What Is a Semen Analysis Report? – Purpose, Preparation & Cost

By BSc, MSc, PhD (embryologist), MD, MSc, PhD (gynecologist), BSc, MSc (embryologist), MD (gynecologist), BSc, MSc (embryologist) and (invitra staff).
Last Update: 04/22/2020

A semen analysis or sperm test, also known as seminogram, semenogram or spermogram, is a diagnostic test which purpose is to evaluate the quality of sperm. Thanks to it, the specialist can assess various macroscopic parameters, including the pH and volume of the semen, as well as microscopic, like the sperm morphology, sperm motility, and sperm count.

The World Health Organization (WHO) has established reference values to determine what are normal results for a semen analysis report. Based on these guidelines and the results obtained, we can look for the presence of abnormalities that may lead to male infertility, and anticipate what are a man's chances of achieving pregnancy.

Provided bellow is an index with the 9 points we are going to expand on in this article.

Instructions & preparation

For the results of a semen analysis to be accurate, the WHO recommends patients to abstain for 3 to 5 days before the analysis. This includes any form of ejaculation, whether it is sexual intercourse or masturbation.

To obtain a reliable result and be able to get a reliable diagnosis of male infertility, it is recommended to undergo a second semen analysis within one month after the first to check if the result is the same or varies. Sometimes, certain environmental or lab conditions can lead to abnormal sperm test results, and qualify a man as infertile when he's actually not.

Recommended reading: Sperm Test Results Explained – Interpretation & Normal Values.

How to collect sperm for analysis

Semen vials are collected by means of masturbation, after washing your hands and genitalia adequately. Your fertility clinic will provide you with a sterile sample cup for you to ejaculate directly into it.

It is crucial to collect the entire specimen. Most men feel uncomfortable or are nervous providing the semen sample, and this may cause a portion of the sample to spill, especially the first fraction.

If you lose part of the semen or any portion spills, the results of your semen analysis won't representative, and the test will be considered invalid. You should notify the lab technician if this happens and book an appointment to collect your semen anew.

Ideally, the sample should be collected at the fertility clinic in order to prevent environmental factors to alter the sample. However, many clinics offer their patients the possibility of collecting the specimen at home and dropping it off directly at the lab, as long as it occurs within the next 30 minutes following ejaculation.

If you prefer to collect the specimen at home, you should take special care of the sample until you get to the clinic or lab by keeping it under adequate temperature and light conditions. Keep the sterile container in a pocket, close to your body, covered in an aluminum foil to avoid exposure to sunlight.

If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

What's a normal report like?

In 2010, the World Health Organization (WHO) produced the latest reference values for examining the results of a semen analysis. Results under these reference values mean that a sample is abnormal.

The process for evaluating a man's semen sample is divided into two stages: On the one hand, a macroscopic exam, and on the other hand, a microscopic exam. Generally, a complete seminogram pays attention only to the basic values established by the WHO. Depending on the clinic or lab, the steps involved in the process may vary, though.

Macroscopic examination

A macroscopic examination is the first analysis carried out when it comes to evaluating the results of a sperm test. It is used to examine basic semen features, including:

Used to measure, in milliliters (ml), the amount of semen expelled with ejaculation. Values from 1.5 ml or above are considered normal.
It measures the time it takes for the semen to change from a thick gel into a liquid. Normally, it occurs within 20 minutes. The specialist needs the sample to be less thick in order to perform the macroscopic examination more accurately. Fibrinolysin, a protein that is expelled along with the ejaculate, is responsible for semen liquefaction. If it does not occur, we may suspect that there exists a pathology.
For it to be examined, the specialist measures the length of the threads formed by drops. In cases of semen hyperviscosity (SHV), the threads must break so that the sperms can swim freely in the seminal fluid.
Under normal conditions, the color of semen ranges between cloudy white-gray to slightly yellowish. Should it be different, it may indicate the presence of an infection.
Normal values of semen pH vary between 7.2 to 8.0. These are considered average-pH-of-semen values. Results above or below average can indicate an infection or alterations in the production of seminal fluid.

