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Getting Pregnant

Semen Analysis: How to Know if You Need One

semen analysis

Essential Takeaways

  • A semen analysis measures sperm count, morphology, and motility
  • A typical semen analysis doesn’t test the genetic health of sperm
  • You might want a semen analysis if you’re thinking about trying to conceive, would like to freeze your sperm, had a vasectomy or vasectomy reversal, or simply want to better understand your health.

A semen analysis, or sperm analysis, is often the first step in fertility testing for men. This non-invasive test is a simple way to get a lot of information about your or your partner’s sperm health, reproductive system function, and fertility potential. But how do you know when you need one—and what should you do with the results? Let’s review.

What does a semen analysis test for?

Sperm and fertility

Sperm cells are the male sex cells (gametes) that carry half the genetic material for a new baby. In order to get pregnant naturally, sperm needs to enter the vagina and travel upwards, through the uterus, toward the fallopian tube, where an egg is ovulated. Then, one sperm must successfully penetrate the egg, combining its DNA with the other half of the genetic material housed within the egg cell, a process called egg fertilization.

Each testing company, laboratory, or doctor’s office is different, but most evaluate a few basic semen and sperm parameters. Each parameter measured in a semen analysis—sperm count, motility, and morphology—can affect the sperm’s ability to reach and/or fertilize the egg.

While certain sperm health parameters can be associated with a higher or lower likelihood of pregnancy, it’s important to note that a sperm analysis won’t tell you whether or not you’ll be able to conceive naturally. There are many factors that contribute to fertility (or infertility); sperm health is just one of those factors, and just one of the markers of fertility potential.

Sperm count/concentration

Sperm count refers to the total number of sperm in the semen; sperm concentration, on the other hand, is the density of the sperm within the semen. For example, a certain sample may have 3 milliliters of semen (volume) and a total sperm count of 45 million; that would be a concentration of 15 million sperm per mL. A sperm analysis typically includes both measures.

While we only need one sperm to reach the egg for fertilization, sperm count/concentration are important for fertility because there are many obstacles on sperm’s route to the egg. So, you need to start with quite a few to increase your chances that one will be able to fertilize the egg for pregnancy. A low sperm count can change how often you should have sex to get pregnant, how long it may take to achieve natural conception, which fertility treatment options are right for you, and more.

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Morphology (the size, structure, and shape of sperm)

Sperm cells are made up of a few distinct parts:

  • the tail, made up of protein fibers, which helps it swim toward the egg
  • the midpiece, or body, which contains mitochondria to power the sperm’s movement
  • the head, which houses the nucleus (where genetic information is stored) as well as the acrosomal vesicle, a structure full of enzymes that digest proteins and sugars on the surface of the egg to aid in sperm penetration.

“Morphology” is a term that refers to the proper shape, size, and structure of the sperm. Being too big or too small, missing a head or tail, or having a misshapen head or tail—any of these errors could impact whether or not the sperm is able to swim to, penetrate, and fertilize the egg. A semen analysis measures what percentage of sperm in a semen sample are morphologically normal.

Motility (how sperm are moving)

Sperm “swim” using small movements of their tails; these movements, along with a little help from the female reproductive system, propel them toward the egg. The tail’s flagellations, which get faster as the sperm approaches the egg, also help the sperm penetrate the egg’s outer layer.

A semen analysis measures what proportion of sperm are moving (total motility). In addition, the test may measure what’s known as “progressive” motility. That’s the proportion of sperm that are not just moving, but moving in a way that’s conducive to reaching and fertilizing the egg: travelling forward or in large circles.

What a standard semen analysis doesn’t test for

A typical semen analysis doesn’t test the genetic health of sperm. We’ve discussed that sperm carries half the genetic material (DNA) for a new baby. However, that DNA can become broken or altered—due to infection or illness, toxin exposure, age, or other factors—preventing it from combining properly with the DNA in the egg to create a healthy pregnancy. A more in-depth test, such as a sperm chromatin structure assay (SCSA), is required to evaluate genetic damage within sperm.

A sperm analysis also typically does not test for antisperm antibodies. Sometimes, a man may make perfectly healthy sperm, but also produce certain immune system substances (called immunoglobulins) that mistakenly attack the sperm in his semen. There are a few tests available, such as the mixed antiglobulin reaction (MAR) test, that detect the presence of these substances within semen.

And of course, a semen analysis doesn’t test for sexual problems, such as erectile dysfunction or inability to ejaculate. While sexual dysfunction is not solely a fertility concern, ejaculation during intercourse is required for natural pregnancy.

How is a semen analysis done?

