Guide to Sperm Testing

Male fertility issues contribute to 30–50% of diagnosed infertility cases. In the past four decades, sperm counts have dropped about 50%. Additionally, people are having children later in life than ever before, and age has an impact on male fertility: every 8 months of a male-bodied person’s life introduces a new genetic mutation into their sperm.

Learn more about age and male fertility and how male fertility testing can help identify sperm quality.

Sperm are a key component of male fertility. Without at least some healthy sperm, you won’t be able to create a healthy pregnancy without medical intervention.

Semen volume refers to the volume of the entire sample sent to the lab. A normal semen volume is 1.5 mL to 4.5 mL; lower than 1.5mL is considered “low” and higher than 4.5mL is considered “high.”

A low semen volume, known as hypospermia, could be caused by a variety of structural issues in or illnesses of the male reproductive system, and can contribute to subfertility. Our at-home sperm testing kits will quickly highlight this. 

Fifteen million sperm per milliliter of semen is considered a normal sperm concentration, but researchers have noted that concentrations under 40 million/mL may impede chances of pregnancy.

Having too little sperm in your semen is known as oligospermia; having no sperm at all is known as azoospermia. Both conditions can contribute to infertility. You can be alerted to these conditions with at-home sperm testing kits or male fertility testing.

Morphology refers to the proper shape and structure of sperm, which is essential for it to move toward and fertilize an egg. Sperm morphology testing can be done using one of two sets of criteria:

• Kruger morphology criteria are very strict, and under this method of testing, very small discrepancies will deem sperm abnormal.
• World Health Organization (WHO) sperm testing is slightly more lenient, with a wider range of “normal” morphology.
• Your sperm testing results will report the percentage of “normal forms.” Every sample will have some abnormal sperm. In fact, a healthy sperm morphology result may be as few as 4–14% normal sperm, depending on the criteria.

Abnormal sperm can come in a multitude of forms. In some reports, you may see a breakdown of the types of abnormal sperm your sample contains. Some examples include:

• Abnormalities in the sperm head size or shape, including amorphous, pyriform, vacuolated, tapering, or large heads. 
• Defects in the sperm midpiece or “neck,” including a bent or asymmetrical neck.
• Defects or absence of the acrosome, the cap that covers the sperm head and helps the sperm penetrate the egg.
• Abnormalities in the sperm tail, such as a coiled tail.
• Multiple heads or tails, or the absence of heads or tails.
• The presence of droplets of excess residual cytoplasm, or cell material that once held immature sperm together but should have been removed during the maturation process.

Poor sperm morphology, as evidenced by a low percentage of normal sperm, is known as teratozoospermia. It’s important to note that a very low percentage of normal sperm — or even no normally shaped sperm at all — does not necessarily mean you are infertile.

In one study, nearly 30% of men with 0% normal morphology were still able to achieve pregnancy with their partner without fertility treatment, as compared to 55% of men with healthy morphology results. Morphology is just one of many factors that contribute to the overall understanding of male fertility.

As part of your at-home sperm testing results, you’ll get details on your sperm motility test results. The first value you’ll get is total motility, which is the percentage of your sperm that are in motion; ideally, 40–50% of your sperm are motile.

The report will also include progressive motility, the percentage of your sperm that are not just motile, but moving in a helpful manner — in straight lines or in large circles.

Non-motile sperm may be slow, sluggish, or completely immobile (not moving at all). Poor sperm motility or asthenospermia is diagnosed when less than 32% of the sperm are able to move efficiently.

On more comprehensive sperm testing results, you may also get a few other parameters, such as:

• Velocity (speed).
• Amplitude of lateral head displacement (ALH), a measure of how much the head of the sperm rotates or moves from side to side.
• Linearity, a measurement of how quickly the sperm moves on its forward path (as opposed to just how quickly it moves from side to side or in circles).
• Beat cross frequency, or how often the head of the sperm moves across the middle of its path.

Each of these sperm testing values help lab technicians determine total and progressive motility.

Legacy’s at-home sperm testing kits include a unique benefit: guidance on how to improve your sperm health, based on questions you’ve answered about your lifestyle (for example, how often you exercise, your diet, and the type of underwear you wear).

These recommendations can help you understand how your lifestyle choices impact your sperm health and sperm testing results, and how to make changes that will result in healthier sperm and higher fertility.

Whether or not, and when, you should redo sperm testing depends on why you’re testing in the first place. If you’ve received a completely normal result, you may not need or want to repeat sperm testing at this time.

If you’ve received an abnormal sperm testing result that you believe is due to a spilled or contaminated sample, a too-short period of abstinence prior to the test, illness or fever at the time of the test, or some other anomaly, you can retest again after 2–5 days of abstinence from ejaculation.

For those who have had a vasectomy, you should test your sperm approximately 12 weeks after the surgery to ensure it was successful. For those who are doing sperm testing after a vasectomy reversal, the recommended frequency is to retest once per month for 12 months, to ensure that sperm count and quality are recovering as they should.

For those who are making lifestyle changes and hope to see improvements in their sperm testing results, it’s important to know that sperm take about 74 days to produce through the process of spermatogenesis. Therefore, any changes will take at least 2–3 months to affect your sperm testing results. If you’ve, for example, quit smoking or started an exercise routine, you may want to retest again 3 months later to see how that change has improved your fertility health.

If you have received a very abnormal semen analysis report (for example, no sperm was found at all), you’ve attempted to make lifestyle changes with no impact on your sperm testing results, or you have not been able to achieve pregnancy with your partner after 6–12 months of unprotected sex, it’s recommended that you see a doctor for a consultation.

You might see a reproductive endocrinologist (who sees couples trying to conceive) or a urologist (who treats male patients for infertility and sexual health dysfunction). Be sure to bring your semen analysis results to your appointment to discuss with your doctor.