Semen analysis results: reading the report and what happens next

The report is only as reliable as the sample. Illness with fever, recent heavy drinking, very short or very long gaps since the last ejaculation, and incomplete collection can all change the figures. Laboratories give instructions about abstinence and about delivering the sample promptly at body temperature, and following them makes the result easier to interpret.

The NHS places semen analysis among the first investigations for male infertility, alongside a chlamydia urine test, and advises seeing a GP after a year of trying without success, or earlier when there are concerns.

Different laboratories format reports differently, but most include a similar set of measurements. Each tells a different part of the story.

• Volume: the amount of fluid produced. Very low volume can point to collection problems, a blockage, or retrograde ejaculation, in which semen passes back into the bladder; the NHS says sperm can sometimes be taken from urine or testicles in that situation for assisted conception.

• Concentration and total count: how many sperm are present per millilitre and in the whole sample.

• Motility: the proportion of sperm that move, and how well. Progressive motility describes sperm that swim forwards.

• Morphology: the percentage with a typical shape. Laboratories apply strict criteria, so many normal men have a high proportion of atypical forms.

• Vitality and other findings: sometimes the proportion of living sperm, the presence of white blood cells, or clumping.

Reports and clinic letters use shorthand that can sound alarming. These are descriptions, not diagnoses.

Sperm production is a continuous process and counts fluctuate. For this reason a specialist will usually ask for at least one repeat sample, taken after an interval, before drawing conclusions. A borderline result in someone with a healthy partner may simply be a variation, and many couples with below-reference results still conceive without treatment, while some with normal reports still struggle because of other factors.

This guide does not quote threshold numbers, because laboratories apply their own reference ranges, often based on international guidance, and your report states the ones used. Ask the clinic to explain where your results sit against them.

A low count prompts questions and examination. The NHS lists causes including testicular damage from infection, cancer, surgery or undescended testes, hormone problems such as low testosterone, ejaculation disorders and medicines. A doctor may check testicular size, look for a varicocele, and arrange blood tests for FSH, LH and testosterone.

Lifestyle measures from the NHS, such as cutting alcohol to within guidelines, stopping smoking, losing excess weight, wearing loose underwear and avoiding anabolic steroids and other drugs, are sensible alongside investigation. Where treatment is needed, options include correcting a treatable cause, IUI, IVF or ICSI depending on the results.

Azoospermia is investigated by separating blockage from failure of production. The HFEA describes surgical sperm extraction techniques, including needle aspiration, testicular biopsy and microscope-assisted testicular sperm extraction, for men with no or extremely low counts, and notes that success is not guaranteed and that ICSI is generally needed to use the sperm. Genetic testing is commonly advised before treatment.

Receiving an abnormal result can feel deeply personal, and men are often reluctant to talk about it. It helps to separate the number from your sense of identity: the figures describe a sample on a given day. Counselling is available through fertility clinics, and a GP can arrange referral to urology or a fertility service. Keep a copy of the report and take it to any appointment.