How to Read a Semen Analysis (Spermiogram): What Do the Values Mean?
What do sperm count, motility and morphology values mean? Preparation before the test, reference ranges, why a single analysis is not enough and the path followed when values are low, explained.
A semen analysis (spermiogram) is the first and most basic test in assessing male reproductive health. For couples who want to have a child, the evaluation of the man begins with this test. Yet most men who receive the report do not know what the numbers mean, and so either panic unnecessarily or overlook an important finding. This article is written to help you read your report correctly.
What is a semen analysis and why is it requested?
A semen analysis is a laboratory test that examines the volume of semen and the number, movement characteristics and shape of the sperm cells within it. It is the first step in evaluating the man in couples who have not conceived after a year of unprotected intercourse (six months if the partner is over 35). It is also requested to see the effect of conditions such as varicocele, previous testicular surgery or a hormonal disorder on reproductive health.
What should you pay attention to before the test?
- Abstinence period: 2–7 days is usually recommended. If this period is too short, volume and count may be low; if too long, motility may be reduced.
- Febrile illness: a high fever in the past three months can affect results; tell the laboratory if this applies.
- Sample conditions: the sample should preferably be produced at the laboratory; if produced elsewhere it must be delivered within the stated time and temperature.
- Medication and habits: tell your doctor about the medicines you use and about smoking and alcohol.
What do the main values in the report mean?
The principal lines you will encounter are:
- Volume: the amount of semen ejaculated. A very low volume may indicate a duct-related problem or loss of part of the sample.
- Concentration: the number of sperm per millilitre — the most frequently quoted value.
- Total sperm count: volume multiplied by concentration; this can be more meaningful than concentration alone.
- Motility: the proportion of moving sperm and the percentage of those able to move forward. Progressive movement matters for fertilisation.
- Morphology: the percentage of normally shaped sperm. Because strict criteria are used, low percentages are expected and this value is not interpreted on its own.
- Leukocytes (white cells): a raised level may suggest infection or an inflammatory process.
What do normal values and reference ranges actually mean?
The reference ranges in reports show the lower limits derived from men who have fathered children. This has two important consequences: a man whose values fall below the limit is not necessarily infertile, and a man above it is not certainly fertile. The reference range is a guiding framework, not a decision threshold. The result is therefore interpreted not by numbers alone but together with examination, history and, where needed, hormonal assessment.
Is a single test enough?
No. Sperm production varies over time within the same man; illness, stress, sleep patterns and the abstinence period can all affect the result. A single low result is therefore not decisive; usually at least two separate analyses are requested a few weeks apart. If there is a marked difference between them, a third may be needed.
What happens if the values are low?
Low values are not a diagnosis but a starting point. Naming follows the finding: a low count, reduced motility, a high proportion of abnormal shapes, or the complete absence of sperm in the semen (azoospermia). The next step is to investigate the cause: is there a varicocele on examination, what are the hormone levels, is there a history of infection or surgery, is a genetic factor suspected. In a significant proportion of cases where a cause is found, it turns out to be a correctable one.
Can sperm values be improved?
In many cases, yes. If there is a correctable cause such as varicocele, a surgical option is considered; in hormonal deficiency, appropriate treatment is planned. Alongside this, stopping smoking, weight management, avoiding excessive heat (sauna, a laptop on the lap) and a regular sleep pattern can contribute. One important detail: sperm production follows a cycle of roughly three months, so at least that long is needed before changes are reflected in the results.
When should you see a doctor?
If pregnancy has not occurred after a year of unprotected intercourse (six months if the partner is over 35), assessment of the man should not be delayed. If you already have a low result in hand, do not wait for a second analysis and an andrology assessment. The most accurate result comes from evaluating the couple together.
Assoc. Prof. Zülfü Sertkaya practises in the field of urology and andrology in Istanbul; male infertility assessments are carried out with individualised planning and full confidentiality.