Male Fertility Testing: What to Expect During a Semen Analysis

When people talk about infertility, the conversation almost always leans toward the female side of things. But here’s the truth: men play a substantial role in nearly half of all infertility cases, and that lack of focus can delay solutions. 

Fortunately, testing exists to shine a light on what’s going on behind the scenes of male reproduction, and the best way to do this is through a semen analysis. Let’s take a look at how a semen analysis works.

What Is a Semen Analysis?

A semen analysis is a review of your sperm. It provides a detailed snapshot of how your sperm are doing, looking at quantity, shape, movement, and quality. Fertility clinics rely on semen analysis to pinpoint any potential weak spots. It’s the first step in understanding male reproductive health and making sense of why pregnancy isn’t happening.

Semen Analysis Process

The semen analysis process usually happens in a specialized fertility center like Reproductive Partners Medical Group, though some guys prefer to collect the sample in the comfort of their own home. Either way, you’ll need to provide a sample of semen, usually via masturbation. 

If you choose the home option, the sample must go into a sterile container provided by the clinic; also, speed matters. You have to get it to the clinic within an hour. Keeping it at room temperature is best, like tucking it in your armpit or inside a coat pocket.

Before producing the sample, hygiene is crucial. Wash your hands and penis with warm water (no soap, which can harm sperm), and avoid touching the inside of the container, or you could contaminate the sample and taint the results.

It’s common to repeat the process once or twice more because sperm levels can fluctuate like Wi-Fi signals. Testing multiple times helps the clinic get an accurate, reliable picture.

What Does a Semen Analysis Measure?

You might think semen analysis is all about “how many swimmers you’ve got,” but that’s only part of the picture. This test checks multiple criteria to give a nuanced read on fertility potential.

Semen Volume

First, the lab measures how much fluid you produce. Less than 1.5 milliliters per ejaculation might suggest there’s an issue like a blockage, a problem with the seminal vesicles, or a condition like retrograde ejaculation (where semen goes backward into the bladder instead of out).

Sperm Count

A healthy count is at least 15 million sperm per milliliter. Fewer than that might lower your chances of natural conception, though it doesn’t necessarily mean you’re infertile. 

Sperm Motility

Even if you’ve got a lot of sperm, if they’re all sluggish or swimming in circles, they won’t do much good. The analysis checks how many are moving and how well. Ideally, 40% or more should be motile, with many showing forward progression. 

Sperm Morphology (Shape and Structure)

Your sperm’s shape affects its ability to penetrate and fertilize an egg. A normal sperm has an oval head, a midpiece packed with energy, and a tail that whips it forward. Misshapen or headless sperm don’t get far. A small percentage of well-formed sperm may be enough, but too many abnormalities can raise concerns.

pH Levels and Liquefaction

Normal semen is slightly alkaline and should liquefy within 15–30 minutes after ejaculation. If it stays too thick or the pH is off, it might suggest infections, inflammation, or problems with the seminal vesicles or prostate.

White Blood Cells

There shouldn’t be many white blood cells in semen. If white blood cells show up in high numbers, that could mean there’s an infection that’s impacting fertility.

Other Diagnostic Tests for Male Infertility

If the semen analysis raises a red flag or if things still aren’t adding up, further tests might be recommended. Think of the semen analysis as opening the door. These additional tests walk you through it.

Hormone Testing

It’s not just about testosterone (though that matters). Hormones like FSH, LH, and prolactin play vital roles in sperm production and regulation. A simple blood test can reveal whether hormone levels are off-kilter. For example, high FSH might point to poor sperm production, while high prolactin levels could indicate a pituitary gland issue that’s throwing off the entire hormonal orchestra.

Genetic Testing

When sperm count is very low or nonexistent (azoospermia), genetics might be the culprit. Conditions like Klinefelter syndrome or tiny deletions on the Y chromosome can disrupt sperm creation. Genetic testing through blood samples can uncover these conditions, helping guide future treatment or counseling.

