Normal Values for Semen Analysis
The most current reference values for semen analysis are based on the 2025 AUA/ASRM guidelines, which recommend lower reference limits of 1.4 mL for volume, 16 million/mL for sperm concentration, 39 million per ejaculate for total sperm number, 30% for progressive motility, 42% for total motility, 4.0% for normal morphology, and pH >7.2. 1
Standard Semen Parameters
Volume and pH
- Semen volume: Lower reference limit of 1.4 mL (range 1.3-1.5 mL) 1
- pH: Greater than 7.2 1
- Low volume (<1.4 mL) with acidic pH (<7.0) suggests ejaculatory duct obstruction or absence of seminal vesicles 1
Sperm Concentration and Count
- Sperm concentration: Lower reference limit of 16 million/mL (range 15-18 million/mL) 1
- Total sperm number: Lower reference limit of 39 million per ejaculate (range 35-40 million) 1
- Severe oligospermia (<5 million/mL) warrants genetic testing including karyotype and Y-chromosome microdeletion analysis 1
Motility Parameters
- Progressive motility: Lower reference limit of 30% (range 29-31%) 1
- Total motility: Lower reference limit of 42% (range 40-43%) 1
- Forward progression should be greater than 2 on a scale of 0 to 4 2
Morphology and Vitality
- Normal morphology: Lower reference limit of 4.0% (range 3.9-4.0%) 1
- Sperm vitality: Lower reference limit of 54% live spermatozoa (range 50-56%) 1
Collection and Handling Requirements
Pre-Collection Instructions
- Abstinence period: 2-3 days before collection 1
- Inadequate abstinence significantly affects volume and concentration 1
Collection Methods
- Masturbation or intercourse using specialized semen collection condoms 1
- If collected at home, specimen must be kept at room or body temperature during transport 1
- Examination timing: Within one hour of collection 1
Critical Pitfalls to Avoid
- Improper collection technique invalidates results 1
- Delayed analysis affects motility assessment 1
- Failure to follow WHO standardized procedures leads to high variability between laboratories 1
Frequency of Testing
- Initial evaluation: A single properly performed semen analysis is often sufficient 1
- Confirmatory testing: If abnormalities are detected, perform a second analysis at least one month after the first 1
- Two semen analyses should be performed at least one month apart for complete evaluation 2
Clinical Interpretation
Normal Terminology
- Normozoospermia: All semen parameters within normal reference ranges 1
Abnormal Findings
- Azoospermia: Complete absence of spermatozoa (requires centrifugation to confirm) 1
- Oligozoospermia: Low sperm concentration 1
- Asthenozoospermia: Reduced sperm motility 1
- Teratozoospermia: Abnormal sperm morphology 1
- Aspermia: Complete absence of semen in ejaculate 1
Additional Testing When Indicated
- Post-ejaculatory urinalysis: Perform if ejaculate volume <1 mL to rule out retrograde ejaculation 1
- Endocrine evaluation: Indicated if sperm concentration <10 million/mL, sexual function impaired, or clinical findings suggest endocrinopathy 2
- Minimal hormonal workup includes serum testosterone and FSH 2
Important Clinical Context
Limitations of Reference Values
- Only 12% of infertile men and 41% of fertile men present with completely normal sperm parameters 3
- Semen analysis alone cannot distinguish fertile from infertile men 2
- Even in fertile men, only 4% of sperm have normal morphology according to WHO reference values 4
- The entire profile should be considered when evaluating fertility potential—avoid over-reliance on a single parameter 1
Genetic Testing Indications
- Karyotype testing recommended for males with primary infertility and azoospermia or sperm concentration <5 million/mL when accompanied by elevated FSH or testicular atrophy 1
- Y-chromosome microdeletion testing should be considered for severely oligospermic males (found in 5% of males with sperm concentrations 0-1 million/mL) 1