What do my semen analysis results mean?

A semen analysis measures the volume of semen and the number, movement and shape of the sperm. Results are compared with the World Health Organization's 2021 reference values, but these are not a sharp line between fertile and infertile. One abnormal result should be repeated. Many men with low numbers still become fathers, naturally or with IUI, IVF or ICSI.

This page explains what the numbers mean and what usually happens next. It follows the WHO laboratory manual and the current European (EAU) and American (AUA/ASRM) male infertility guidelines, listed at the end.

Why test the man at all?

In about half of couples who have not conceived after a year of trying, a male factor plays a part, according to the American AUA/ASRM guideline. European guidelines recommend that the man is examined and has a semen analysis, and that the woman's fertility, including her egg reserve, is checked at the same time, because one partner's results can change the plan for both. If you are wondering when to start, see when to see a fertility specialist.

How should I give the sample?

The WHO manual asks for a sample collected after 2 to 7 days without ejaculation, by masturbation into a clean container, ideally in a private room close to the laboratory. The laboratory should start the analysis within 30 minutes, and at least within 60 minutes. Collect the whole sample, and tell the laboratory if any of it was lost. A recent illness with fever can lower the results, so mention it if you have had one.

What are the normal values?

The WHO manual (6th edition, 2021) gives the results of about 3,500 men whose partners became pregnant naturally within a year. The figures below are the lower fifth percentile: only 5 in 100 of these fathers had a result lower than this.

What is measured	WHO 2021 lower reference limit
Semen volume	1.4 mL
Sperm concentration	16 million per mL
Total sperm number	39 million per ejaculate
Total motility (all moving sperm)	42%
Progressive motility (sperm swimming forwards)	30%
Vitality (live sperm)	54%
Normal forms (morphology)	4%

The WHO is clear that these numbers do not represent a limit between fertile and infertile men. A result just below a limit doesn't mean you can't father a child, and a result above every limit doesn't guarantee that you can. Your specialist looks at all the results together, alongside your partner's tests.

What do the words on my report mean?

• Oligozoospermia: fewer sperm than the reference limit.
• Asthenozoospermia: fewer moving sperm than the limit.
• Teratozoospermia: fewer normally shaped sperm than the limit. Even in fertile men, most sperm look abnormal under the microscope, which is why the limit is only 4%.
• Azoospermia: no sperm seen. The WHO says this word should only be used when no sperm are found even after the sample has been spun down (centrifuged) and checked.

My result is abnormal. What happens next?

Counts vary a lot from one sample to the next, so the European guideline recommends at least two semen analyses if the first is abnormal. It also recommends, for men with abnormal results:

• a full medical, family and lifestyle history and a physical examination, including the size of the testes;
• hormone blood tests (testosterone, FSH and LH), at least when the count is low or zero;
• a chromosome test (karyotype) and genetic counselling if the count is below 5 million per mL or there are no sperm;
• a test for small missing pieces of the Y chromosome (Y microdeletions) if the count is 1 million per mL or less, and to consider it below 5 million.

A scrotal ultrasound may be added. If you have a varicocele (swollen veins in the scrotum) that can be felt, with abnormal semen and no other cause found, the European guideline recommends treating it when your wife's egg reserve is good. It does not recommend treating a varicocele when the semen analysis is normal, or one seen only on a scan.

The guidelines also advise counselling men with abnormal results about their general health, since poor semen quality can go with other health problems.

Can lifestyle changes improve my sperm?

They can help, and the European guideline gives this a strong recommendation: men should be told that obesity, low physical activity, smoking and heavy drinking harm sperm quality and testosterone, and should be helped to change them. Two more points from the guidelines:

• Don't take testosterone or anabolic steroids if you want children now or soon. Both guidelines advise against testosterone for male infertility, because it switches off the testes' own sperm production and can lower the count to zero. Men who have used anabolic steroids should stop them; the European guideline suggests waiting 6 to 12 months before hormone treatment to restart sperm production is considered.
• Supplements and antioxidants are of questionable benefit. The American guideline says the data are not good enough to recommend any particular product, and the European guideline advises against using them routinely.

Sperm take several months to develop, so give any change about three months before repeating the test.

