About the Test
Purpose of the test
There are several circumstances in which a doctor may order a semen analysis. The most common reason for ordering this test is to evaluate fertility in a male or anyone who produces sperm.
Infertility describes challenges in getting pregnant or carrying a fetus to term. Infertility can be caused by a disease or health condition affecting the reproductive tract in one or both partners.
After a medical history and physical exam, a semen analysis is usually the first test ordered to detect fertility issues in people who produce sperm. Depending on the results of this test, a doctor may recommend additional testing or medical treatment to enhance fertility.
Another purpose of semen analysis is to assess the results of a vasectomy. A vasectomy is a surgical procedure to prevent sperm from entering the semen. Performing a semen analysis around three months after a vasectomy helps doctors ensure that sperm is not present in the semen, meaning a person is no longer fertile.
What does the test measure?
A standard semen analysis includes several measurements used to evaluate the semen and sperm.
During this analysis, a medical professional begins by measuring semen volume, which indicates the total amount of semen contained in the sample. They also note other factors like the color, consistency, and chemical makeup of the semen. Semen pH is then measured to determine the acidity or alkalinity of the sample.
Additional measurements are made by examining the semen under a microscope. These measurements include a sperm count, which describes the total number of sperm in the sample, and sperm concentration, which is a measurement of the number of sperm contained in a milliliter of semen.
When viewed under a microscope, the health professional can also measure sperm motility, which is the percentage of sperm in the sample that are moving. Progressive motility refers to sperm that are mainly moving in a straight line, while non-progressive motility refers to sperm that are not moving in a straight line. Sperm morphology is another measurement that describes how many sperm in the sample have a shape that looks normal.
A health professional may note other abnormalities seen in the semen, including evidence of agglutination, which describes clumping of the sperm. Microscopic examination may also check for other types of cells in the semen such as immature germ cells, which are sperm cells that are not yet fully formed, and white blood cells called leukocytes.
When should I get a semen analysis?
Testing to determine whether a person is fertile is called an infertility evaluation. Doctors usually determine when to do an infertility evaluation based on several factors, including a person’s medical history, age, and the results of a physical exam.
Infertility testing may be recommended when a couple is unable to get pregnant after having frequent unprotected sex for more than a year or for more than 6 months if the female partner or partner with a uterus is older than 35 years of age. Doctors may also recommend a semen analysis for couples that have concerns about fertility and are interested in testing.
When conducted to evaluate the success of a vasectomy, a semen analysis is typically performed around three months after the patient undergoes surgery.
Finding a Semen Analysis
How to get tested
A semen analysis is usually performed at a doctor’s office or similar medical setting. Patients are given access to a private room with instructions on how to collect a sample of semen via masturbation.
Patients may be able to obtain a sample at home by using a special condom that can collect semen during sex. In this case, the sample must be quickly brought to a medical setting where the semen can be analyzed.
Can I take the test at home?
Several options are available for testing sperm at home including self-tests and self-collection tests:
- Self-tests allow you to both collect and test a semen sample at home. The tests usually measure sperm count and/or sperm motility and don’t typically provide any other assessments of semen or sperm.
- Self-collection tests provide the materials to collect a semen sample at home and send it to a laboratory for analysis. These tests provide a wider variety of measurements than at-home self-tests. However, self-collection tests may not provide the same number of measurements as a physician-ordered test.
How much does the test cost?
The cost of a semen analysis is variable. Costs vary based on where the test is conducted, whether other tests are performed at the same visit, and whether the semen analysis is covered by your health insurance plan. For questions about the cost of infertility testing or a semen analysis, it’s important to consult with a doctor, your insurance company, and/or the medical facility where the test is performed.
Taking a semen analysis
Semen analysis requires first collecting a sample of semen and returning the sample to a health care provider who analyzes it under a microscope. Two or more semen analyses may be recommended with samples collected one or more weeks apart.
Before the test
Prior to the test, your doctor will provide instructions for collecting a sample of semen. Your doctor will recommend abstaining from ejaculation beforehand, usually for around two to seven days. Make sure to carefully follow your doctor’s instructions because this can affect the accuracy of your test results.
Prior to sample collection, you may be instructed to urinate, wash your hands, and wash your penis to in order to avoid contaminating the semen sample with bacteria from your skin.
During the test
Samples of semen are usually collected by masturbating into a sterile container. This may be done at home but is usually performed in a private area at your doctor’s office or a laboratory.
If you prefer a different collection method, your doctor can provide a special condom that can be used during intercourse to collect semen. Do not use another type of condom, which may contain lubricants and other chemicals that are toxic to sperm.
When collecting a semen sample, it’s important to collect all of the ejaculate produced. Tell your doctor if for any reason you were not able to collect all of the semen in the container.