During a semen analysis, a semen sample is typically produced via masturbation and collected in a small “sample cup,” like what’s used for a urine test. Then, the sample is examined by a doctor or lab technician under a microscope.

Tips for semen analysis

  • Avoid ejaculation for at least 48 hours before the test, to get an accurate reading on sperm count—but not for more than 4 days before the test, as a long period of abstinence can impact the motility of the sperm and increase DNA fragmentation.
  • Lubricant and even saliva can contaminate the sample and affect the results, so go without.
  • It may sound obvious, but a semen analysis sample shouldn’t be collected in a condom—many condoms contain spermicidal ingredients (substances that kill sperm).
  • Sperm health can be affected by illness and fever for up to 2 months, so try to avoid doing sperm testing while you’re sick, recovering from sickness, and for the month or two following.

In-office semen analysis

Traditionally, semen analysis is performed at a fertility clinic, urologist’s office, or laboratory. What to expect: you’ll be brought to a “collection room” (where there’s a chair or bed and often a selection of adult materials) to produce the semen sample. Once you’ve completed that task, you’ll drop off the sample at the lab, where it will be analyzed. Results are usually available within a few days. An in-office sperm analysis usually costs about $250–$500.

At-home semen analysis

Today, there are several at-home options for semen analysis. The at-home sperm analysis kit offered by Legacy provides the opportunity to collect your sample in the convenience and comfort of your own home, and at a lower cost.

An important note: Some at-home kits only test for sperm count. This is a good start, but as we’ve discussed, how many sperm is just one piece of the male fertility puzzle. Legacy’s mail-in kit provides in-depth analysis, just like—or in some cases, more comprehensive than—what you’d receive from a doctor’s office.

How to decide if you need a semen analysis

Who needs a semen analysis? You may want to do this test if you:

Are trying to conceive now or soon

If you’re trying to get pregnant, you might consider having a semen analysis earlier, rather than later, in your fertility journey. Many people wait until they’ve been trying to conceive for 6 – 12 months or more before doing male fertility testing. But early testing can allow you to identify any male fertility problems and potentially improve them on your own, saving time and money (since you can do this step without a doctor consultation). Plus, male fertility testing is generally easier and less invasive than female fertility testing.

Are considering sperm freezing

If you’re considering sperm freezing—maybe before a vasectomy, medical treatment, or military deployment, or because you may have children later in life—you’ll want to know you’re preserving the best possible sperm. By having a sperm analysis before freezing, you have the opportunity to identify any parameters that are sub-optimal (like a low sperm count) and make changes, such as improving your diet or quitting smoking, to get your sperm as healthy as possible before cryopreservation.

Had a vasectomy or vasectomy reversal

A vasectomy is a form of permanent birth control, in which the vas deferens, the duct through which sperm pass from the testicles into the penis, is cut or blocked to prevent sperm from entering the semen. It’s recommended that you get a semen analysis approximately 12 weeks after a vasectomy, to confirm it’s worked as intended.

On the other hand, if you’ve had surgery to reverse a vasectomy (by repairing the vas deferens), it’s recommended that you get a semen analysis every month for 12 months following the procedure, to ensure sperm quality, count, and motility are recovering normally.

Want to understand your fertility potential and your health more comprehensively

Experts believe fertility and overall health are closely linked. There are strong associations between male infertility and obesity, metabolic syndrome, elevated blood pressure, testicular cancer, lymphoma, and even mortality. There’s tons of research currently underway that hopes to understand the exact way sperm health works as a biomarker for general health. So, while there’s still a lot of work to be done before we draw precise conclusions, it can’t hurt to have one more data point to consider in the overall picture of your health.

How to read a semen analysis report

Your semen analysis report will typically include reference numbers for each parameter, indicating what’s considered “normal” according to the World Health Organization’s 5th Edition parameters, as well as your own personal results. Here are the normal ranges for each parameter tested in a semen analysis:

Semen analysis parameter

Normal range

Sperm concentration At least 15 million sperm/mL of semen

Researchers have noted that sperm concentrations under 40 million/mL, while normal, may lower chances of conception.

Sperm motility
Total motility At least 40% of sperm
Progressive motility At least 32% of sperm
Sperm morphology or “normal forms” (NF) At least 4%, may vary depending on testing criteria

Kruger morphology criteria are very strict; under this method of testing, very small discrepancies will deem sperm abnormal. World Health Organization (WHO) semen analysis criteria is slightly more lenient, with a wider range of “normal” morphology.

