What do your ‘Normal’ Semen Analysis Test Results Mean?

You’ve just had your initial semen test results back, and the doctor/receptionist will says ‘yes it was all normal’, without actually giving you the report. Please, always ask for a copy of your semen analysis, it is SO helpful to have the actual document to hand and provides really valuable information. Many semen analysis sheets that I review may be ‘normal’ but are not optimal for fertility.

What is a sperm sample?

A semen or sperm sample is the fluid produced when you ejaculate/orgasm, and should contain sperm, which are the male cells that fertilise a human egg. Samples are collected into a pot, and sent to a lab for assessment. Samples are assessed using basic criteria, and you can usually have the analysis done via a request from your GP.

These criteria, based on reference ranges for male fertility via semen testing, are usually measured against World Health Organisation agreed levels. These have just been republished as until this year the most recent figures used were from 1999!

The criteria give expected ranges for a viable semen sample, so if your results fall outside those ranges – either below or above, then there may be an issue with your semen/sperm.

A basic sperm test usually give a report on all (or some) of the following measures:

Volume (the amount produced for the sample)
Appearance
Liquefaction
Viscosity
pH
Debris
Agglutination
Motility, broken down into rapid, slow, non-progressive and immotile
Vitality
Anti-sperm Antibodies
Concentration/count per ml and total for the sample
Round/other cells
Morphology, broken down into normal, abnormal, head/mid-piece/tail defects, cytoplasmic droplets

What is a normal sperm sample?

The WHO criteria look specifically at volume, total number of sperm in the sample, concentration of sperm per ml, motility, morphology and pH level, so these are what I am going to discuss in this article.

* There should be a certain volume of semen in a sample, the new range suggests a minimum of 1.5 ml, and up to 5ml is considered within range.
* The total of sperm in the sample should be greater than 39 million, and concentration per ml greater than 15 million.
* Motility will usually be total (all the sperm together) greater than 40%, and progressive greater than 32%.
* pH levels in the sample should be 7.2, anything below this or greater than 8 should be investigated further.
* Finally, morphology or normal forms should be greater than 4%

If a semen sample comes back outside of these ranges you may see notes on the report such as low motility, poor morphology, even azoospermia. These are technical terms which refer respectively to sperm which do not move well, sperm which are not properly formed, and lack of sperm observed. Observations about the pH might indicate infection or urine contamination of the sample, and issues with volume could be indicative of an issue with sperm production including physical obstructions, heat damage from varicoceles etc.

The above are all common, although as I’ve said before, not necessarily addressed, because male factor issues – despite being 50% of the base material for embryos – are not considered until last resort in many cases.

What might be wrong with a sperm sample?

Below I have listed some common causes of poor quality sperm samples. Hopefully, this article will help you understand the issues surround male fertlity better. My job as a reproductive reflexology specialist is to guide you to understanding what’s happening with your sperm, by interpreting your specific results, and then a) use targeted reproductive reflexology (and a holistic approach) to see if we can make changes which may sustain improvements to sperm quality, and/or b) refer you for further testing as necessary, with continuing reflexology and holistic support.

Causes of low semen volume

You might see a low volume (called hypospermia) if some of the sample missed the collection pot, however, other causes can be linked to ejaculation problems such as retrograde ejaculation where semen travels backwards into the bladder, prostate gland cancer treatments, medications, diabetes and hormonal issues. Blockages in the seminal vesicles which deliver the sperm to the penis can be caused by varicocele, infections can also be a cause.

Causes of low sperm in semen samples

Low quantities of sperm in a sample can cause problems with conceiving a child. The reasons for fewer sperm in a sample can include problems with sexual function (low libido, erectile dysfunction), pain or swelling in the testicles, hormone abnormalities, previous injury to the testicles or penis, infections, varicoceles, anti-sperm antibodies (an immune system problem), blockages in the tubules anywhere in the male reproductive system and undescended testicles. Celiac disease, prior surgery and chromosome defects can also be the cause of low sperm counts. Many of these issues can be resolved, discovering them initially may be the hardest part of the problem.

Low motility in semen samples

Causes of poor motility are connected to infections, defects in the sperm DNA, alcohol and drug use, and inflammation. Low motility means that the sperm are not moving well – either going in circles, not moving fast enough or failing to move forward. As with poor morphology, low motility has effects on the ability of sperm to move to the fallopian tubes where the egg is waiting, and thus has a negative affect on male fertility. The corkscrew motion of a well formed sperm is much more effective in the long journey to fertilise an egg, so you can see again that good quality sperm making forward progress are likely to be better at moving through the uterus to their destination. Reducing inflammation, treating infection, and changing lifestyle habits can all have a positive effect on motility.

Semen pH levels

Semen is usually slightly alkaline with a normal pH range between 7.2-8.0. The acidity or alkalinity of a semen sample can indicate issues or infections – which are often invisible, additional screening often reveals these and then treatment with antibiotics and supplements can help to improve the levels. High or low semen pH can cause sperm death. It can also impact the ability of the sperm to swim and be able to penetrate the egg.

Causes of poor morphology

Morphology issues can be caused by heat damage, which include external heat such as use of saunas, heated car seats etc., or damaged caused by varicocele (lumpy collections of veins on the testicles), infections and lifestyle choices including drug and alcohol use. Some prescribed medications can also have a negative effect on the morphology of sperm, so it’s worth checking that any drugs prescribed are fertility friendly. Well formed sperms should have an evenly formed head, mid-piece and tail. Each part has a job to do: the head contains the genetic material, the mid-piece is the engine and the tail provides the movement towards the egg. If morphology is classed as poor, then the sperm may have missing or partial tails, wonky heads, and mid-piece defects, which can cause issues with actually getting into the fallopian tubes, egg penetration, and then faulty fertilisation, which can lead to poor implantation rates and contribute to chemical pregnancies and early miscarriage.

