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.
The different sections of this article have been assembled into the following table of contents.
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 a aluminum foil to avoid exposure to sunlight.
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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.
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.
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 live (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 (leukocytospermia or pyospermia).
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 an 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
How long should you abstain before a sperm analysis?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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 you how to 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.
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FAQs from users: 'How long should you abstain before a sperm analysis?', 'Can you do a sperm analysis at home?', 'What is the ideal motile sperm count for IUI?', 'How long should you wait for sperm test after vasectomy?', 'How much does it cost to get a sperm analysis?', 'Do the results of a sperm analysis improve after vasectomy reversal?', 'How much can a Sperm DNA Fragmentation test cost?', 'What is WBC count in sperm analysis?', 'How long before sperm test results?', 'Do you always need a referral to get a sperm analysis?', 'Is there a sperm test to detect the gender in sperm?' and 'They found sperm in my urine test, is it normal?'.