Diagnostic Workup: Semen Analysis

What Is It?

Carefully conducted examination of a man's semen provides much more than the usual reference of a "sperm count". Semen analysis (SA) provides an indicator of how a man's reproductive hormonal cycle is functioning, the quality of his sperm cells in shape, motility, and quantity, and the patency of his reproductive tract.

The World Health Organization has a manual (WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction, Fourth Edition) which provides technical recommendations and standards for performing the basic techniques involved in SA from a clinical standpoint. In short and from the patient's perspective, a semen analysis consists of:

  • Abstaining from ejaculation for 48 to 72 hours prior to testing;
  • Obtaining a semen sample via masturbation, using a sterile receptacle, either at patient's home or clinic, depending on the length of travel time;
  • Turning in recently obtained sample to clinic or lab, where it will be assessed.

Generally, assessment occurs within a few hours, but you may or may not get your results on the same day -- check with the lab to be sure. The following parameters will be observed and noted:

  • Volume -- low volume may be associated with incomplete collection, retrograde ejaculation, ejaculatory duct obstruction, or androgen deficiency;
  • Motility -- both percentage and quality i.e. how fast and straight the cells swim; clumping may suggest inflammatory or immunologic problems;
  • Morphology -- looking for normal oval heads, mid piece, and tail; mal-shaped cells may represent altered testicular function; slow liquefaction of semen may indictor glandular dysfunction;
  • Presence of white blood cells -- indicating possible infection.

According to the WHO, fertile semen specimens should have at least 20 million sperm, with at least 50% of the sperm motile and at least 30% with good morphology. Normal volume is 2-5 cc.

Dr. Neil Baum overviews the initial appointment and examination by a specialist. FertilityPlus' FAQ does a good job of describing the male assessment process, including and beyond the SA. Fertilitext lists some good questions you should ask your doctor about your SA results.