From the Guidelines
Semen analysis is a crucial diagnostic test for evaluating male fertility, and it should be performed in accordance with the latest guidelines from the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) 1.
Key Parameters
The test measures several key parameters, including:
- Sperm count: normal is 15 million or more per milliliter
- Motility: at least 40% should be moving
- Morphology: at least 4% should have normal shape
- Semen volume: 1.5-5 milliliters is normal
- pH: 7.2-8.0 is typical
Preparation and Collection
To prepare for the test, men should:
- Abstain from ejaculation for 2-5 days before collection
- Avoid alcohol, tobacco, and recreational drugs
- Maintain a healthy lifestyle The sample is typically collected through masturbation into a sterile container at a clinic or at home if delivered within an hour.
Interpretation of Results
If abnormalities are found, the doctor may recommend:
- Lifestyle changes
- Treating underlying conditions like varicocele or infections
- Referral to a reproductive specialist Multiple tests may be needed for accurate assessment since sperm quality can vary over time due to illness, stress, or environmental factors.
Special Considerations
In cases of azoospermia, the laboratory should centrifuge the ejaculate and re-suspend the pellet in a small volume of seminal plasma and examine under wet mount microscopy for the presence of rare sperm 1.
World Health Organization Reference Limits
The World Health Organization reference limits for human semen characteristics are:
| Semen Parameter | One-Sided Lower Reference Limit (Fifth Centiles With 95% Confidence Intervals [CI]) |
|---|---|
| Semen Volume | 1.4 mL (1.3-1.5 mL) |
| Total Sperm Number | 39 million per ejaculate (35-40 million per ejaculate) |
| Sperm Concentration | 16 million/mL (15-18 million/mL) |
| Vitality | 54% Live (50-56%) |
| Progressive Motility | 30% (29-31%) |
| Total Motility (Progressive + Non-Progressive) | 42% (40-43%) |
| Morphologically Normal Forms | 4.0% (3.9-4.0%) |
| as outlined in the latest guidelines [1]. |
From the Research
Semen Analysis
- Semen analysis is a crucial test for evaluating male fertility, and various factors can affect the results, including ejaculatory abstinence, sperm quality, and medical treatments 2, 3, 4, 5, 6.
- The World Health Organization recommends an ejaculatory abstinence period of 2-7 days for semen analysis, but recent studies suggest that shorter or longer abstinence periods may have different effects on sperm quality 2, 4.
Effects of Abstinence Time on Semen Quality
- A study published in 2020 found that samples collected after 1 day of abstinence showed better sperm motility and function compared to samples collected after 4 days of abstinence 2.
- Another study published in 2023 found that short abstinence periods may be recommended to maintain optimal sperm DNA integrity, while long abstinence periods were associated with reduced progressive motility and total motility 4.
- A study published in 2024 found that consecutive ejaculations after short abstinence can improve sperm motility and morphology, which are associated with better ICSI and IUI outcomes 5.
Medical Treatments for Male Infertility
- Clomiphene citrate is a selective estrogen receptor modulator that may improve semen quality by stimulating hormone synthesis and spermatogenesis 3, 6.
- A systematic review and meta-analysis published in 2023 found that clomiphene citrate increased sperm concentration and motility, and could be considered as a safe therapy for improving sperm parameters in infertile males 6.
- Another study published in 2007 found that clomiphene citrate exerted its effect on spermatogenesis by raising the endogenous serum FSH, LH, and testosterone levels to initiate and maintain gametogenesis 3.