Do I need a sperm DNA fragmentation test?

Sperm DNA fragmentation (SDF) testing measures how many sperm have breaks in their genetic material. It is not part of a routine semen analysis. Guidelines differ on how useful it is:

• The European guideline (EAU 2025) recommends SDF testing for couples with recurrent miscarriage after natural conception, failed IVF or ICSI, or unexplained infertility.
• ESHRE is more cautious. Its recurrent pregnancy loss guideline says testing could be considered for diagnostic purposes, and its 2023 recommendations on repeated implantation failure after IVF do not recommend it.

What to do about a high result is less certain. The European guideline says varicocele repair may be considered in some men with high SDF, and calls the use of sperm taken directly from the testis for ICSI experimental. The 2024 American update says testicular sperm may be considered for these men. Ask your specialist how the result would change your plan before you have the test. See also recurrent miscarriage and failed IVF.

When are IUI, IVF or ICSI used?

• IUI places washed sperm in the womb around ovulation. The American guideline notes it works less well when the number of moving sperm after washing is low (under about 5 million), and that IVF or ICSI may then be considered.
• IVF with ICSI injects a single sperm into each egg. According to the American guideline, ICSI largely overcomes the effect of low count, poor motility or abnormal shape, as long as enough living sperm are available.

The choice also depends on your wife's age, egg reserve and tubes. For a fuller comparison, see IUI or IVF?

What if there are no sperm at all?

First, the cause. In obstructive azoospermia, the testes make sperm but a blockage (for example after a vasectomy or an infection) stops them getting out. In non-obstructive azoospermia, the testes make few or no sperm. Hormone tests, an examination, a scan and genetic tests usually tell the two apart.

• Blockage: sperm can usually be taken from the epididymis or testis with a needle (PESA, TESA) or by small surgical procedures (MESA, TESE), or the blockage may be repaired microsurgically, especially when the woman's egg reserve is good.
• Low sperm production: both guidelines prefer microdissection TESE (micro-TESE), an operation under a microscope that searches the testis for areas still making sperm. The European guideline advises against needle aspiration (TESA) here.
• Genetic results matter: when certain parts of the Y chromosome (AZFa and AZFb) are completely missing, sperm retrieval surgery is not recommended, because sperm are not found. Any Y microdeletion is passed on to sons conceived by ICSI.

Sperm found in surgery can be used fresh or frozen for ICSI. See male fertility for more on these procedures.

Things to know in Malaysia

• Donor sperm is not allowed in Malaysia. Treatment must use the husband's own sperm, which is why tests, retrieval and ICSI matter so much here. See what Malaysian law allows.
• Sperm can be frozen, for example before cancer treatment or ahead of an IVF day when giving a sample may be difficult. Frozen sperm may only be used within the marriage.
• LPPKN's BuAI programme subsidises IUI only, and one of its conditions is that the husband's sperm count and movement are normal.
• EPF Akaun Sejahtera withdrawals can be used for IUI, IVF and ICSI. See paying for fertility treatment.
• Your family doctor, a government health clinic (klinik kesihatan) or a fertility clinic can arrange a semen analysis or a referral. Ask whether the laboratory follows the WHO 2021 methods.

Sources

• World Health Organization, WHO laboratory manual for the examination and processing of human semen, 6th edition, 2021: sample collection (section 2.2) and Table 8.3.
• European Association of Urology, EAU Guidelines on Sexual and Reproductive Health, pocket edition 2025, Male infertility (the 2026 edition did not change this chapter); summarised in Minhas et al., European Urology 2025.
• Schlegel et al., Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II, Fertility and Sterility 2021; amended as Brannigan et al., Updates to Male Infertility: AUA/ASRM Guideline (2024), Journal of Urology 2024.
• ESHRE, Recurrent pregnancy loss: an update in 2022, Human Reproduction Open 2023, and ESHRE good practice recommendations on recurrent implantation failure, Human Reproduction Open 2023.
• Malaysian Medical Council, Medically Assisted Reproduction, 2025, and LPPKN, Program BuAI.

This page is general information, not a diagnosis or a substitute for advice from your own doctor.