A semen analysis (spermiogram) is the first and most informative test in evaluating male fertility. It measures how many sperm are present, how well they move and how many have a normal shape. Yet a lab report full of percentages and abbreviations can be confusing. This guide explains, step by step, what each value means according to the World Health Organization (WHO) 6th edition manual (2021) — and what your options are if the results are below the reference limits.
Getting the Test Right
The reliability of a semen analysis depends directly on how the sample is collected and processed:
- Abstinence period: 2 to 7 days of sexual abstinence is recommended before the test.
- Sample collection: The sample should ideally be produced by masturbation into a sterile container at the laboratory; samples collected at home must reach the lab within 30 minutes.
- Complete sample: The entire ejaculate must be collected — losing the first fraction significantly distorts the results.
- Accredited laboratory: The analysis should be performed in an experienced laboratory working to WHO standards.
- Repeat testing: If an abnormality is found, the test should be repeated after 2–4 weeks before any diagnosis is made.
Count, Motility and Morphology
Sperm Concentration
According to WHO 6th edition criteria, a normal result is 16 million sperm per millilitre or more, and 39 million or more per ejaculate in total. A count below these limits is called oligozoospermia; the complete absence of sperm in the ejaculate is azoospermia — a condition with its own treatment pathways, explained in our guide to azoospermia and micro-TESE.
Sperm Motility
Motility describes how sperm move. Progressive motility means the sperm swim actively forward in a straight line; total motility includes both progressive and non-progressive movement. The WHO 6th edition reference limits are ≥ 30% progressive motility and ≥ 42% total motility. Reduced motility is called asthenozoospermia.
Sperm Morphology
Morphology assesses whether the head, midpiece and tail of the sperm are structurally normal. Using strict (Kruger) criteria, a result of ≥ 4% normal forms is considered within the reference range. A lower percentage is called teratozoospermia.
WHO 6th Edition Reference Values at a Glance
- Semen volume: ≥ 1.4 mL
- pH: ≥ 7.2
- Sperm concentration: ≥ 16 million/mL
- Total sperm count: ≥ 39 million per ejaculate
- Total motility: ≥ 42%
- Progressive motility: ≥ 30%
- Vitality: ≥ 54%
- Morphology (Kruger): ≥ 4% normal forms
- Leukocytes: < 1 million/mL
- Liquefaction: within 30 minutes
It is important to remember that these numbers are reference points, not verdicts. They represent the 5th percentile of fertile men — a value below a limit lowers the probability of natural conception but does not by itself diagnose infertility.
What If the Results Are Abnormal?
Further Evaluation
- Urology consultation: physical examination, screening for varicocele and undescended testis
- Hormone tests: testosterone, FSH, LH and prolactin levels
- Genetic tests: karyotype analysis and Y-chromosome microdeletion screening
- Scrotal ultrasound
- Post-ejaculatory urine analysis to investigate retrograde ejaculation
Treatment Options
Lifestyle changes — quitting smoking and alcohol, a balanced diet, regular exercise, maintaining a healthy weight, managing stress and avoiding heat exposure — can measurably improve sperm quality within about three months, since that is how long spermatogenesis takes.
Medical treatment targets hormonal imbalances and infections, while surgery can correct varicocele or ductal obstruction. When natural conception remains unlikely, assisted reproduction steps in: intrauterine insemination (IUI) for mild abnormalities, IVF with ICSI (microinjection) for severe male-factor infertility, and surgical sperm retrieval (TESA / TESE / micro-TESE) when no sperm are found in the ejaculate.
An abnormal semen analysis is the beginning of a diagnostic journey, not the end of the road. With modern treatment, the great majority of couples facing male-factor infertility can still achieve a healthy pregnancy. If you would like your results reviewed by our team led by Prof. Dr. Kubilay Vicdan, you can book a free initial consultation.