Other notes on your semen analysis report

Depending on who performs on your semen analysis, you may get additional values. For example, Legacy’s analysis includes extra details on morphology—not only how many sperm are normal, but a thorough breakdown of what the abnormal ones look like. This data is useful for clinics and doctors when deciding how to use the sample. If sperm has a misshapen midpiece, for example, it may still be able to fertilize an egg with a little help from the lab, but a sperm with no head is of no use (since the head houses the genetic material).

For those who want to freeze their sperm, it’s also helpful to have a post-thaw analysis. In this test, the sperm is frozen and then thawed, and an analysis is run to check the concentration and motility of the sample after thawing. This analysis gives doctors a good idea of how many cells will survive the thaw and how many of them will be motile afterwards, which helps them to make more informed decisions about treatment options. At Legacy, we always run a post-thaw analysis prior to freezing sperm.

What to do with your semen analysis results

Freeze sperm

If your or your partner’s sperm analysis report comes back with top marks, it may be a great time to consider freezing some sperm. While male fertility doesn’t decline quite as rapidly, or as dramatically, as female fertility, there are changes to the health of a man’s sperm with age. Sperm acquire a new genetic mutation—which is passed onto offspring—every 8 months. Women with partners over the age of 35 have a higher likelihood of miscarriage, and fathers over 40 are nearly 6 times more likely to have a child with autism spectrum disorder.

By freezing now, you can ensure that you or your partner are preserving the youngest, healthiest possible sperm for potential use later, when age, injury, illness, or a myriad of other possibilities could impact natural fertility. Scientific evidence tells us that sperm can be frozen indefinitely with no effect on pregnancy rates. While sperm preservation is sometimes done at a fertility clinic or sperm bank facility, sperm freezing kits, like Legacy’s, allow you to preserve your sample from the comfort of your own home.

Improve your sperm health

There are many fairly simple lifestyle changes, such as quitting smoking, improving your diet, upping your exercise routine, or switching from briefs to boxers, that can improve factors associated with better sperm health. The Legacy report includes individualized recommendations for better habits that can improve your sperm parameters.

You’ll want to retest to see if your changes have had a measurable improvement on your semen analysis results. Remember that the process of making sperm takes around 74 days, so you’ll want to keep up your new habits for 2–3 months before retesting.

See a fertility specialist

If you’ve been trying to conceive for 6–12 months and your partner’s semen analysis results are abnormal, it’s a good time to see a fertility specialist. A fertility physician, also known as a reproductive endocrinologist, can help assess the issue and suggest strategies to boost your chances of conception.

View sources

Donald P. Evenson and Lorna K. Jost, et al. “Characteristics of Human Sperm Chromatin Structure Following an Episode of Influenza and High Fever: A Case Study.” Journal of Andrology, September/October 2000.

Joshua A. Halpern, MD, and Annie L. Darves-Bornoz, MD, et al. “Underutilization of primary medical care among men presenting for fertility evaluation.” Fertility & Sterility, June 2020.

Augustine Kong and Michael L. Frigge, et al. “Rate of de novo mutations, father’s age, and disease risk.” Nature, August 2012.

Rémy Slama and Jean Bouyer, et al. “Influence of paternal age on the risk of spontaneous abortion.” American Journal of Epidemiology, May 2005.

Abraham Reichenberg, PhD, and Raz Gross, MD, MPH, et al. “Advancing Paternal Age and Autism.” Archives of General Psychiatry, September 2006.

Trevor G. Cooper and Elizabeth Noonan, et al. “World Health Organization reference values for human semen characteristics.” Human Reproduction, November 2009.

Niels E. Skakkebaek. “Normal reference ranges for semen quality and their relations to fecundity,” January 2010.

C. H. Heller and Y. Clermont. “Kinetics of the germinal epithelium in man.” Recent Progress in Hormone Research, 1964.

Dr. Ramy Abou Ghayda

As a dual fellowship trained urologist, Dr. Ramy Abou Ghayda aspires to contribute and advance the field of Men’s Health and Male Infertility. Dr. Ghayda graduated as a general urologist from of Medicine the American University of Beirut Medical Center. Following his training, he completed two fellowships at The University of Illinois at Chicago in Chicago and at Brigham and Women’s Hospital in Boston. In addition, Dr. Ghayda has a Master degree of Public Health from the Harvard T H Chan School of Public Health and a Master of Health Administration from École des Hautes Etudes En Santé Publique and Paris Diderot University-Paris 7, Paris, France. Dr. Ghayda recently joined University Hospitals and Case Western Reserve University as an assistant professor in Urology. He is currently the Head of research and Chief Medical Officer at Legacy, a Harvard-incubated company. Dr. Ghayda is married with 2 kids. He enjoys travel, having visited over 40 countries already.

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