Microscopic examination

Through a microscopic examination of the semen, we can evaluate the following parameters:

Sperm count & concentration
Measured in two values. On the one hand, the sperm concentration per milliliter (ml), which is considered normal when the result is 15 million/ml or higher. On the other hand, the total sperm count in the ejaculate. Values from 39 million of sperm/ml are considered within the normal range.
Sperm motility/mobility
It refers to the sperm's ability to move.
Generally, it is divided into two values: the total motile sperm count, which should be at least 40%, and the total progressive motility (sperms can "swim" and move forward), which should 32% or above to be considered normal. Some labs pay attention to the type of movement as well—rapid, moderate, or sluggish/slow.
Sperm vitality
This parameter is typically examined using a dye. However, this is not the method used by default: Only if an elevated number of non-motile spermatozoa is found, to determine whether they are non-motile life (NML), or dead. According to the WHO's guidelines, the percentage of total live sperm must be 58% or above.
Sperm morphology
The shape of the head, the presence of a middle-piece and neck, and the tail are the features taken into account when examining this parameter. The WHO's guidelines consider that a semen sample is morphologically normal when at least 4% of the total sample has a normal shape, free from sperms with defects in any of their parts.
White Blood Cell (WBC) count
It is not uncommon to find other cells in the sample in addition to spermatozoa. WBCs or leukocytes, as well as epithelial cells, are the most common ones. Samples with an elevated number of leukocytes usually translate into the presence of an infection (leukocytopenia or pyospermia).

We have talked to Dr. Sergio Rogel about all aspects that are evaluated during a seminogram:

Classically, during a seminogram, macroscopic aspects of the semen sample are evaluated, such as volume, pH, consistency, color; and then the microscopic parameters that are most important are analyzed, including sperm count, concentration per milliliter, motility, and normality of the seminogram shapes. This is typically the seminogram that everyone knows.

Furthermore, nowadays there are aspects that we can look at in a semen sample that is not really what we would call a seminogram, but they are techniques that can be used and would be called advanced seminograms, such as the study of apoptosis in sperm, DNA fragmentation, etc.

Total Motile Sperm Count (TMSC)

The Total Motile Sperm Count (TMSC) is an additional test that is normally carried out along with the seminogram.

When measuring the TMSC, the specialist classifies the sperms into groups based on their motility.

By doing this, we can obtain a fraction of the sample containing only the sperms with the best motility level. In short, this allows us to evaluate the quality of the spermatozoa recovered. This allows us the specialist to discover what fertility treatment will offer the highest success rates depending on the quality of the sample analyzed.

For instance, sometimes the sperm count and the sperm motility appear to be excellent with a basic sperm test. However, it may not respond very well after being capacitated, and its quality can become poorer after centrifugation. This would mean that performing intrauterine insemination (IUI) would be useless, as the chances for a pregnancy to be achieved with this technique would be too low.

To get a fraction of motile spermatozoa, the specimen goes through a process called sperm capacitation or sperm washing. Although there exist various methods to capacitate a sample, it can be done using the swim-up technique, or by means of density gradient centrifugation.

A sample is considered normal when the Total Motile Sperm Count (a+b) is above 3-5 million sperms.

How much does a semen analysis cost?

Normally, the cost range for semen analysis is $50-300, although it varies from clinic to clinic, and can be higher if it is done without insurance—more often than not, the price of out-of-pocket semen analyses is $275 approximately.

Many of the costs of fertility tests are usually covered by health insurance plans, but we recommend that you ask your health insurance provider for detailed information on what's covered and what's not.

As mentioned earlier, the total price of semen analysis testing depends on the type of exam ordered. It should be clear that not all clinics and/or labs charge the same fees, and not all may include the same parameters. For example, some clinics do not include morphology in the most basic semen analysis. This means that you have to pay an extra amount to have the morphology of your sperm analyzed as well.