Red Flags for Sperm Quality and Quantity

Red flags which can contribute to issues of sperm quality and quantity include:
– Smoking
– Drugs (including prescriptions and steroids)
– Alcohol
– Infections (can be invisible)
– Nutritional deficiencies
– Shift work/poor sleep

Next Steps

Being aware of the issues surrounding your sperm sample can help you to understand where you can make positive changes to improve it. There are of course lots of things that can affect sperm quality, including physical issues but the above are very COMMON and many can be resolved with the right advice and support.

You may need additional testing or screening, or you may just need to make changes to your lifestyle. I expect to work with you for a minimum of 3 months, as this is when I see the best results for improvements with previous clients. Are you ready for the next step? If you have received a less than positive semen analysis, or have been told that you have a normal result but are still having problems conceiving, then book a call with me today.

Fertility Language can be very confusing and exclusive if you’re new to the game.

I’ve listed some of the more common abbreviations here that you may come across during your journey to conceive, and hopefully this article will help you to understand them a bit better. Save it for later, and do share with anyone else who may be struggling!

TTC – Trying To Conceive

This is one you’re likely to know already, as probably it’s where you are right now. People who are trying to get pregnant or preparing to do so!

CD – Cycle Day

Very simple – if your period/bleed starts on Monday 1st Jan, that is your Cycle Day 1. The last day of your cycle is the day before a bleed. Recording cycle length is helpful, as not everyone has regular cycles, and even knowing the length of a cycle can help identify an issue. In co-ordination with charting temperatures, cycle days can be used to record bleeding days, days of fertile fluid observed, days when you have had sex, when/if you ovulate, and the length of the luteal phase after ovulation. It all comes back to data!

AF – Aunt Flo (Period/Bleed)

This somewhat jokey term is often uses as a quick way of referring to the onset of the monthly menstrual cycle. It’s when you start to bleed – shedding last months uterine lining. Bleeds should not be painful, should have a defined start and end, and you should not see spotting after the bleed has ended. Any of these may indicate an issue with hormonal balance, or structural issues with the uterus like endometriosis, adenomiosis, fibroids, polyps and more.

CM (CF) – Cervical Mucus/Cervical Fluid

Cervical Mucus or Fluid (CM/CF) can be a valuable tool in observing your menstrual cycle and its stages. When you wipe, it’s easy to check and see the colour, texture and amount. From the bleed to the end of your cycle, the cervical fluid changes from non-fertile, to fertile (around ovulation) and then changes again post-ovulation to protect a potential pregnancy before reverting to a bleed if not pregnant. Seeing fertile CF is one of the key signs of ovulation, and a great way to start noting how your body works. Download my handy guide to the types of CF here.

FSH – Follicle Stimulating Hormone

Ovarian follicle development is governed by a pituitary hormone called FSH: follicle-stimulating hormone, which stimulates the follicles to grow. You have less FSH when younger, and more as you mature – leading to shorter or irregular periods. FSH levels also contribute to how heavy or light your bleed is – the hormone stimulates estradiol which influences the thickening of the uterine lining.

LH – Luteinising Hormone

As you come up to the time of ovulation (which is the midpoint of your menstrual cycle), your hormones are preparing to release an egg from a mature follicle. Luteinising Hormone (LH) levels reach a peak at ovulation, triggering the follicle to ripen and release into the fallopian tubes, ready to be fertilised. Defects in the hormone balance can affect whether you ovulate or not.

DPO – Days Past Ovulation

This abbreviation is used to indicate how far past ovulation in your cycle you are. It’s used often for charting and fertility apps. Usually, if an egg has been released (ovulation) and potentially fertilised and implanted in the uterus, it will be producing enough hcG hormone to indicate a pregnancy if you tested at 14 days past ovulation. It’s useful to know to identify how long the luteal phase lasts – the time between ovulation and the next bleed. Often also called the Two Week Wait (TWW), see below.

TWW – Two Week Wait

For many people, this is the worst part of the whole cycle. The two week wait refers to the 14 days post ovulation, when you *could* be pregnant. It also refers to the wait after an IVF embryo transfer. There’s not a lot to do at this stage – if you’ve got everything right during the cycle, there’s about a 25% chance of a pregnancy. A lot of nail biting and symptom spotting takes places during this period of time. I recommend taking up an absorbing hobby!

BBT – Basal Body Temperature

We use a BBT to chart temperatures throughout a menstrual cycle, as they can help to identify the different phases of the cycle. Using a digital thermometer (accurate to 2 decimal places) and either a paper chart or an online app (I recommend Fertility Friend), you take your temperature under the tongue every day, record it on the chart, and then you can see an overall pattern of each cycle. It’s very helpful to record this information, as it can help to identify ovulation, pregnancy, or if there are potential fertility problems such as not ovulating, spotting, long or short cycles and more. I recommend charting to ALL of my clients, for at least 3 months because the chart data is so useful.

MFI – Male Factor Infertility

Male factor infertility is often not well understood, and can be ignored until female partners have had all sorts of intervention. Issues like poor quality sperm, deformations in the structure, lack of ability to move properly and quantity of viable sperm all have an impact on the potential for a pregnancy and viable embryo. If you have a male partner, ALWAYS get at least a basic semen analysis carried out if you are having difficulties conceiving. I’ve written more about semen analysis in this article.

This is not an exhaustive list, and you are likely to see many, many more fertility related abbreviations, particularly if you are having IVF support. Please do feel free to ask me anything if you want them explained. You can book a discovery call with me if you want to chat about your journey to conceive. Remember to sign up to my newsletter if you want to read my articles first.