After the test
Once you’ve collected a sample of semen, the collection container can be returned to the medical professional conducting the analysis. If a special condom was used to collect the sample during intercourse, instructions are provided for closing the condom and getting it to the lab.
If you are collecting your semen sample at home and transporting it to your doctor, it’s important to get your sample to the laboratory within 30 minutes of ejaculation. For the most accurate results, your sample should be analyzed within one or two hours depending on the collection method.
There are no risks associated with collecting a sample of semen, and you can return to normal activities after the test is complete.
Semen Analysis Test Results
Receiving test results
The results of a semen analysis are often available within a few business days. Your doctor may call you with the test results or request that you make an appointment to discuss them in person. You may also receive your results through a website or other secure online platform.
Interpreting test results
To understand fertility, doctors consider the results of a semen analysis along with your health history, the findings of a physical exam, and the results of other tests.
Each measurement in a semen analysis provides information about the presence or severity of fertility issues. Your semen analysis is usually compared to reference limits. These reference limits have been determined by research studies that have analyzed semen in couples that had successful pregnancies.
Based on that research, the likelihood of becoming pregnant is lower in people with the following results from a semen analysis:
- Semen volume: 1.5 milliliters (mL) or less
- Total sperm count: 39 million sperm per sample or less
- Sperm concentration: 15 million sperm per mL or less
- Sperm motility (total): 40% or less
- Sperm morphology: 4% or less of sperm has a normal shape
- Semen pH: 7.2 or lower
- Leukocytes: More than 1 million
It’s important to understand that the results of a semen analysis cannot definitely diagnose fertility or infertility. People who have results below the established ranges may be fertile, and those with seemingly healthy results may be infertile. In addition, reference limits for sperm analysis can vary by geographic area and by laboratory.
Abnormal results from semen analysis may reflect an underlying health issue that affects the amount of sperm produced or its ability to reach and fertilize an egg in a partner’s body. Sperm may be affected by factors like age, lifestyle, genetics, hormone function, and health conditions affecting the testicles and reproductive tract.
When semen analysis is used to confirm the results of a vasectomy, doctors look for the absence of sperm in the semen. Even after a successful vasectomy, it can take at least 20 ejaculations to clear all semen from the reproductive tract.
For more information about the reference ranges used to interpret your semen analysis and what they mean for your fertility or vasectomy results, talk to your doctor or reproductive specialist.
Are test results accurate?
A semen analysis is a common and important test used to assess fertility. However, several issues can impact semen testing and affect the accuracy of test results:
- Timing of ejaculation: Follow your doctor’s advice carefully when timing how long to abstain from ejaculating prior to testing. Waiting too many or too few days can affect test results.
- Not collecting a complete sample: If your sample is missing a fraction of the semen you produce, it can cause misleading results. For this reason, it is important to collect all of the semen produced during ejaculation.
- Taking too long to return the sample: Semen samples should be evaluated quickly after collection, and waiting too long to return the sample can change test results.
When considering the results of a semen analysis it’s also important to keep in mind that sperm production can vary based on many factors including your overall health, activities, and stress level. This normal variation in sperm production is why several samples may be collected on different days for semen analysis.
Do I need follow-up tests?
Doctors may recommend several follow-up tests depending on the reasons for the semen analysis.
If the results on an initial semen analysis are abnormal for a patient undergoing infertility testing, a second semen analysis may be ordered one or two weeks after the initial test.
A semen analysis is typically just one test used in a broad assessment of fertility in people who produce sperm. Semen analysis may show possible problems with sperm, but it cannot determine their cause. For this reason, further tests may be necessary to understand your reproductive health.
Depending on the results of the semen analysis, doctors may recommend imaging and other tests used to evaluate fertility and find potential causes of infertility. These tests often check the levels of certain hormones including:
Other types of tests may also be used to look for specific problems with the sperm or the reproductive tract. In some cases, testing may check for genetic conditions that can affect fertility.
In patients undergoing testing after a vasectomy, follow-up testing may be recommended if healthy sperm are still detected in the semen at the three-month follow-up visit. If healthy semen are found, an additional semen analysis may be conducted a month or two later.
Questions for your doctor about test results
When reviewing the results of your sperm analysis, your doctor can answer questions about what the results mean for your health. Helpful questions for your doctor may include:
- What are the results of my semen analysis?
- What do these results mean for my fertility?
- Do I need any follow-up tests?
- Is there anything I can do to improve the results of my semen analysis and increase my fertility?
Fertility testing describes tests used to estimate a person’s fertility and determine the cause of fertility issues. While a semen analysis is an important part of fertility testing in people who produce sperm, there are several other tests that may be ordered when conducting an overall assessment of fertility.
