For many couples unable to conceive, a semen analysis is the first clear step in assessing male fertility. Modern laboratories use digital methods aligned with WHO guidelines to determine whether sperm concentration, motility and morphology are sufficient to fertilise an egg. This guide explains how the test is carried out, what it costs in the UK, the current WHO reference ranges and which evidence-based measures can reliably improve your sperm quality.
What Is a Semen Analysis?
A semen analysis (sometimes called a sperm count) is a laboratory assessment of male fertility. It records:
- Sperm concentration – number of sperm per millilitre
- Motility – percentage of moving sperm (progressive and non-progressive)
- Morphology – percentage of normally shaped sperm
- Volume – total ejaculate fluid
- Vitality – percentage of live sperm, indicating cell integrity
- pH – acidity/alkalinity, which can signal infection or inflammation
- White blood cells – elevated levels may indicate infection
Together, these parameters give a reliable overview of whether natural conception is likely.
When Is a Semen Analysis Recommended?
The NICE guideline NG224 advises offering a semen analysis after 12 months of regular unprotected intercourse without conception, or after 6 months if the female partner is aged over 35. You may test sooner if you have:
- A history of varicocele or testicular surgery
- Undescended testicles in childhood
- Previous chemotherapy or pelvic radiotherapy
- Repeated miscarriage in the partner
- Abnormal hormone levels
Semen Analysis – Cost & NHS Coverage
On the NHS, a semen analysis is usually provided free of charge on referral from your GP. Private tests in the UK typically cost between £60 and £120. Many private fertility clinics include a follow-up analysis in their assessment packages; check your policy or package details for specific coverage.
How It Works: Preparation & Sample Collection
Preparation
- Abstain from ejaculation for 3–5 days
- Avoid alcohol, tobacco and recreational drugs for 48 hours beforehand
- Accurate results require no fever, severe infection or prolonged sauna use
- Ensure adequate sleep and minimise stress
Sample Collection
- Wash hands and genitals with water and gentle soap only
- Do not use lubricants or oil-coated condoms, which can affect sperm function
- Collect the entire ejaculate in the sterile container provided
If you collect at home, keep the sample close to body temperature (around 37 °C) and deliver it to the laboratory within 60 minutes.
WHO Reference Ranges (2021)
According to the WHO Laboratory Manual (6th Edition, 2021), the following minimum values are considered normal:
- Volume: ≥ 1.5 mL
- Concentration: ≥ 15 million/mL
- Total sperm count: ≥ 39 million per ejaculate
- Total motility: ≥ 40% moving
- Progressive motility: ≥ 32%
- Morphology: ≥ 4% normal forms
- Vitality: ≥ 58% live sperm
- pH: ≥ 7.2
Values below these thresholds indicate reduced fertility potential but do not necessarily mean infertility.
Lab Quality: What to Look For
Accuracy depends on laboratory standards. Look for UKAS or CAP accreditation, participation in external quality schemes (e.g. UKNEQAS), and adherence to WHO protocols. Ideally, two trained technicians should evaluate each sample independently.
Turnaround & Follow-Up
Microscopic assessment takes about 60–120 minutes. Most labs issue a full report within 2–4 working days, often via a secure online portal, followed by discussion of the results with your doctor.
Interpreting Abnormal Results
- Oligozoospermia – low sperm count
- Asthenozoospermia – reduced motility
- Teratozoospermia – abnormal shape
- Kryptozoospermia – extremely low concentration
- Azoospermia – no sperm detected
To rule out natural variability, clinicians often repeat the analysis about six weeks later.
Common Causes of Poor Sperm Quality
- Hormonal imbalances (testosterone, FSH, LH, prolactin)
- Genetic factors (e.g. Klinefelter syndrome)
- Infections (chlamydia, mumps orchitis)
- Lifestyle: smoking, alcohol, obesity, chronic stress
- Environmental exposures: heat, pesticides, plasticisers
Temporary factors such as fever or certain medications can also lower sperm parameters.
6 Evidence-Based Ways to Improve Sperm Quality
- Nutrition: antioxidants (vitamins C, E, zinc), omega-3, plenty of fruit & veg
- Exercise: regular moderate activity; avoid excessive heat (long bike rides, hot tubs)
- Quit smoking & limit alcohol: reduce toxin exposure
- Stress management: meditation, yoga, breathing exercises
- Keep testes cool: loose underwear, avoid laptops on your lap
- Supplements: coenzyme Q10, L-carnitine may help—consult your GP first
A meta-analysis (Nagy et al., 2021) confirms lifestyle changes can significantly boost sperm count and motility.
Advanced Testing & Fertility Treatments
If results are markedly abnormal, your specialist may recommend:
- Comprehensive hormone panel
- Genetic testing (karyotype, Y-chromosome microdeletion)
- Scrotal ultrasound
- DNA fragmentation assay
- Testicular sperm extraction (TESE/MESA) in azoospermia
Assisted reproduction such as IVF or ICSI can overcome many male-factor barriers.
Normal Results—What Next?
A normal semen analysis rules out most male factors. If conception still does not occur, investigation of the female partner (cycle tracking, hormone tests or postcoital testing) may be advised. A fertility specialist can coordinate comprehensive evaluation.
Conclusion
A semen analysis provides objective data on male fertility potential. Abnormalities can often be addressed with lifestyle modifications, targeted treatments and assisted conception. When results are normal, a joint approach involving both partners gives the best chance of success—fertility truly is a team effort.