Semen analysis test referral letter and semen sample potThe semen analysis test is the standard fertility test for men. It looks at the number of sperm in an ejaculation, their shape (morphology), and how they move (motility). There are a few other things that are looked at, but I’ll go through them in more detail later when I tell you how to interpret semen analysis results.

Most men tend to experience at least some anxiety and embarrassment over taking the semen analysis test. This is perfectly normal and I have designed this page to try and take some of those concerns away. However, it is important for men to take this test, even if they have no problem ejaculating, as many causes of male infertility show no symptoms.

Because you may want to skip to a specific section of this topic, I have listed the sections below and you can just click on a section to jump to it:

How to Prepare Before the Semen Analysis Test
Producing a Semen Sample
Interpreting Semen Analysis Report Results
Semen Disorders Terminology
Semen Analysis Test Accuracy
What If the Semen Analysis Results Are Abnormal?
Anything Else I Should Know

 

How to Prepare Before the Semen Analysis Test

If your doctor refers you for a semen analysis test, they will supply you with a referral form, a sample pot and plastic bag. The form will contain instructions specific to the pathology lab you will need to droop the sample off at. Read these instructions carefully.

Please note that some cultures do not allow the standard method of semen sample production. This very common and if your beliefs are contra to any of the methods described here, speak with your doctor and they can advise you of alternative methods of sample production that are compatible with your beliefs.

No Ejaculation 2-3 Days Before the Test

You should not ejaculate for 2 to 3 days before the semen analysis test, either by sex or masturbation. This is to make sure that your sperm count is at its highest. You should also ejaculate 1 week before the test to ensure your sperm are fresh, as sperm stored for a longer time can be more lethargic. Some laboratories will also want to know the date you last ejaculated before the test, so keep a note of it in case.

Book A Room for Producing the Sample

The sample needs to be delivered to the laboratory within one hour of the sample being produced. Any longer than this and the sperm will start to die and it may not be possible for the lab to establish a semen liquefaction reading (more on that in the Interpreting Semen Analysis Report Results section). This is fine if you live close to the laboratory where you need to drop the sample off, but will be a problem if you live further than an hour’s travelling time. Because of this, you can use a room at the hospital where the lab is located to produce the sample. This room must be pre-booked, so check out the form your GP provided you with for booking information, or call the laboratory direct. Please note that it is illegal to masturbate in public toilets, even if you are doing it for a good cause.

 

Producing a Semen Sample

Wash Your Hands and Penis

Wash both your hands and penis thoroughly before producing the sample, making sure you remove all the soap residue. This is to make sure there are no substances that could interfere with the test results. Washing thoroughly is especially important if you are a smoker as nicotine and tobacco are toxic to sperm.

Do NOT Use a Condom or Lubricant

Condoms and lubricant can contain substances that could kill sperm or otherwise interfere with the semen analysis test results. Because of this, you should not use them. However, specialised condoms can be provided for people whose beliefs prevent them from masturbation, but you must request one from your doctor before you are due to take the test.

Use The Sample Bottle Provided

Only use the sample bottle provided as it is sterile. If you use any other bottle, there may be contaminates that affect the test results and the laboratory may not accept the sample. If you lose the bottle, request a new one from your doctor’s surgery or the laboratory.

Get ahead of the game and write your name and date on the bottle before you fill it up. This tip comes from my husband who advises me that it can be a bit strange writing on the bottle after it has been filled.

Make Sure It All Goes into The Bottle

When you are ready, masturbate into the sample bottle, making sure all the ejaculate goes into the bottle. This isn’t easy and if any of the ejaculate is lost, you must advise the laboratory. They may decide it is necessary for you to come back on another date to provide another sample.

Don’t worry if it doesn’t look like a lot, as a normal semen ejaculate volume is only 2 to 5 millilitres, or about 1 teaspoon.

Remember to Complete the Sample Bottle Information

Write the time you ejaculated on the label of the sample bottle. This will allow the laboratory to make calculations such as the semen liquefaction. Also, add your name and date to the bottle if you have not done so in advance.

Put The Form and Bottle into The Plastic Bag Provided

Insert the bottle into the sealable plastic bag along with the form the doctor provided you with. Some people can be embarrassed carrying around the sample in a see-through bag, so if you want you can bring another bag to put the sample in or wrap the bottle in tissue before inserting it in the see-through bag.

Transporting The Sample to The Laboratory

Keep the sample warm by placing the sealable plastic bag containing it in a trouser pocket, where your body heat can keep it warm. Do not put your mobile phone in the same trouser pocket and do not put the sample in direct sunlight. Make sure you get the sample to the hospital pathology laboratory within one hour of producing it.

 

Interpreting Semen Analysis Report Results

Once the laboratory has analysed your sample (which can take up to a couple of weeks), they will send a Semen Analysis Report to your doctor. Ideally you should discuss the results of this report with your doctor, rather than try to interpret them yourself. This is because different combinations of results can also have different interpretations. For example, if your results say semen volume is low, but sperm count is high, then the combination of these results would not necessarily indicate a problem. Also, different laboratories perform different tests resulting in different acceptable semen analysis normal values.

However, if you should see a copy of your semen analysis report, these are what the different sections broadly mean:

Semen Volume

This is a measurement of how much semen has been produced. Either a higher or lower semen volume might be something to investigated as a potential cause of reduced fertility. A normal value for semen volume is 2 to 5 millilitres (about 1 teaspoon). Less than this semen volume could indicate a problem with the prostate gland, a degree of retrograde ejaculation or a vas deferens blockage (the ducts that carry sperm from the testicles to the urethra). More than 5 millilitres could be the result of inflammation of the reproductive glands.

