How to Read a Semen Analysis Report

You or your partner have a semen analysis PDF in hand. There are numbers in millilitres, percentages, and "million per mL," some flagged with asterisks. You want a calm, parameter-by-parameter walkthrough that tells you what each number means, what counts as normal, and what each abnormal pattern points to next.

A semen analysis report is a panel of seven parameters interpreted against the WHO 2021 (6th edition) reference values.^{1 4} Those reference values are 5th-percentile lower limits drawn from a population of men whose partners conceived within 12 months; they describe the lower edge of the fertile range, not a pass/fail line. A single abnormal result almost always needs a repeat in 4 or more weeks, not a treatment decision.^{2 5} If you came to this page searching for how to read FSH test results, you are in a related place. FSH on the male side sits in the hormone panel that runs alongside the semen analysis, and we will get to where it fits below.

How should a semen sample be collected?

The first thing I check on any analysis is how the sample was collected, because handling can make a normal sample look abnormal and the other way round. WHO 2021 specifies 2 to 7 days of abstinence before collection.¹ Shorter windows can lower concentration; longer windows can drop motility. On-site collection at the andrology lab is preferred. Home collection is acceptable when the sample is delivered in a sterile, lab-approved container, kept at body temperature, and analysed within 1 hour of ejaculation.

Lubricant is not used; most lubricants are spermicidal. A standard condom is not used; if collection is by intercourse, a special silicone non-spermicidal collection condom is required. Lab analysis itself should happen within 1 hour of liquefaction.

One sample is not a diagnosis. The AUA/ASRM 2021 Guideline and the WHO 2021 Manual both require two samples at least 4 weeks apart before the result is considered characterising.^{1 2} If your report is based on a single collection, that is the first thing to fix before any plan is built around it.

What do semen volume and appearance tell you?

WHO 2021 sets the 5th-percentile lower reference limit for semen volume at 1.4 mL.¹ A volume below that prompts three checks: was the full sample collected (sometimes a portion is lost during collection), is there retrograde ejaculation (urine sample after collection looks for sperm), and is there ejaculatory duct obstruction or a low-androgen state.

A high volume with a low concentration is a dilution effect. The total count, calculated as concentration multiplied by volume, matters more than concentration in that scenario.

Liquefaction should be complete within 30 minutes. Failure to liquefy can point to seminal vesicle or prostate issues. The pH should be at or above 7.2. A low pH paired with a low volume suggests ejaculatory duct obstruction or congenital absence of the vas deferens, both of which take the workup in a specific direction.

What do sperm concentration and total number mean?

The concentration lower reference limit is 16 million per mL. The total sperm number lower reference limit is 39 million per ejaculate.¹ Total sperm number is the more biologically meaningful figure of the two, because a low-volume sample with a high concentration can still have a normal total count, and a high-volume sample with a borderline concentration can have a strong total count.

Azoospermia is no sperm seen on direct examination, including after centrifugation of the pellet. Azoospermia needs a urology referral and a hormone panel; it does not need an indefinite series of repeat analyses. The diagnostic question is obstructive versus non-obstructive, which requires hormone, ultrasound, and sometimes genetic workup.

The full reference table is in normal sperm count ranges so you can compare your numbers side by side.

What is the difference between total and progressive motility?

Two motility numbers appear on most reports. Total motility is any movement at all, including non-progressive twitching in place; the WHO 2021 lower reference limit is 42 percent. Progressive motility is forward movement, the kind that actually contributes to fertilisation under natural conditions; the WHO 2021 lower reference limit is 30 percent.¹

Non-progressive motile sperm exist on every analysis but are not the ones swimming toward an egg. So progressive motility is the more meaningful figure if you have to pick.

Asthenozoospermia means reduced motility. The common drivers are heat exposure, oxidative stress, recent infection, varicocele, and anti-sperm antibodies. If two samples show total immotility, the lab adds a vitality test (eosin staining or hypo-osmotic swelling) to distinguish dead sperm from immotile-but-alive sperm. That distinction matters for the treatment pathway.

What does sperm morphology by strict Kruger criteria mean?

WHO 2021 retains the strict Kruger criteria for morphology and sets the lower reference limit at 4 percent normal forms.^{1 4} This number is the one that worries readers most and probably the one that should worry them least in isolation.

Morphology below 4 percent does not equate to infertility. Many men who fathered pregnancies in the WHO reference cohort had strict morphology below 4 percent. Severe teratozoospermia (below 1 percent) is associated with lower natural conception rates and is sometimes a factor in deciding between IUI and ICSI when paired with other abnormalities, but it is rarely a treatment driver on its own.

The other limitation worth saying: morphology is the most subjective parameter on the report, and inter-laboratory variability is high. A 3 percent result at one lab may read as 5 percent at another. If a borderline morphology is being used to drive a major decision, ask whether the analysis was performed by a WHO 6th-edition-trained andrology lab.

What do vitality, leukocytes, and other items mean?

