Guide to Sperm Testing

Sperm testing is the first step in understanding male fertility. This guide will explain what to expect during a semen analysis test, how to interpret the results, and what to do next to improve your sperm health.

Table of contents

1. Sperm basics
2. Sperm parameters: count, motility, and morphology
3. Male fertility testing: why check your sperm?
4. Sperm testing process: what to expect when you’re doing a semen analysis
5. How to read a semen analysis report
6. Next steps: what to do with your sperm testing results
7. References

Sperm basics

Components of sperm

Sperm is the male sex cell, also known as a gamete. Sperm cells are composed of a few distinct parts:

• the tail, made of protein fibers, which helps it “swim” toward the egg
• the midpiece, or body/neck, which contains mitochondria to power the sperm’s movement
• the head, which houses the nucleus where the sperm’s precious cargo—genetic information—is stored, as well as the acrosome, a tiny structure at the tip of the sperm full of enzymes that helps the sperm penetrate the egg by digesting proteins and sugars on the surface of the egg.

Each sperm cell contains 23 chromosomes, which is half the number of chromosomes in a typical human cell; it’s known as a “haploid” cell. A chromosome is a molecule of DNA, the material that guides the growth and development of the entire human body. The egg contains the other half. Together, they create a fully realized cell of 46 chromosomes (known as a “diploid” cell), which then divides to become all of the other cells in the body. The fact that half of our DNA comes from the sperm and the other half from the egg is why we inherit some traits from each of our parents.

Sperm are produced in the testes (testicles) in a process called spermatogenesis, which takes about 74 days. Approximately 50–100 million viable sperm are produced by the testes each day. Spermatogenesis begins at puberty and continues, typically uninterrupted, until death. There are, however, changes in the health and quantity of the sperm with age.

Sperm parameters

There are several characteristics that, when examined in sperm testing, can indicate the health of sperm and overall male fertility.

Male fertility testing

Fertility testing is a set of tools used to determine the chance that you’ll be able to achieve pregnancy. The best male fertility test we have is a semen analysis. A semen analysis tests for the health and fertility of sperm as well as the volume and chemistry of the semen, the fluid that carries sperm.

Sperm testing is often done:

• If you are trying to conceive. If you and your partner have been having unprotected sex for 6–12 months and haven’t yet gotten pregnant, semen analysis is a first-line test to help diagnosis or rule out male fertility issues. Doing sperm testing early on in the process of trying to conceive can help you avoid costly and unnecessary tests or treatments down the line.
• To proactively improve fertility. Even if you’re not trying to conceive right now, you may want to proactively assess—and address—sperm health issues. Because sperm take about 74 days to produce, it will take at least 2–3 months for any lifestyle changes you make to have a measurable impact on your sperm health. Sperm testing in advance can help ensure that, by the time you’re ready to start a family, your sperm is in its best possible shape.
• If you plan to freeze your sperm. If you’re freezing your sperm for the future—whether because you’re about to undergo cancer treatment or because you simply want to preserve your sperm at its youngest, healthiest state—sperm testing is crucial. You’ll want to ensure your sperm is healthy and fertile before freezing.
• To assess the results of a vasectomy or vasectomy reversal. If you have a vasectomy for long-term birth control, it’s recommended that you get a semen analysis around 12 weeks after the procedure, to confirm the vasectomy has worked as intended. Similarly, if you have surgery to reverse a previous vasectomy, sperm testing every month for 12 months is recommended to ensure sperm quality, count, and motility is recovering normally.

Learn more about why semen testing is important.

Sperm test: What to expect

How is a sperm test done? And which is the best sperm count test for you—in-office, or at-home?

In-office semen analysis

Traditionally, a semen analysis happens at a fertility clinic or urologist’s office with an andrology lab (a lab specifically set up for sperm testing, processing, and freezing). In this context, the office will usually require a prescription or referral from your doctor.

The semen sample for sperm testing is typically collected in a small cup via masturbation, either there in the office (in a “collection room”) or at home, and brought to the lab within 60 minutes. From there, the lab staff will examine the sample under a microscope to evaluate the sperm count, morphology, and motility, and results will be prepared and available in a few days. 