Sperm Count

This is a count of how many sperm there are in a millilitre of semen. The normal value for sperm count is 20 million per millilitre or more. Less than 20 million could indicate a problem with the production of sperm or ejaculatory duct obstruction. While having a lower sperm count does not necessarily mean you are infertile, it could mean it takes you longer to father a child (men with sperm counts as low as 1 million have fathered children). However, if the result says azoospermia, it means there are no sperm in the semen and this is a problem.

Sperm Motility

This is the number of sperm that move, also referred to as swimming. This is usually expressed as a percentage, with a normal sperm motility value being 50% or more. However, different laboratories may express sperm motility values differently. Laboratories may also factor in if the sperm are swimming in a straight line or not, and if their movements appear sluggish. If your semen analysis results are less than 50% sperm motility, talk it through with your doctor who will know more about the type of analysis performed by the laboratory. However, if the result says Asthenospermia (poor sperm motility), then you likely have a problem which could be the result of an illness, exposure to toxins, or lifestyle and dietary habits.

Sperm Morphology

This is the percentage of sperm that have a normal shape (as opposed to abnormal or misshapen sperm). There are several different ways of measuring this, with the most accepted being the Kruger test. Normal values for sperm morphology in the Kruger test are 14% or greater. 14% may not seem very high, but the Kruger test has some very strict rules. Abnormally shaped sperm do not necessarily affect fertility, so don’t worry if your results are slightly less than this. If your semen analysis report uses a different test for sperm morphology than the Kruger test, you will need to speak to your doctor to help you interpret the results.

Semen pH

This is a test that measures how acidic or alkaline the semen is. A normal value for this in a semen analysis report is a semen pH of 7.2 to 8, which is slightly alkaline. Acidic or high alkaline semen pH can kill sperm and may indicate blocked ejaculatory ducts or vas deferens obstruction.

Semen Liquefaction

When first ejaculated, semen’s viscosity is like a gel in that it is quite thick. This initially helps it to stick within the cervix, but after 20 to 30 minutes, it liquefies (turns into a liquid) allowing the sperm to swim better. If semen liquefaction takes longer than 30 minutes, it could indicate a problem with the reproductive glands and may reduce fertility.

White Blood Cell Count

While not part of every Semen Analysis Report, many laboratories do report on the number of white blood cells (also called leucocytes, which are part of the immune system). It is normal to have less than 1 million white blood cells per millilitre of semen. More than this is a condition called pyospermia (also referred to as leucocytospermia), which can cause infertility in some cases. It is usually caused by infections, or autoimmune conditions, but can be related to lifestyle and diet.

 

Semen Disorders Terminology

Some reports use medical language in their semen analysis results. Any of these terms could mean there is a problem which requires further investigation to see if it is causing a problem with the man’s fertility.

  • Asthenozoospermia – low sperm motility, meaning they don’t move very much
  • Azoospermia – no sperm count, meaning there are no sperm in the semen at all
  • Haematospermia – blood has been found in the semen
  • Hyperspermia – large quantity of semen volume
  • Hypospermia – a low quantity of semen volume
  • Necrozoospermia – The sperm are all dead
  • Oligoasthenozoospermia – both a low sperm count and low sperm motility (a combination of oligospermia and asthenozoospermia)
  • Oligospermia – a low sperm count, meaning few sperm in the semen
  • Polyzoospermia – excessive sperm count, meaning too many sperm in the semen
  • Pyospermia – a high white blood cell count in the semen
  • Teratozoospermia – high abnormal sperm morphology, meaning excessive strange shaped sperm

 

Semen Analysis Test Accuracy

The semen analysis test is not 100% accurate. This is because it does not look at every possible thing that can be wrong with the sperm. Also, new discoveries that could affect a man’s fertility are still being discovered. For example; sperm’s “power kick”, which enables individual sperm to penetrate the egg, was only discovered in 2016.

There are more advanced tests for semen, but these are usually only used if there is some indication there may be a problem. If there is no indication of a problem with the man’s semen, but the couple are not conceiving, they will be given the diagnosis of Unexplained Infertility. This basically means the standard tests can find anything wrong with them.

 

What If the Semen Analysis Results Are Abnormal?

It is important to know that if the values in the report are not in the normal range, this does not necessarily mean you are infertile. Rather it gives an indication that there may be a problem that needs further investigation. It is also common for the results for a test to be inconclusive, often requiring the man to go for a second or even third test.

So if you have abnormal results on the first test you take, don’t worry too much about it and get tested again. You could always try and boost your results by checking out the section: How to Maximise Male Fertility.

 

Anything Else I Should Know About the Semen Analysis Test

Can I Bring My Partner to Help Me Produce My Sample?

If you are booking a room at the hospital to produce your sample, it is usually acceptable to have your partner join you in the room. However, it is polite and may save misunderstanding if you call the hospital to seek permission. Make sure your partner also washes their hands before producing the sample and don’t use oral stimulation.

Is There Porn Available?

If you are booking a room at the hospital to produce your sample, sometimes porn is provided. If you are lucky, some clinics even provide a TV with a choice of porn channels. However, this is not always the case, so bring your own or be prepared to use your imagination.

Home Semen Analysis Kits

There are several home kits available for you to perform a semen analysis test yourself. Though these are getting better, they are still not as good as a laboratory semen analysis test. I would only recommend these if you would like to do a fertility MOT on yourself and are not intending to father a child any time soon.

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