If you prefer to collect the specimen at home, the cost of at-home semen analysis kits is $150 with insurance, or more than $250 without insurance, plus an average fee for shipping that varies from lab to lab.

FAQs from users

What are normal sperm values?

By Dr. Luis Rodríguez Tabernero MD, MSc, PhD (gynecologist).

As for the normal values of a spermiogram or also called seminogram, the most important ones are:

  • Sample volume ≥ of 1.5 ml
  • pH between 7.2 and 8.0
  • Sperm concentration ≥ of 15 million/ml
  • Total sperm count > 40 million
  • Progressive motility (A+B) ≥ of 32%
  • Living spermatozoa > of 58%
  • Normal spermatozoa ≥ of 4%
  • REM (sperm capacitation) > 5 million, being this the most determining parameter of the seminogram

How long should you abstain before a sperm analysis?

By Rebeca Reus BSc, MSc (embryologist).

Experts recommend patients to refrain from any form os sexual activity that involves ejaculation for at least two days. However, abstinence periods of ten days or over are considered counterproductive, as they may result in a lower sperm count or even decreased sperm motility.

Can you do a sperm analysis at home?

By Rebeca Reus BSc, MSc (embryologist).

Yes, although they cannot replace a sperm test done at lab by no means. Home sperm tests only measure the sperm count, which is a key factor, but not the unique factor to keep in mind when diagnosing infertility, as we have seen throughout this post. The only thing required by home tests is for the man to ejaculate into a collection cup and to wait for 10 minutes to get a result.

What is the ideal motile sperm count for IUI?

By Rebeca Reus BSc, MSc (embryologist).

Above 5 million sperm/ml. If the total motile count after being processed is less than 5 million, success is unlikely, and other techniques such as IVF should be considered. Keeping this in mind, we can say that sperm counts between 20-30 million/ml of semen before washing and subsequent IUI are ideal.

How long should you wait for sperm test after vasectomy?

By Rebeca Reus BSc, MSc (embryologist).

Typically, the second test is done 20 weeks post vasectomy. Semen testing after vasectomy is an essential part of the process, is it confirms the absence of sperm in your semen (azoospermia) and removes the risk of getting an unwanted pregnancy. In fact, you will need to produce various samples during a determined period of time to make sure that the presence of sperm does not reappear in your sample.

How much does it cost to get a sperm analysis?

By Zaira Salvador BSc, MSc (embryologist).

The general rate for a lab semen analysis in the United States of America ranges between $100 and $300, although it varies from US state to state.

In the United Kingdom, a basic semen analysis costs £130 approximately. Finally, in Canada, it costs 250 CAD on average.

Do the results of a sperm analysis improve after vasectomy reversal?

By Rebeca Reus BSc, MSc (embryologist).

Although it is actually very complicated to recover your initial levels of sperm quality after vasectomy, it can be recovered if the reversal is done properly. Some semen achieves high sperm count and good motility after 3-4 months post reversal, but it does not happen in all cases.

How much can a Sperm DNA Fragmentation test cost?

By Rebeca Reus BSc, MSc (embryologist).

Sperm DNA Fragmentation tests give you an overview of the amount of damage in the sperm cells, which can decrease a couple's chances of pregnancy. These test normally cost about $275, but it depends on the clinic chosen.

What is WBC count in sperm analysis?

By Rebeca Reus BSc, MSc (embryologist).

WBC count or concentration refers to the presence of White Blood Cells (also known as leukocytes or pus cells) in the semen. They appear when there is an infection, and can indicate that the patient suffers from leukocytospermia or pyospermia. If this is the case, your doctor will prescribe antibiotics to destroy the bacteria and erradicate the infection. This will prevent the infection from spreading through the rest of the patient's body.

How long before sperm test results?

By Rebeca Reus BSc, MSc (embryologist).

