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.
Sperm is the male sex cell, also known as a gamete. Sperm cells are composed of a few distinct parts:
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.
There are several characteristics that, when examined in sperm testing, can indicate the health of sperm and overall male fertility.
Sperm count is the total number of sperm in a particular quantity of semen, the fluid that carries sperm out of the penis. Sperm concentration refers to how densely packed those sperm are within the semen. For example, a sample may include 3 milliliters of semen (volume) and a total sperm count of 45 million; that would be a concentration of 15 million sperm per mL.
Motility refers to the ability of the sperm to move or “swim,” which is essential for them to move through the female reproductive system and fertilize the egg. Progressive motility is the best type of movement that can be seen in sperm testing—that means the sperm move forward in straight lines or in large circles, as opposed to in small tight circles or along erratic paths.
Morphology means the sperm’s structure or shape, which is ideally:
This shape is important because it impacts a sperm’s ability to travel to and penetrate an egg.
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.
Male fertility issues contribute to at least 30% of diagnosed infertility cases, and 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 genetic mutations in sperm.
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.
Sperm testing is often done:
Learn more about why semen testing is important.
How is a sperm test done? And which is the best sperm count test for you—in-office, or at-home?
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.
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.
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.
Semen volume refers to the volume of the entire sample set 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.
These values refer to the total number of sperm in a particular quantity of semen as well how concentrated those sperm are within the semen. 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.
As part of your sperm testing results, you’ll get details on your sperm motility test results. “Sperm motility” refers to your sperm’s ability to move efficiently. 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/asthenozoospermia is diagnosed when less than 32% of the sperm are able to move efficiently.
Your sperm test results will report the percentage of “normal forms.” Every man will have some abnormal sperm. In fact, a healthy sperm morphology result may contain as few as 4–14% normal sperm, depending on the 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:
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.
Legacy’s sperm testing report includes 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.
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 70–90 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.