Mixed Antiglobulin Reaction (MAR) Test

Your immune system is supposed to ignore sperm, but sometimes it doesn’t. When it misidentifies them as threats, it releases anti-sperm antibodies, which can latch onto sperm and sabotage their movement. The MAR test checks for these antibodies. If a significant percentage of your sperm are under attack, it could explain fertility issues.

How to Prepare for a Semen Analysis

The preparation is simple.

• Abstain from ejaculation for 2 to 5 days before giving your sample. Too soon, and the sperm count might be low. Too long, and they may be sluggish.
• Skip alcohol, tobacco, and caffeine during that time too. These substances can wreak havoc on sperm quality.
• No saunas, hot tubs, or overheated laptops resting on your lap. Sperm are heat-sensitive.
• Disclose all medications or supplements you’re taking. Even seemingly harmless ones, like antihistamines or herbal remedies, can influence sperm performance.
• If collecting at home, keep the sample at room temperature and deliver it quickly, within an hour, ideally.

Understanding Your Test Results

When your results land in your inbox or get discussed in a follow-up appointment, they can look coded. It’s easy to panic, but don't. Your provider will walk you through what everything means.

Here’s the key thing: normal doesn’t guarantee fertility, and abnormal doesn’t guarantee infertility. These numbers are just part of the story. They can fluctuate depending on stress, illness, recent fevers, diet, and sleep.  

If your first test looks off, don’t despair. Many men need a second or third analysis to spot trends or rule out temporary disruptions. And even those with poor results sometimes go on to father children naturally, or with the help of modern medicine.

Next Steps & Treatment Options

Let’s say your results show a few concerning signs. Now what? Don’t assume this is the end of the road. In fact, for many couples, it’s just the beginning of the solution.

Lifestyle changes often top the list. Quit smoking, moderate alcohol, eat nutrient-rich foods, get enough sleep, exercise moderately, and manage stress. These changes can lead to significant improvements in sperm quality.

Medications or hormone treatments may be used to fix underlying imbalances. Surgery might be needed if there’s a physical issue, like a varicocele (a bundle of enlarged veins in the scrotum) or a blockage.

Assisted Reproductive Technologies (ART) such as IUI (Intrauterine Insemination), IVF (In Vitro Fertilization), or ICSI (Intracytoplasmic Sperm Injection) can create new paths to parenthood even when natural conception seems out of reach.

FAQs

How does IVF help with male infertility?

IVF bypasses a lot of the natural hurdles. Instead of sperm needing to complete the journey through the female reproductive tract, IVF brings sperm and egg together in a lab. It’s ideal when sperm count or motility is too low to rely on natural conception. In other words, IVF cuts out the need for perfect swimmers.

What is ICSI, and how does it improve male fertility treatment?

ICSI or Intracytoplasmic Sperm Injection takes IVF to the next level. A single, healthy-looking sperm is chosen and injected directly into the egg using precise microscopic tools. This is a game-changer for men with very low sperm counts or structural sperm issues. It’s also the go-to method when sperm is surgically retrieved.

Who needs ICSI?

ICSI is recommended for:

• Men with extremely low sperm count or poor motility
• Cases of unexplained infertility where IVF hasn’t worked
• Men who’ve had sperm extracted surgically due to blockages or ejaculation problems
• Severe sperm shape abnormalities (morphology issues)

What is the success rate of IVF with ICSI for male infertility?

The numbers are encouraging. Fertilization rates can hit 70–80% per egg in optimal lab conditions. Still, success doesn’t rely on sperm alone. Maternal age, embryo quality, and overall health are huge factors. Even with ICSI, multiple cycles may be needed.

Is there an increased risk of genetic issues with ICSI?

There’s a slightly increased risk, especially if the infertility has a genetic basis. That’s why preimplantation genetic testing (PGT) is often suggested. PGT checks embryos for chromosomal abnormalities before transfer, helping lower the risk of miscarriage or inherited conditions.