Semen Analysis (Spermiogram) 2025: process, cost, WHO values & effective tips

A semen analysis is the objective starting point when pregnancy isn’t happening. The standardized assessment shows whether sperm concentration, movement, and shape are sufficient for fertilization. Here’s a practical overview: realistic costs, the current WHO standard, clear prep steps, and evidence-based measures that can improve semen quality.

What is a semen analysis (spermiogram)?

It’s a laboratory test to assess male fertility. Typical measures include:

• Ejaculate volume (mL)
• Sperm concentration (million/mL) and total count per ejaculate
• Motility (total and progressive)
• Morphology (percentage of normally shaped sperm)
• Vitality (living sperm)
• pH and leukocytes as an inflammation indicator

Parameters are measured using internationally accepted protocols and are always interpreted in clinical context (history, course over time, associated findings).

When is a semen analysis appropriate?

Workup is recommended after 12 months of regular unprotected intercourse without pregnancy. Earlier testing is sensible with risk factors (e.g., varicocele, undescended testis, after chemo-/radiotherapy). For a structured work-up, see the EAU guideline on male infertility.

• Primary or secondary infertility
• Abnormal hormones or pubertal disorders
• Pre-/post-vasectomy checks
• Recurrent miscarriage
• Pelvic surgery or radiotherapy

Semen analysis – cost & coverage

Typical in the United States: about $100–200 per test at private labs. With a clinical indication, health insurance may cover testing when ordered by a clinician; coverage varies by plan and network. Fertility centers often offer packages including a repeat test. Important: results fluctuate — plan a repeat after ~ 6 weeks to smooth natural variation and measurement error.

Semen analysis: process & preparation

Preparation

• 3–5 days of abstinence (for comparability)
• No fever or acute infections; avoid prolonged sauna sessions
• Minimize alcohol and nicotine; ensure sleep and stress reduction

Sample collection

• Wash hands and penis with water and soap
• No lubricant or condom with additives
• Collect the entire ejaculate in a sterile container
• If collected at home, keep at body temperature (~ 98.6 °F / 37 °C) and deliver within 60 minutes to the lab

In the lab, standardized measurements (microscopic/digital) are performed per the WHO manual.

WHO reference values (6th edition, 2021)

The WHO reference lists, among others, these thresholds:

• Volume: ≥ 1.5 mL
• Concentration: ≥ 15 million/mL
• Total count: ≥ 39 million per ejaculate
• Total motility: ≥ 40%
• Progressive motility: ≥ 32%
• Morphology (normal forms): ≥ 4%
• Vitality: ≥ 58%
• pH: ≥ 7.2

Values below these thresholds don’t automatically mean infertility, but they do warrant medical interpretation and follow-up.

Laboratory quality: what to look for

• Accreditation (e.g., DIN EN ISO 15189)
• Regular external quality assurance/ring trials
• Strict WHO protocols, documented SOPs
• Double reading or a quality-assured second review

Helpful patient information on diagnosis and treatment: the NHS and the UK regulator HFEA provide accessible overviews; evidence-based guidance is available from NICE.

Turnaround & report

The analysis usually takes 60–120 minutes. A written report is often available within 2–4 business days — commonly via a secure online portal followed by a clinical discussion.

Interpretation: what do deviations mean?

• Oligozoospermia — low concentration
• Asthenozoospermia — reduced motility
• Teratozoospermia — abnormal morphology
• Cryptozoospermia — extremely low concentration
• Azoospermia — no sperm detected

To account for natural fluctuation, a repeat after ~ 6 weeks is usually advised — same preparation and conditions.

Common causes

• Hormonal disorders (testosterone, FSH, LH, prolactin)
• Genetics (e.g., Klinefelter syndrome, Y microdeletions)
• Infection/inflammation (e.g., chlamydia, mumps orchitis)
• Lifestyle (smoking, alcohol, obesity, chronic stress)
• Heat/environment (tight clothing, sauna, pesticides, plasticizers, microplastics)
• Temporary factors: fever, certain medicines

Structured assessment includes history, exam, hormones and, if indicated, genetics — see EAU Male Infertility.

Practical tips: improve semen quality

• Stop smoking and reduce alcohol
• Normalize weight (even 5–10% loss can help)
• Regular, moderate exercise; avoid overheating
• Stress management (breathing exercises, sleep hygiene, realistic workload)
• Diet rich in fruit/veg, omega-3s and zinc; cut highly processed foods
• Supplements with care (e.g., CoQ10, L-carnitine) after medical advice

Realistic timeline: improvements often need at least 3 months — roughly one spermatogenesis cycle.

Patient-friendly overviews: NHS treatment; evidence-based guidance: NICE CG156.

Comparison & alternatives

When to see a doctor

• No pregnancy after 12 months of regular unprotected intercourse
• Abnormal first result or azoospermia
• Risk factors: varicocele, undescended testis, chemo-/radiotherapy
• Pain, swelling, or signs of infection

Guideline-based assessment and treatment are summarized in the EAU guideline.

Myths & facts

• Myth: “One semen analysis is always enough.” — Fact: Values fluctuate; repeating after ~ 6 weeks improves reliability.
• Myth: “A hot bath or sauna improves quality.” — Fact: Heat often lowers motility; cooler, breathable clothing is preferable.
• Myth: “More exercise equals more fertility.” — Fact: Moderate activity helps; over-training and heat may harm.
• Myth: “Supplements solve everything.” — Fact: CoQ10, L-carnitine etc. may support, but don’t replace cause-finding and lifestyle change.
• Myth: “The longer the abstinence, the better the result.” — Fact: Usually best is 2–5 days; very long gaps can reduce motility and vitality.
• Myth: “Tight underwear doesn’t matter.” — Fact: It raises testicular temperature; loose boxer shorts are often better.
• Myth: “A normal semen analysis guarantees pregnancy.” — Fact: It’s a snapshot; fertility also depends on timing and female factors.
• Myth: “Morphology must be over 14%.” — Fact: Current WHO references use ≥ 4% normal forms; older cut-offs can mislead.
• Myth: “Bad values stay forever.” — Fact: After infections, fever, or lifestyle changes, parameters often improve within ~ 3 months.
• Myth: “Laptop on your lap is fine.” — Fact: Direct heat sources raise testicular temperature and may impair quality.
• Myth: “Caffeine/boosters give an instant lift.” — Fact: Moderate intake is usually fine; high doses, energy drinks, and sleep loss are counterproductive.
• Myth: “Varicocele always needs surgery.” — Fact: Surgery can help in selected cases; decisions are individual and guideline-based.
• Myth: “COVID-19 causes permanent infertility.” — Fact: Temporary worsening can occur; values often normalize over months.
• Myth: “DNA fragmentation testing is necessary for everyone.” — Fact: It’s an add-on for specific scenarios (e.g., recurrent miscarriage), not a routine for all.

Summary

A semen analysis provides a clear status check. WHO references set the frame, but the decisive factor is the overall clinical view with trend, history, and partner assessment. Many factors are modifiable — with realistic expectations, focused lifestyle optimization and, if needed, modern reproductive medicine. You’ll go into your consultation well prepared.