Understanding a Semen Analysis: What the Numbers Mean, and What They Do Not

បានធ្វើបច្ចុប្បន្នភាពចុងក្រោយ៖ ខែ​សីហា 26, 2026

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A couple is investigated for infertility when pregnancy has not happened after a year of regular unprotected intercourse. Around one couple in seven is affected, and a male factor contributes in roughly half of them — which is why the semen analysis is usually the first test done, and why it is so often misread.

• មជ្ឈមណ្ឌលផ្នែកជម្ងឺប្រព័ន្ធទឹកនោមនៃមន្ទីរពេទ្យបាងកក ប្រទេសថៃ។ កក់លេខរៀងការណាត់ជួបតាម online 02-310-3009 bhquro@bdms.co.th
• មន្ទីរពេទ្យ Samitivej Sriracha ខេត្តឈុនបូរី។ 088-022-1445

The most important thing to understand before you read your result

An earlier version of this article called the WHO figures a normal reference and described results below them as abnormal. That framing is the commonest source of unnecessary distress in an andrology clinic, and it has been corrected here.

The WHO figures are not a pass mark. They were produced by measuring the semen of men whose partners conceived within twelve months, and taking the fifth centile of that group — the value below which the least fertile one in twenty of those fertile men fell. They are a description of a population, not a boundary between fertile and infertile.

Two consequences follow, and both matter:

• Men whose numbers fall below these limits father children — one in twenty of the men used to build the reference did exactly that. A result under the line means fertility is statistically reduced, not that conception is impossible.
• Men whose numbers are entirely above the limits are sometimes infertile. A semen analysis counts sperm and watches them move; it does not test whether they can fertilise an egg.

The result is a piece of information about a couple’s chances, to be read alongside the female partner’s assessment. It is not a verdict on a man.

Producing a sample that can actually be interpreted

More abnormal results come from collection problems than from disease. Getting this right saves repeat tests and needless worry.

• Abstain for two to seven days beforehand. Much longer does not improve the result and worsens motility.
• Produce the sample by masturbation, into the sperm-safe container the laboratory provides. If a condom must be used it has to be a special non-toxic collection condom — an ordinary latex condom kills sperm and makes the result meaningless.
• Tell the laboratory if any of the sample was spilled, particularly the first portion, which carries most of the sperm. An incomplete collection is the commonest reason a volume or count looks falsely low.
• Keep it near body temperature and deliver it within an hour. Do not refrigerate it.
• Mention a recent fever or illness. A fever six to eight weeks earlier can wreck a result from a man whose sperm production is entirely normal, because of how long the production cycle takes.

The reference limits

នេះ។ World Health Organization issued its fifth edition in 2010 and its sixth in 2021, and laboratories have not all moved across at the same time — so your report may quote either set. Both are given below. The differences are small, and none of them turns a normal result into an abnormal one or the reverse; if your figures sit near a line, which edition your laboratory used matters far less than the points made above about what these limits actually represent.

What is measured	5th ed. (2010)	6th ed. (2021)	What a low value can indicate
Semen volume	1.5 mL	1.4 mL	Incomplete collection first of all; then retrograde ejaculation, ejaculatory duct obstruction, or absence of the vas deferens
Sperm concentration	15 million/mL	16 million/mL	Varicocele, undescended testis in childhood, genetic causes, heat or toxin exposure, and — less often than assumed — a hormonal cause
Total sperm number	39 million	39 million	More meaningful than concentration alone, since concentration depends on volume
Progressive motility	32%	30%	Antisperm antibodies, infection, varicocele, or delay and cooling between production and analysis
Total motility	40%	42%	As above
Vitality	58%	54%	If motility is poor but most sperm are alive, the problem is with the tail rather than with survival
Normal forms	4%	4%	Strict criteria — 4% is the reference limit, not a sign that 96% of sperm are defective
White blood cells	under 1 million/mL		Possible genital tract infection or inflammation, which warrants investigation rather than automatic antibiotics
pH	7.2		Low pH with low volume suggests obstruction or absent seminal vesicles

Two further corrections to the earlier version. It gave two different concentration thresholds in the same section, which was simply an error. And it attributed low concentration chiefly to hormonal causes; hormonal problems are important because they are among the few that are treatable, but they are a minority of cases, and the list above reflects that better.

If no sperm are found at all

This was missing from the earlier version, and it is the result that matters most.

A report of no sperm — azoospermia — should never be accepted on a single test. The laboratory must spin the entire sample and examine the pellet, because small numbers of sperm are often found that way, and the test must be repeated. Only then does the real question arise: whether sperm are being produced but cannot get out, or are not being produced.