It depends on the lab you are working with and their workload, of course. Technically, the results of a sperm test can be obtained on the same day after the collection of the sample. However, in practice, it takes about 2-3 days.

Do you always need a referral to get a sperm analysis?

By Rebeca Reus BSc, MSc (embryologist).

Yes. When a man has been trying to conceive for one year without success, the couple is recommended to visit a fertility specialist to have the fertility of both checked. In such case, the man will be referred to get a sperm analysis or seminogram, and the if he produces fertile sperm or not. You can, however, take an at-home sperm test kit, although its effectiveness is not as good as if done at the lab.

Is there a sperm test to detect the gender in sperm?

By Rebeca Reus BSc, MSc (embryologist).

Yes, and it is known as sperm sorting. It is a widely used gender-selection technique that is done prior to the insemination of the egg. Sperm sorting allows the specialist to separate X-chromosome (female) sperm from Y-chromosome (male) sperm. While sperm sorting is done prior to conception, PGD with sex selection is performed after conception, once the embryos have been created, and prior to being transferred to the uterus.

Learn more about the different gender selection options available nowadays here: Guide to Gender Selection Methods.

They found sperm in my urine test, is it normal?

By Rebeca Reus BSc, MSc (embryologist).

No, it is not. It may indicate that your spermatozoa are traveling backwards into the bladder, instead of being expelled from the penis during ejaculation. In other words, it may be an indicator of retrograde ejaculation. It can be detected by a post-ejaculation urianalysis, which may be recommended by your doctor in order to find out other possible causes of infertility.

Suggested for you

After getting the results of a semen analysis, the patient is given a diagnosis. The following article explains to you how to understand it: How to Interpret the Results of a Semen Analysis.

Also, if you want to learn more about the sperm capacitation or washing procedure, you can get more info here: Instructions & How to Prepare for a Semen Analysis.

We make a great effort to provide you with the highest quality information.

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Authors and contributors

 Luis Gijón Tévar
Luis Gijón Tévar
BSc, MSc, PhD
Bachelor's Degree in Biological Sciences with specialization in Genetics from the University of Valencia. Master's Degree in Human Reproduction from the Pediatrics, Obstetrics and Gynecology Department of the University of Valencia, where he completed the PhD program "Obstetrics & Gynecology II" as well. Cryopreservation Lab Supervisor at FIV Valencia and Coordinator of CrioFIVV. More information about Luis Gijón Tévar
Dr. Luis Rodríguez Tabernero
Dr. Luis Rodríguez Tabernero
MD, MSc, PhD
Degree in Medicine and Surgery from the University of Salamanca and Specialist in Obstetrics and Gynaecology via MIR. Dr. Rodríguez Tabernero is responsible for the Human Assisted Reproduction Unit of the Gyaecology and Obstetrics Department of the Hospital Clínico Universitario de Valladolid since 2013 and has also been working in the field of reproductive medicine since 2000. More information about Dr. Luis Rodríguez Tabernero
Licence number:474705276
 Rebeca Reus
Rebeca Reus
BSc, MSc
Degree in Human Biology (Biochemistry) from the Pompeu Fabra University (UPF). Official Master's Degree in Clinical Analysis Laboratory from the UPF and Master’s Degree about the Theoretical Basis and Laboratory Procedures in Assisted Reproduction from the University of Valencia (UV). More information about Rebeca Reus
 Sergio Rogel Cayetano
Sergio Rogel Cayetano
Bachelor's Degree in Medicine from the Miguel Hernández University of Elche. Specialist in Obstetrics & Gynecology via M. I. R. at Hospital General de Alicante. He become an expert in Reproductive Medicine by working at different clinics of Alicante and Murcia, in Spain, until he joined the medical team of IVF Spain back in 2011. More information about Sergio Rogel Cayetano
License: 03-0309100
 Zaira Salvador
Zaira Salvador
BSc, MSc
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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