swim toward the egg. Natural conception relies on sperm moving efficiently through the female reproductive tract, so poor or sluggish movement can significantly reduce the chance of fertilisation.

Abnormally low or high pH levels in semen can impact sperm survival and motility. While this may seem like a minor detail, pH imbalances can indicate underlying issues such as infection or inflammation.

Poor morphology reflects how many sperm are structurally normal. While this doesn’t directly measure DNA quality, it can be a marker of how well sperm were produced and whether they’re functionally capable of reaching and fertilising an egg.

Agglutination and aggregation, where sperm clump together, may result from infection, inflammation, or immune reactions, particularly when paired with the presence of sperm antibodies. These antibodies, often produced after infection, injury, or surgery, can impair motility and function.

Semen pH and sperm antibodies are two markers that are often overlooked or dismissed in conventional medical assessments unless they’re significantly abnormal. However, from a functional medicine standpoint, even subtle changes in pH or the presence of low-level antibodies can be clinically relevant. These findings may point toward underlying issues such as chronic infection, inflammation, or immune disregulation. In these cases, further investigation is warranted, such as blood tests to assess hormone profiles or a semen culture to rule out infection, especially if conception is proving difficult despite ‘normal’ semen parameters.

Where Things Can Get Complicated

Semen analysis on its own should not be relied on to rule out male factor infertility or suboptimal sperm quality. Your semen analysis results could all come back within the normal range, but as this doesn’t give the full picture, you could still have trouble conceiving.

A key limitation of the semen analysis is how the results are often interpreted in clinical settings. There’s a common misconception, both among patients and sometimes even among clinicians that if a result is just above the normal threshold, everything is fine. In reality, these reference ranges represent the lowest 5th percentile of fertile men. So if your results are sitting right on the edge or slightly above the cut-off, this does not necessarily mean your sperm are "super sperm", it just means you're not in the lowest-performing group. It’s a low bar, not an optimal one.

For example, a sperm concentration of 17 million/ml technically meets the reference range, but it's only barely above the cut-off of 16 million/ml. In functional terms, this may still present challenges with natural conception, especially when paired with suboptimal motility or morphology. Medical assessments that overlook this nuance risk missing underlying issues that could delay or prevent pregnancy.

Furthermore, semen analysis does not evaluate key aspects of sperm function, such as DNA integrity, oxidative stress levels, or the presence of subclinical inflammation or infection. These limitations mean that a “normal” semen analysis result does not rule out male factor infertility.

A DNA fragmentation test, which assesses the integrity of your sperm’s DNA, is a reliable marker of sperm quality. This test gives further insight into your ability to conceive both naturally and via IVF/ICSI (Agarwal et al., 2021).

If a DNA fragmentation test shows a high level of DNA damage to the sperm, this may warrant further investigation with your GP or fertility consultant. Certain medical conditions, infections, injuries, nutrition, and lifestyle can all have an impact on the quality of your sperm.

The Takeaway

It's important to understand that male factor infertility could present as the sole factor, or as a contributing factor, in up to 50% of infertility cases. As such, we should be ensuring that male fertility is included as a standard part of the investigation process (Krausz, 2015).

A semen analysis is a good starting point, but it doesn’t provide all the information needed to assess male fertility health. You may need to test hormone levels to ensure adequate testicular function, assess the seminal microbiome or do a semen culture to identify potential infections, and measure specific nutrient levels required for sperm health.

Optimal fertility requires optimal overall health! Any health issues contributing to systemic inflammation will affect your sperm quality. Any improvements to your health in the lead-up to conception will not only be beneficial for your fertility but also the health of your future child.

Disclaimer

This blog post is for informational purposes only and should not be considered medical advice. Always consult with a healthcare professional for any health concerns or before making any decisions related to your health or treatment. Interpretation of these results should always be done in consultation with a healthcare professional or fertility clinician.

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References

Agarwal, A., Tadros, N. N., & Sharma, R. (2021). Evaluation of sperm DNA damage by TUNEL assay and its correlation with sperm parameters and outcomes in infertile men. Basic and Clinical Andrology, 31(1), 1–10. https://doi.org/10.1186/s12610-021-00117-1

Krausz, C. (2015). Male infertility: Pathogenesis and clinical diagnosis. Best Practice & Research Clinical Endocrinology & Metabolism, 29(3), 271–285. https://doi.org/10.1016/j.beem.2014.08.002