A semen analysis, also known as sperm test or spermogram, is a type of test to evaluate the quality of a sperm sample and the sperm count. In other words, it is an effective method for determining male fertility.
Broadly speaking, after collecting the semen sample, the clinic analyzes the different sperm parameters in the lab. When the results are ready, a report with the results is provided to the patient. In order to understand them, it is important that you learn how to read them. Here are some key factors to keep in mind when it comes to interpreting a semen analysis.
The different sections of this article have been assembled into the following table of contents.
The WHO (World Health Organization) has published a series of guidelines as regards the sperm parameters that should be examined in a semen analysis, and has established the reference values to determine if the results are normal or not.
Sperm parameters can be examined macroscopically and microscopically. Continue reading in order to learn how to understand each type of analysis along with the reference values of each:
A macroscopic examination allows the specialist to evaluate the basic characteristics of the sperm sample, that is, the ones that can be seen by the naked eye, without using a microscope. The following are key values:
- Measured in milliliters (ml). Samples are considered normal if the volume is above 1.5 ml.
- The sample needs to be liquefied for 20 minutes prior to doing the analysis until it becomes totally liquid.
- The normal color of the semen is yellowish to greyish. If the sample is too transparent, it may indicate the presence of white blood cells (leukocytospermia). If it is too opaque, it is likely that the sperm count is high.
- The specialist measures the length of the threads formed by drops. Threads must break so that the sample can be examined accurately. A sample that is too viscose can indicate prostate problems.
- The normal pH of semen ranges between 7 and 8. Variations under or above this range are associated with infections.
If a macroscopic examination is more associated with the external traits of the semen and the fluids it is composed of, a microscopic examination focuses on all aspects related to the sperm cells.
To this end, a drop of semen is put in a Makler counting chamber to analyze the following sperm parameters under the microscope:
- Sperm count
- The total sperm count must be higher than 15 million sperm per milliliter or 39 million per ejaculate in order to be considered normal.
- Sperm motility
- It is used to examine the percent of motile sperms in the sample, as well as the ones that are able to "swim" in terms of rapidly progressive, slowly progressive, or non progressive. A sperm sample is considered normal when more than 40% of sperm are able to move and over 32% are able to make forward progress.
- Sperm vitality
- There exist many tests to determine whether there are dead sperm cells in the ejaculate: eosin Y dye test, hypo-osmotic swelling test, etc. For a semen sample to be considered normal, the percentage of live sperm should be above 58%.
- Sperm morphology
- Hematoxylin and Eosin stain is used to evaluate the morphology of a drop of semen. The sperms are examined one by one to detect the presence of anomalies. Normal forms must be present in at least 4% to consider that the sample is normal.
- Presence of WBCs
- In case white blood cells (WBCs) are present in the sample, the amount is examined under the microscope. If the presence of WBCs or leukocytes is above 1 million/ml, it is an indicator of infections. This condition is known as leukocytospermia or pyospermia.
You may also enjoy some further information reading this: What Is a Semen Analysis Report? – Purpose, Preparation & Cost.
How to read a sperm analysis report
Once you have the results of the semen analysis, you should consider the following aspects concerning the format in order to understand your report accurately:
- The WHO's reference values are normally included in brackets next to your result.
- The sperm count is provided in millions per milliliter (ml).
- Sperm motility, morphology, and vitality are provided in percentages.
- The unit measures or reference values used might differ from lab to lab, should you repeat the semen analysis at a different clinic.
- The WHO's reference values used today are the ones they published back in 2010.
If the results of your spermogram reach the lower reference values of semen variables established by the WHO, your semen analysis report is considered normal. In other words, you don't have any fertility issues. This is known as normozoospermia.
In case any of these parameters fall outside these ranges, the sample will be considered abnormal. These are the different types of sperm disorders that may be diagnosed:
- Zero sperm count
- Low sperm count
- Poor sperm motility
- Abnormal sperm morphology
- High number of dead sperm
- Low sperm volume
It is also possible to have a combination of two or more of these pathologies, such as oligoasthenoteratospermia. The prognosis in these cases will be worse.
In any case, the chances of getting pregnant will depend on the parameter that is affected and the grade of severity.
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FAQs from users
What happens if my sperm sample is rejected?
Sperm specimens that are rejected for any reason should be repeated three days after last ejaculation in order to respect the abstinence period.
The results of my semen analysis are abnormal, what's next?
Your doctor will evaluate the results of the semen analysis along with other tests such as hormonal testing, anatomical evaluation, related conditions, genetic factors, medical history, etc.
Only by doing this, he or she will be able to identify the cause behind abnormal results and find the best possible solution or treatment. In case the results don't improve after repeating the semen analysis, it is likely that a fertility treatment is needed.
What causes round cells in sperm?
Sometimes, a macroscopic examination of a sperm specimen shows a high percentage of round cells in addition to sperms. Normally, they are just bladder, prostate or urethral epithelial cells, immature germ cells, or white blood cells (leukocytes).
The presence of leukocytes indicates the presence of an infection, which could lead to alterations in other parameters. In this case, the semen analysis would be repeated after treating the infection with antibiotics.
Suggested for you
This post focuses on the interpretation of a semen analysis report. To learn how to prepare, how long you should abstain before a sperm analysis and more, read: What Is a Semen Analysis Report? – Purpose, Preparation & Cost.
Also, we have made several references to a condition called leukocytospermia or pyospermia, which is diagnosed when the presence of white blood cells is detected in a sperm sample. See this for more: Leukocytospermia or Pyospermia – Symptoms, Causes & Treatment.
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