For many couples struggling to conceive, a semen analysis (also called a sperm count) is the first concrete step in understanding male fertility. Modern labs use digital methods aligned with WHO guidelines to assess concentration, motility and shape of spermatozoa. This guide covers how the test works, what it costs in the U.S., the latest WHO reference ranges, and proven strategies to boost your sperm quality.
What Is a Semen Analysis?
A semen analysis is a laboratory test that evaluates key parameters of male fertility:
- Sperm concentration – number of sperm per milliliter
- Motility – percentage of moving sperm (progressive vs. 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 inflammation
- White blood cells – elevated counts suggest infection
Together, these metrics give a reliable picture of your ability to achieve natural conception.
When Is a Semen Analysis Recommended?
Professional societies like the American Urological Association (AUA) recommend a semen analysis after 12 months of regular unprotected intercourse without pregnancy. If you have risk factors—varicocele, history of chemotherapy or pelvic radiation—you may test sooner.
- Primary or secondary infertility
- Abnormal hormone levels
- Pre- or post-vasectomy check
- Repeated miscarriages
- History of pelvic surgery or trauma
Early testing may also be wise if you had undescended testicles in childhood or a significant testicular injury.
Semen Analysis Cost & Insurance
In the U.S., a standard semen analysis typically ranges from $60 to $150. Many health plans cover it under infertility diagnostics; check your policy for coverage details. Some fertility centers include a second analysis at a discounted rate if done as part of a package.
How It Works: Preparation & Sample Collection
Preparation:
- Abstain from ejaculation for 3–5 days
- Avoid alcohol, tobacco and recreational drugs for 48 hours ahead
- Skip saunas or fevers and avoid heavy illness
- Get good sleep and minimize stress
Sample Collection:
- Wash hands and genitals with water and mild soap only
- Do not use lubricants or oil-coated condoms, which can skew results
- Collect the entire ejaculate in the sterile container provided
If you collect at home, keep the sample near body temperature (about 98.6°F) and deliver it to the lab within 60 minutes.
WHO Reference Values (2021)
The World Health Organization’s Laboratory Manual sets these minimums:
- 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 cutoffs indicate reduced fertility potential but do not guarantee infertility.
Lab Quality: What to Look For
Accuracy hinges on lab standards. Choose facilities accredited under CAP or ISO 15189, participating in external proficiency testing (e.g., CASA programs), and following WHO protocols. Ideally, two technicians read the sample independently.
Turnaround & Follow-Up
Microscopic analysis takes about 60–120 minutes. Most labs return a full report within 2–4 business days, often via secure online portal, followed by a consultation to discuss next steps.
Interpreting Abnormal Results
- Oligozoospermia – low sperm count
- Asthenozoospermia – poor motility
- Teratozoospermia – abnormal shape
- Kryptozoospermia – very low concentration
- Azoospermia – no sperm detected
To account for natural fluctuations, doctors often recommend two analyses about six weeks apart.
Common Causes of Poor Sperm Quality
- Hormonal imbalances (testosterone, FSH, LH, prolactin)
- Genetic issues (e.g., Klinefelter syndrome)
- Infections (chlamydia, mumps orchitis)
- Lifestyle factors: smoking, alcohol, obesity, chronic stress
- Environmental toxins: heat, pesticides, plastics chemicals
Temporary factors like fever or certain medications can also lower counts.
6 Evidence-Based Ways to Improve Sperm Quality
- Nutrition: antioxidants (vitamins C, E, zinc), omega-3s, plenty of fruits & veggies
- Exercise: regular moderate activity, avoid excessive heat (long bike rides, saunas)
- Quit smoking & limit alcohol: reduce toxin exposure
- Stress reduction: meditation, yoga, breathing exercises
- Keep testes cool: loose underwear, avoid laptops on lap
- Supplements: coenzyme Q10, L-carnitine may help—consult your doctor first
A meta-analysis (Nagy et al., 2021) confirms lifestyle changes can significantly boost sperm count and motility.
Advanced Testing & Fertility Treatments
If basic results are concerning, your doctor may order:
- Comprehensive hormone panel
- Genetic testing (karyotype, Y-chromosome microdeletion)
- Scrotal ultrasound
- DNA fragmentation assay
- Testicular sperm extraction (TESE/MESA) if azoospermia
Assisted reproductive technologies like IVF or ICSI can overcome many barriers to conception.
Normal Results—What’s Next?
A normal semen analysis rules out most male factors. If pregnancy still doesn’t occur, evaluation of female partners—cycle monitoring, hormone tests or postcoital tests—may be indicated. A fertility specialist can guide comprehensive next steps.
Conclusion
A semen analysis provides clear metrics on male fertility potential. Deviations from normal can often be mitigated by lifestyle adjustments, medical therapies and assisted reproduction. With normal results, a joint evaluation of both partners is the best path forward—fertility truly is a team effort.