A male factor is involved in about half of couples who cannot conceive — and the test that finds it is cheap, quick, and still the one most often skipped.
In roughly half of couples who cannot conceive, a male factor is involved — as the sole cause in a substantial minority, and alongside a female factor in many more.1 Yet in an Indian OPD the commonest pattern is still a woman arriving alone, a year into trying, with three scans and no semen analysis.
The test costs a fraction of what she has already spent, takes two days to report, and in a large number of couples is the finding that changes the plan. This page explains what it measures, what the numbers actually mean — which is not what most people assume — and what happens when a result comes back abnormal.
Giving the sample properly, because it changes the result
A badly collected sample produces a bad report, and the couple then spends months treating a problem that was never there. The conditions matter:
- Abstinence of two to seven days. Less than two and the count is falsely low; more than seven and motility falls.
- The complete sample. The first fraction carries most of the sperm. If any is lost, say so — the report is unreliable without that.
- No lubricant, no condom unless it is a special non-spermicidal collection condom.
- Delivered within an hour and kept near body temperature. A sample brought across the city in a January morning will read poorly regardless of the man’s fertility.
- Not during or soon after a fever. A high fever suppresses sperm production for two to three months afterwards, so a test taken then describes the fever, not the man.
The numbers, and what they are not
Current reference limits come from the World Health Organization’s sixth edition manual.2
| Parameter | Lower reference limit | What it describes |
|---|---|---|
| Semen volume | 1.4 mL | Output of the seminal vesicles and prostate. A very low volume can point to an obstruction or a duct problem. |
| Sperm concentration | 16 million per mL | Density — the number most people mean by “count”. |
| Total sperm number | 39 million per ejaculate | Concentration × volume. Clinically more useful than concentration alone. |
| Total motility | 42% | The proportion moving at all. |
| Progressive motility | 30% | The proportion moving forward. This is the one that matters most. |
| Vitality | 54% | The proportion alive. Checked when motility is very low, to separate dead sperm from live but immotile ones. |
| Normal forms | 4% | Strict morphology. Yes, 4% — see below. |
The single most misunderstood thing on the report. These are not the boundary between fertile and infertile. They are the fifth percentile of men whose partners conceived naturally within twelve months. In other words, one in twenty men who fathered a child would fall below each of them. A man slightly under a limit is not sterile, and a man comfortably above them is not guaranteed fertile. The report describes a probability, not a verdict — which is why it is read alongside her age, her investigations and how long you have been trying, never on its own.
“Only 4% normal forms” causes more distress than any other line, and it is almost always misread. Strict morphology criteria are deliberately severe: a sperm is counted abnormal for very small deviations, and even in fertile men the great majority of sperm are abnormal by that standard. Isolated low morphology, with normal count and motility, is a weak predictor on its own.
One abnormal test means very little
Sperm production takes about 74 days, plus a further two weeks in transit. A single report therefore describes what happened to the body three months ago — an illness, a fever, a course of treatment, a stretch of poor sleep and heavy work.
So an abnormal result is repeated after roughly three months before any conclusion is drawn. Two abnormal tests three months apart is a finding. One is a reason to test again. Couples who are told to start ICSI on the strength of a single poor report have been given a decision, not a diagnosis.
The exception is azoospermia — no sperm at all in the sample. That is confirmed on a repeat with a centrifuged pellet examined properly, and then investigated straight away rather than watched.
What happens when it is genuinely abnormal
| Step | What it is looking for |
|---|---|
| History | Undescended testis in childhood, mumps after puberty, hernia or scrotal surgery, injury, diabetes, thyroid disease, tobacco and alcohol, occupational heat, anabolic steroids, and any medication — several common drugs affect sperm. |
| Examination | Testicular volume and consistency, the presence of the vas on both sides, and a varicocele — the commonest correctable cause. |
| Hormones (FSH, LH, testosterone, prolactin) | Separates a production problem from an obstruction. A high FSH with small testes points to failure of production; a normal FSH with normal testes and no sperm points towards a blockage. |
| Scrotal ultrasound | Varicocele, absent vas, testicular volume, occasionally an unsuspected mass. |
| Karyotype and Y-chromosome microdeletion | Offered where the count is very low or absent. This is a genetic finding that can be passed to a son conceived by ICSI, so it is discussed before treatment, not after. |
What is treatable, and what is not
- Stopping tobacco in every form, including gutka and khaini, is the highest-yield change available and costs nothing.
