Course / The Semen Analysis
Semen is the fluid ejaculated from the male reproductive system, composed of sperm cells and seminal plasma.
Sperm are the male reproductive cells responsible for fertilizing an egg.
Semen is the complete ejaculate containing sperm and secretions from the seminal vesicles, prostate gland, and other reproductive structures.
A Semen Analysis (SA) is the cornerstone diagnostic tool for evaluating male fertility potential. It assesses sperm concentration, motility, morphology, and several other parameters that collectively indicate the capacity for natural conception or success through assisted reproductive technologies (ART) such as IVF or ICSI.
A standard semen analysis evaluates multiple components. The most critical among them include:
Semen Volume – Typically ranges from 1.5–5.0 mL. Low volume may indicate ejaculatory duct obstruction or issues with seminal vesicle function.
Sperm Concentration – The number of sperm per milliliter. Normal values are generally above 15 million/mL.
Total Sperm Count – Total number of sperm in the entire ejaculate.
Motility – The ability of sperm to move efficiently; essential for reaching and penetrating the egg.
Morphology – The structural appearance of sperm; abnormal forms may impact fertilization capability.
Vitality – Percentage of live sperm in the sample.
pH and Viscosity – Reflects the biochemical environment and accessory gland function.
Semen analysis results can vary significantly due to multiple biological and external factors:
Illness, fever, or recent infections can temporarily lower sperm quality.
Abstinence duration affects volume and concentration.
Lifestyle factors like smoking, alcohol consumption, and obesity can influence outcomes.
Because of this variability, at least two separate semen analyses, spaced 2–4 weeks apart, are recommended to establish an accurate baseline.
Sample Collection: The sample is usually obtained via masturbation after 2–5 days of abstinence.
Handling and Timing: The sample must reach the lab within one hour, maintained at body temperature.
Microscopic and Computer-Assisted Evaluation: Laboratories assess the parameters under strict WHO (World Health Organization) guidelines.
Advanced Testing (if needed): Sperm DNA fragmentation, oxidative stress assessment, and reactive oxygen species (ROS) analysis may be performed for deeper insight.
The semen analysis provides data that helps fertility specialists decide on the next steps:
Normal results indicate good potential for natural conception or intrauterine insemination (IUI).
Abnormal results may lead to further evaluation, including hormonal testing, genetic studies, and urological consultation.
Interpretation must always consider the clinical context—age, duration of infertility, and the female partner’s fertility status.
Sperm Concentration measures the density of sperm in the ejaculate.
Total Count reflects the total number of sperm available for fertilization.
Men with counts below normal thresholds may have conditions like oligospermia (low count) or azoospermia (no sperm), which require further investigation to determine if the cause is obstructive (blockage) or non-obstructive (production failure).
Motility is categorized into:
Progressive motility (sperm moving forward efficiently)
Non-progressive motility (sperm move but not directionally)
Immotile (no movement)
A normal semen sample should contain at least 40% motile sperm, with 32% or more progressively motile. Reduced motility (asthenozoospermia) may stem from varicoceles, infections, or oxidative stress.
The Total Motile Count combines sperm concentration, motility, and ejaculate volume.
It is a key fertility predictor and guides treatment recommendations:
TMC > 20 million: Good candidates for natural conception or IUI.
TMC < 5 million: IVF or ICSI may be necessary for conception.
Morphology examines the size and shape of sperm using strict Kruger criteria.
Normal morphology is typically ≥4% normal forms.
Poor morphology (teratozoospermia) can hinder fertilization, though some men with abnormal morphology still achieve pregnancies through ICSI, where a single sperm is injected directly into the egg.
A poor semen analysis can sometimes signal broader systemic health issues, including:
Endocrine disorders (e.g., low testosterone, pituitary abnormalities)
Genetic syndromes (Klinefelter, Y-chromosome deletions)
Metabolic or lifestyle diseases (diabetes, obesity)
Urological problems (infections, varicocele, ejaculatory duct obstruction)
Thus, semen analysis not only informs fertility care but can also serve as a window into men’s overall health.
Always repeat the semen analysis for confirmation—one test is not diagnostic.
Ensure the lab follows WHO 6th edition semen analysis standards.
Encourage patients to adopt healthy lifestyle habits (balanced diet, exercise, and avoiding toxins).
If abnormalities persist, refer to an andrologist or urologist specializing in male infertility.
Consider advanced sperm testing before initiating assisted reproductive techniques, especially if ICSI or donor sperm is being considered.
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