Is a sperm concentration of 33 million/ml considered normal for fertility?

Is a Sperm Concentration of 33 Million/mL Normal?

Yes, a sperm concentration of 33 million/mL is above the lower reference limit for normal fertility and falls within the normal range, though it is not optimal. 1

Understanding the Reference Values

The lower reference limit for normal sperm concentration is 16 million/mL (95% CI: 15-18 million/mL), based on World Health Organization reference values endorsed by the American Urological Association and the American Society for Reproductive Medicine. 1 Your concentration of 33 million/mL is approximately twice this threshold, placing you well above the minimum for normal fertility. 1

However, it's important to understand that this value falls in what some research suggests is an intermediate zone:

• Subfertile range: <13.5 million/mL 2
• Indeterminate fertility range: 13.5-48 million/mL 2
• Optimal fertile range: >48 million/mL 2

Your value of 33 million/mL places you in the indeterminate range, meaning fertility is likely normal but not optimal. 2

Important Context About Fertility Potential

Research suggests that fecundity (ability to conceive) progressively decreases with sperm concentrations below 40 million/mL, even though these values are technically "normal" by WHO standards. 3, 4 This means:

• You are above the clinical threshold for normal (>16 million/mL) 1
• You may have slightly reduced fertility compared to men with counts >40-48 million/mL 3, 4
• Time to pregnancy may be somewhat longer than optimal, but conception should still be achievable 2

Critical Next Steps

You must obtain at least two semen analyses at least one month apart due to significant intra-individual variability in sperm parameters. 1 A single test is insufficient for diagnosis. 1

Proper collection technique is essential: 1

• Abstain for 2-3 days before collection
• Transport sample at room or body temperature
• Analyze within one hour of collection

What Else Matters Beyond Concentration

Sperm concentration alone does not determine fertility. 2 The complete semen analysis should evaluate:

• Sperm motility: Should be >32% progressive motility 5
• Sperm morphology: Should be >4% normal forms 5
• Total sperm number: Should be >39 million per ejaculate 1

Morphology has the greatest discriminatory power for distinguishing fertile from infertile men, even more than concentration. 2

When to Consider Further Evaluation

Further workup is generally not needed unless: 1

• Sperm concentration drops below 5 million/mL on repeat testing
• Accompanied by elevated FSH levels
• Testicular atrophy is present on examination
• Difficulty conceiving after 12 months of regular unprotected intercourse

Common Pitfalls to Avoid

• Never rely on a single semen analysis - values fluctuate significantly 1
• Avoid exogenous testosterone if fertility is desired, as it will suppress sperm production and can cause azoospermia 1
• Don't ignore other semen parameters - motility and morphology are equally important 2

Bottom Line

Your sperm concentration of 33 million/mL is within the normal range and should support natural conception, though it is not in the optimal range (>40-48 million/mL). 1, 3 Repeat the analysis in 1-2 months to confirm this value, and ensure motility and morphology are also evaluated. 1 If you have been trying to conceive for over 12 months without success, both partners should undergo fertility evaluation regardless of this sperm count. 1