- Heat — long-distance driving, foundry and kitchen work, laptops on the lap, prolonged hot baths. Modest effect, easy to change.
- Weight, alcohol, uncontrolled diabetes and untreated thyroid disease all affect sperm and all respond to treatment.
- Varicocele repair improves parameters in selected men with a clinically palpable varicocele and abnormal semen — not in men with a varicocele found only on scan and a normal report.
- Infection, where present, is treated.
- Anabolic steroids and testosterone supplements shut sperm production down. This is worth stating plainly because it is often self-prescribed at the gym, and men taking testosterone “for energy” are frequently unaware it is a contraceptive. It is usually reversible, but recovery takes months.
- What does not work: there is no good evidence for routine antioxidant or herbal supplements, and unregulated preparations have been found to contain undeclared steroids. Bring anything you are taking to the consultation.
What the test does not tell you
A semen analysis counts sperm and watches them move. It says nothing about the DNA inside them. Sperm DNA fragmentation testing exists, and it is genuinely informative in some situations — repeated pregnancy loss, repeated failed cycles — but it is not a routine first-line test, its thresholds vary between laboratories, and it should not be sold as a standard add-on. If it is offered to you, ask what will be done differently depending on the result. If the answer is nothing, the test is not needed.
Where treatment goes from here
- Mild abnormalities with a young partner and open tubes: correct what is correctable and continue trying, with a defined review date rather than an open-ended wait.
- Moderate: IUI, where enough motile sperm can be prepared and her tubes are open.
- Severe: ICSI, where a single sperm is injected into each egg. This is what makes fatherhood possible for men who could not conceive otherwise — and it is a treatment for a specific indication, not a default upgrade to IVF.
- Azoospermia: surgical sperm retrieval, covered in the companion article.
At Cosmic. Both partners are investigated from the first visit — a semen analysis is arranged at the same consultation as her workup, not after a year of treating her alone. Male-factor assessment and surgical sperm retrieval are handled by Dr. Dip Joshi (MBBS, MS, DNB Urology), the andrologist on the hospital’s registered ART team. An abnormal result is repeated after three months before any treatment decision is taken, except where the finding is azoospermia. The hospital is a registered Level 2 ART clinic (Certificate No. GS/AHD/165) under the ART (Regulation) Act, 2021.
A note on confidentiality. Semen analysis results are handled as confidential medical records and are not discussed with family members without the patient’s consent. Under the ART (Regulation) Act, 2021 and the Digital Personal Data Protection Act, 2023, this information is disclosed only to the patient and, where he agrees, to his partner as part of joint treatment.
Sources
- National Institute for Health and Care Excellence. CG156: Fertility problems — assessment and treatment. nice.org.uk
- World Health Organization. WHO laboratory manual for the examination and processing of human semen, sixth edition, 2021. who.int
- American Urological Association / American Society for Reproductive Medicine. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. auanet.org
- European Association of Urology. EAU Guidelines on Sexual and Reproductive Health — male infertility. uroweb.org
- European Society of Human Reproduction and Embryology. ESHRE Guideline: Unexplained infertility. eshre.eu
Considering IVF, or unsure whether you need it?
Cosmic Women’s Hospital & IVF Center is a Level 2 ART clinic in Naroda, Ahmedabad, registered under the ART (Regulation) Act, 2021. Consultations are by appointment, and you will be given a written, itemised estimate before any treatment begins.
77-9383-9383
3rd Floor, The Capital Corporate, Nr. Naroda Muktidham, Naroda, Ahmedabad 382330 · Book an appointment
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Cosmic Women's Hospital
Cosmic Women’s Hospital & IVF Center is a registered Level 2 ART clinic in Naroda, Ahmedabad — obstetrics, gynaecological surgery, IVF and ICSI, with ultrasound in-house and 24-hour emergency obstetric cover. Articles here are written by the clinical team and medically reviewed by Dr. Rahul Khatri or Dr. Bhargavi Khatri before publication.