Vitality, expressed as percent live sperm, has a WHO 2021 lower reference limit of 54 percent.¹ It is tested when motility is very low, to distinguish dead from immotile-but-alive sperm.

Leukocytes above 1 million per mL define leukocytospermia. The workup for leukocytospermia includes ruling out a genitourinary infection (urine culture, urethral swab where indicated, prostate exam) and treating any identified infection. Round cells in the semen can be confused with leukocytes by less experienced labs; a good andrology lab differentiates immature germ cells from true leukocytes using staining.

Anti-sperm antibodies (MAR or immunobead testing) are reported as the percent of motile sperm with adherent particles. A high titre can drive a decision toward IUI or ICSI. Agglutination (sperm sticking to sperm) and mucous strands are noted descriptively when present and add context to the rest of the picture.

Why read the pattern instead of a single number?

Patterns are more informative than any one parameter, and the standard pattern labels are worth knowing.

• Oligozoospermia is a low count alone.
• Asthenozoospermia is reduced motility alone.
• Teratozoospermia is low morphology alone.
• OAT syndrome is oligo-, astheno-, and teratozoospermia together; reduced count, motility, and morphology. This combination typically prompts a urology workup, hormone panel, and scrotal ultrasound, because it suggests a systemic spermatogenesis problem rather than a sampling artefact.
• Azoospermia is no sperm and is a separate pathway entirely.

I look at the named pattern first, then I look at how severe each component is.

How do you read FSH test results alongside a semen analysis?

This is also a reasonable place to address the FSH question. FSH on a male hormone panel sits alongside LH, morning total testosterone, and prolactin. The interpretation of FSH on the male side is broadly threefold. High FSH with low testicular volume suggests primary testicular failure (the pituitary is shouting at testes that cannot respond). Low FSH with low LH and low testosterone suggests hypogonadotropic hypogonadism. A normal FSH with low testosterone suggests a secondary problem (exogenous testosterone use, opioid suppression, obesity-related secondary hypogonadism). So how to read FSH test results in this context: it is one piece of the hormone panel that pairs with the semen analysis to localise the problem anatomically. We do not run male FSH on its own.

What if the semen analysis result is borderline?

A single low value sitting just below the 5th-percentile cutoff is not a diagnosis. The right next move is a repeat after at least 4 weeks. Spermatogenesis is approximately a 74-day cycle plus epididymal transit, so anything that happened in the prior 3 months is in the sample.² The list of things that suppress parameters transiently includes recent fever or viral illness, antibiotic courses, intense heat exposure (sauna, hot tub, occupational), an alcohol binge, a new medication (SSRIs, opioids, finasteride, exogenous testosterone), and an abstinence window outside the 2-to-7-day range.

Two confirmed abnormal analyses earn a urology referral, a hormone workup, and (where indicated) a scrotal ultrasound. That is the threshold for treating an abnormality as characterising rather than coincidental.

What to ask the andrologist or RE

Questions that get the right shape of answer:

1. "Was this analysis a single or a repeat sample, and when was the second drawn?"
2. "Were the parameters interpreted against WHO 2021 (6th edition) reference values?"
3. "Does the pattern fit oligo-, astheno-, terato-, OAT, or azoospermia?"
4. "Is a varicocele present on physical examination or ultrasound?"
5. "Are hormones (morning total testosterone, FSH, LH, prolactin) indicated based on these results?"
6. "Should we add DNA fragmentation testing given our history?"

A good andrologist will work through these in turn rather than handing back a single overall verdict.

What's next

• For the full reference table and what borderline looks like: normal sperm count ranges
• For the workup as a whole and where this fits: the male fertility workup overview
• If the result is concerning and the urologist is the right next step: sperm DNA fragmentation testing: when and why
• For the 3-month lifestyle window before re-testing: preparing your body
• If results are normal but conception is not happening, continue the female workup and review the medicated cycles hub

Sources

1. World Health Organization. WHO Laboratory Manual for the Examination and Processing of Human Semen, 6th edition. Geneva: WHO Press; 2021. https://www.who.int/publications/i/item/9789240030787
2. Schlegel PN, Sigman M, Collura B, De Jonge CJ, Eisenberg ML, Lamb DJ, et al. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline Part I and II. Fertility and Sterility 2021;115(1):54-69. https://doi.org/10.1016/j.fertnstert.2020.11.015
3. Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HWG, Behre HM, et al. World Health Organization reference values for human semen characteristics. Human Reproduction Update 2010;16(3):231-245. https://doi.org/10.1093/humupd/dmp048
4. Björndahl L, Kirkman Brown J, on behalf of the Editorial Board of the WHO Laboratory Manual. The sixth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen: ensuring quality and standardization in basic examination of human ejaculates. Fertility and Sterility 2022;117(2):246-251. https://doi.org/10.1016/j.fertnstert.2021.12.012
5. Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile male: a committee opinion. Fertility and Sterility 2015;103(3):e18-e25. https://doi.org/10.1016/j.fertnstert.2014.12.103