Distinguishing the two requires examination, hormone tests including FSH and testosterone, and — where production is the problem — genetic testing, specifically a karyotype and Y chromosome microdeletion analysis. This is not a formality: the results change what treatment can be offered, and they carry information for any children conceived with assisted reproduction. Blockage is often correctable, and even where production is very poor, sperm can sometimes be retrieved surgically.

An absent count is a reason for proper assessment, not a conclusion.

How many tests, and when to repeat

Semen quality varies considerably in the same man from week to week, which is why a single poor result proves very little. Two samples, taken some weeks apart, give a far better picture than one.

Where something has been found and treated, allow at least three months before repeating — sperm take about that long to be made and mature, so a test done sooner is still reporting on the situation before treatment.

See also what the monthly chance of conception actually is, and — if testosterone treatment is being considered — how testosterone therapy affects fertility and what the alternatives are. Testosterone given from outside the body suppresses sperm production, and a man who has not finished having children should say so before starting it.

Findings that need attention rather than a repeat test

See a urologist promptly for any of the following. In an emergency in Thailand, call 1669.

• A lump in a testis. Testicular cancer is commonest at exactly the age men are investigated for fertility, and it is occasionally found during that investigation.
• No sperm on the report — this needs assessment rather than another test alone.
• Blood in the semen, or pain on ejaculation.
• Loss of desire, poor erections or reduced shaving frequency alongside a poor count — this combination points to the hormonal axis.
• Sudden severe testicular pain — that is an emergency the same day, whatever else is going on.

Frequently Asked Questions About Semen Analysis

My result is below the reference limit. Does that mean I cannot have children?

No. The reference limits are the fifth centile of men whose partners conceived within a year — meaning one in twenty of those fertile men fell below them. A result under the line means the chance per cycle is lower, not that pregnancy is impossible, and many men below these figures father children naturally.

My result is normal. Does that rule out a male problem?

Not entirely. The test counts sperm and observes movement; it does not establish that the sperm can fertilise an egg. A normal result makes a male factor less likely and does not exclude it, which is why both partners are assessed.

How should I prepare the sample?

Abstain two to seven days, produce by masturbation into the container the laboratory supplies, avoid ordinary latex condoms entirely, keep the sample near body temperature, deliver it within an hour, and tell the laboratory if any was spilled or if you have had a fever in the past two months.

Only 4% of my sperm are normally formed. Is that as bad as it sounds?

It sounds far worse than it is. Morphology is assessed by strict criteria under which even fertile men have a low percentage of perfectly formed sperm; 4% is the reference limit, not a sign that something has gone badly wrong.

The report says no sperm were found. What happens next?

It should not be accepted on one test. The laboratory should centrifuge the whole sample and examine the pellet, and the test should be repeated. Assessment then distinguishes blockage from failure of production, using examination, hormone tests and genetic testing including karyotype and Y chromosome microdeletion. Blockage is often correctable, and sperm can sometimes be retrieved surgically even when production is poor.

How many tests do I need?

Two samples weeks apart are much more informative than one, because results vary substantially in the same man. After treatment, wait at least three months before repeating, since sperm take about that long to be produced and mature.

Arranging a consultation

Dr. Soarawee Weerasopone sees male fertility and andrology patients at ទីស្នាក់ការកណ្តាលមន្ទីរពេទ្យបាងកក and at Samitivej Sriracha Hospital in Chonburi on 088-022-1445. Bring the actual laboratory reports rather than a summary, and any results your partner already has.

សេវាថែទាំសុខភាពពីចម្ងាយរបស់មន្ទីរពេទ្យបាងកកអាចរកបានសម្រាប់អ្នកជំងឺដែលមិនអាចចូលរួមដោយផ្ទាល់បាន រួមទាំងអ្នកជំងឺអន្តរជាតិផងដែរ — សូមរៀបចំវាជាមុនតាមរយៈអ៊ីមែលទៅកាន់ផ្នែកជំងឺប្រព័ន្ធទឹកនោមតាមរយៈ bhquro@bdms.co.th. មន្ទីរពេទ្យ Samitivej Sriracha គឺសម្រាប់តែអ្នកមកទទួលផ្ទាល់ប៉ុណ្ណោះ។ ការសាកសួរអំពីតម្លៃនឹងត្រូវបានឆ្លើយតបដោយមន្ទីរពេទ្យ មិនមែនដោយគេហទំព័រនេះទេ។.

ការបដិសេធ៖ This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters, and is intended for education only. It is not medical advice, diagnosis or a prescription for any individual, and no advice, diagnosis or prescription is given through personal messaging channels or social media. Dr. Soarawee operates no public social media account; any account offering private consultation in his name is fraudulent. In an emergency in Thailand, call 1669.