At-home semen analysis

With at-home sperm analysis, such as what’s offered here at Legacy, you are able to collect your sample in the comfort of your home. The Legacy sperm testing kit includes a special buffering medium that keeps your sample viable for up to 48 hours, as opposed to the usual 60 minutes. The sample is shipped overnight to the lab, where a technician will analyze it.

Many mail-in sperm testing kits give only the basic results, like sperm count and concentration. Legacy’s analysis kit tests for every sperm parameter evaluated in an andrology lab, and offers personalized recommendations for improving sperm health based on your lifestyle and sperm testing results.

Sperm analysis test cost

A typical cost for an in-office semen analysis is about $250, but it requires a prescription from a doctor, and the office visit may have a separate fee. The cost of a Legacy at-home semen analysis is $195, and it does not require a prescription from a doctor.

How to read a semen analysis report

Your semen analysis report will include a variety of values. Here’s an overview of what your sperm test results mean:

Semen volume

Sperm count and concentration

Sperm motility details

On more comprehensive reports, you may get a few other results, 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.

Sperm morphology details

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:

Abnormal sperm can come in a multitude of forms. In more comprehensive 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 fact, 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.

Next steps after a semen analysis

Improving your sperm count, motility, or morphology naturally

If you’ve received sperm testing results with low sperm count/concentration or poor motility or morphology, there are some things you can do on your own to improve these parameters. Your Legacy report will include personalized recommendations for improving your sperm health, based on your lifestyle. Optimizing your diet, increasing how much you exercise, quitting smoking, and cutting back on alcohol are all examples of ways to naturally improve your sperm health.

When to retest with another semen analysis

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 2–7 days of abstinence from ejaculation.

When to see a specialist for male infertility

Sperm freezing after semen analysis

If your sperm testing results demonstrate you have healthy, fertile sperm, and you’re not planning to start a family right now, you might consider sperm freezing.

Sperm freezing ensures that your healthy sperm can be used in the years to come, as your natural fertility decreases. It also preserves your parenthood options in the event that an illness or accident threatens your fertility. Scientific research tells us that sperm can be frozen indefinitely with no loss in quality.

Learn more about sperm freezing.

References

1. C.H. Heller, Y. Clermont. “Kinetics of the germinal epithelium in man.” Recent Progress in Hormone Research, 1964.
2. Isiah D. Harris, MD et al. “Fertility and the Aging Male.” Reviews in Urology, 2011.
3. Vanessa A. Comar et al. “Influence of the abstinence period on human sperm quality: analysis of 2,458 semen samples.”  JBRA Assisted Reproduction, 2017.
4. Ashok Agarwal et al. “Abstinence Time and Its Impact on Basic and Advanced Semen Parameters.” Urology, 2016.
5. Ashok Agarwal et al. “Effect of an isotonic lubricant on sperm collection and sperm quality.” Fertility & Sterility, 2013.
6. Elisabeth Carlsen et al. “History of febrile illness and variation in semen quality.” Human Reproduction, 2003.
7. K. Gopalkrishnan et al. “Volume of semen as a parameter of its quality.” Indian Journal of Medical Research, 1992.
8. Matthew Roberts, MD and Keith Jarvi, MD. “Steps in the investigation and management of low semen volume in the infertile man.” Canadian Urological Association Journal, 2009.
9. Trevor G. Cooper et al. “World Health Organization reference values for human semen characteristics.” Human Reproduction Update, 2009.
10. Niels E. Skakkebaek. “Normal reference ranges for semen quality and their relations to fecundity.” Asian Journal of Andrology, 2010.
11. Roelof Menkveld. “Clinical significance of the low normal sperm morphology value as proposed in the fifth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen.” Asian Journal of Andrology, 2010.
12. Jason R. Kovac et al. “Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction.” Asian Journal of Andrology, 2017.
13. Hagai Levine et al. “Temporal trends in sperm count: a systematic review and meta-regression analysis.” Human Reproduction Update, 2017.
14. Augustine Kong et al. “Rate of de novo mutations, father’s age, and disease risk.” Nature, 2012.