What is the standard test for evaluating sperm count?

Standard Test for Sperm Count

Semen analysis is the standard test for evaluating sperm count, and should be performed in a specialized andrology laboratory following WHO guidelines, with at least two analyses obtained one month apart if initial results are abnormal. 1

Core Testing Protocol

Semen analysis provides comprehensive evaluation including:

• Sperm concentration (count per mL) 1
• Total sperm number per ejaculate 1
• Sperm motility 1
• Sperm morphology 1
• Semen volume 1
• pH 1

Collection Requirements

Proper specimen collection is critical for accurate results:

• Abstain from sexual activity for 2-3 days before collection 1
• Collect via masturbation or using specialized semen collection condoms 1
• Keep specimen at room or body temperature during transport 1
• Examine within one hour of collection 1
• If collection occurs at home, transport immediately under proper temperature conditions 1

Testing Frequency

The number of tests required depends on initial results:

• If semen analysis is normal according to WHO criteria, a single test is sufficient 1
• If results are abnormal, at least two semen analyses obtained one month apart are required to account for biological variability 1
• Semen parameters are highly variable biological measures and may fluctuate substantially between tests 1

Laboratory Standards

Testing must be performed in specialized facilities:

• Semen analysis should be conducted in a specialized andrology laboratory for comprehensive evaluation 1
• Point-of-care and mail-in semen tests may provide limited information but cannot substitute for laboratory-based analysis 1
• Numerous factors can impact the accuracy of home testing kits 1
• Results from different testing modalities should not be extrapolated to one another 1

WHO Reference Values

Clinicians should counsel patients that WHO lower limits represent the 5th percentile of fertile men whose partners conceived within 12 months 1. These reference values provide standardized thresholds but semen analysis alone cannot definitively distinguish fertile from infertile men 1.

Special Circumstances

Additional laboratory procedures may be indicated:

• When azoospermia is detected, the laboratory should centrifuge the ejaculate and examine the pellet under microscopy for rare sperm 1
• Post-ejaculatory urinalysis should be performed if ejaculate volume is less than 1 mL to evaluate for retrograde ejaculation 1

Common Pitfalls to Avoid

Do not rely on non-standardized testing:

• Home testing kits lack the comprehensive evaluation provided by specialized laboratories 1
• Single abnormal results should not guide treatment decisions without confirmatory testing 1
• Improper collection technique or timing can produce misleading results 1