Male Fertility Testing: What the Results Really Mean

A semen analysis evaluates several key parameters that indicate sperm health and fertility potential. The main factors assessed include:

These World Health Organisation reference values represent the lower limits of normal. Values below these thresholds may indicate reduced fertility potential, though conception is still possible.

A "normal" result means all parameters fall within the WHO reference ranges. However, understanding these values requires context:

• Normal doesn't guarantee fertility: Even men with normal semen analysis results may experience difficulty conceiving. Sperm function involves complex factors not fully captured by standard testing.
• Abnormal doesn't mean infertility: Men with below-normal results often still achieve pregnancy naturally. The reference values indicate population averages, not absolute thresholds.
• Partner factors matter: Fertility is a couple's issue. Borderline male results may have less impact when female fertility is optimal, and vice versa.

Results should always be interpreted in the context of your partner's fertility assessment and your combined situation.

Semen parameters can vary significantly from one sample to the next. This natural variation means a single test may not accurately represent your typical sperm quality.

Factors causing temporary variation include:

• Recent illness or fever (effects can last 2 to 3 months)
• Abstinence period before the test (recommended: 2 to 5 days)
• Stress and fatigue
• Recent alcohol intake
• Sample collection conditions

If your first test shows abnormal results, a repeat analysis after 6 to 12 weeks is typically recommended before drawing conclusions. Consistent abnormalities across two or more tests are more meaningful than a single result.

Sperm quality can be affected by both modifiable lifestyle factors and underlying medical conditions.

Lifestyle Factors (Potentially Modifiable)

• Smoking, associated with reduced count, motility, and increased DNA damage
• Excessive alcohol, can impair testosterone and sperm production
• Obesity, linked to hormonal changes affecting sperm
• Heat exposure, saunas, hot baths, tight underwear, prolonged laptop use on lap
• Recreational drugs, cannabis and anabolic steroids can significantly impair fertility
• Certain medications, some antidepressants, blood pressure medications

Medical Causes (May Require Treatment)

• Varicocele, enlarged veins in the scrotum affecting sperm quality
• Hormonal imbalances, low testosterone or elevated prolactin
• Previous infections, mumps orchitis, sexually transmitted infections
• Genetic conditions, chromosomal abnormalities, Y chromosome deletions
• Obstruction, blocked tubes preventing sperm release
• Previous surgery or trauma

A thorough evaluation helps distinguish between these causes and guides appropriate management.

Consider a specialist consultation if:

• Two semen analyses show consistently abnormal results
• You have very low or absent sperm (azoospermia)
• There's a known medical history that may affect fertility (undescended testicle, previous chemotherapy, surgery)
• Your partner has also had testing and you want to understand your combined situation
• You've been trying to conceive for 12 months (or 6 months if your partner is over 35) without success

A male fertility specialist can provide additional testing when needed, including hormone assessments, genetic testing, and in some cases, physical examination or imaging.

For significant male factor issues, treatments such as ICSI treatment or IVF may be recommended.

• "If I've fathered children before, my sperm must be fine now":Sperm quality can change over time due to age, health conditions, or lifestyle changes. Previous fertility doesn't guarantee current fertility.
• "Low sperm count means I'm infertile":While lower counts reduce the odds, men with low counts still conceive naturally. It only takes one sperm to fertilise an egg.
• "Supplements can dramatically improve my sperm":While some supplements may offer modest benefits, there's limited evidence for dramatic improvements. Addressing underlying issues is more effective.
• "Men don't have a biological clock":Although less pronounced than in women, sperm quality does decline with age. Older paternal age is associated with slightly increased risks of certain conditions.
• "Tight underwear definitely causes infertility":While excess heat can affect sperm, switching to loose underwear alone is unlikely to solve significant fertility issues.