How to understand sperm test results and what is ‘normal’?

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)
Motility, broken down into rapid, slow, non-progressive and immotile
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.

Further reading

Men’s Health Week 2020




Fertility Language – What Do All These Abbreviations Mean?

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.

Further Reading:

What affects Fertility
When are the best days to get pregnant?


What Afffects Fertility – And What Can You Do?

What factors can affect fertility – can you do something to improve it?

I am a reflexologist, and part of working with clients trying to conceive means we look more widely – w/holistically at what is going on in their lives. This is going to be a longer read, so do get a drink, find somewhere comfy to sit, and take your time.

Here are four of the most important areas that I have found usually need a bit of work when people are thinking about their fertility or already trying for a baby. They are something you can do for yourselves – remembering that BOTH of you should be reading! – without the need for too much advice, and can have a really big impact on your fertility.

  • Sleep
  • Gut/vaginal microbiome
  • Lifestyle choices
  • Toxin exposure

Why is sleep important for fertility?

Getting enough sleep is as important as anything else you try when you’re trying to get pregnant.

Although not many studies directly assess the impact of sleep issues on fertility, there is already good evidence that shift workers, particularly those working nights have documented changes to their overall wellbeing. These included weight gain which is hard to shift, changes to menstrual cycles, poor mental health, and increased time to conceive, and feeling tired. Never a good place to start when you want to start or add to your family.

Sleep has a regulating effect on hormones – many of them do their work whilst we are asleep. Any disruption or disturbances to a regular sleep pattern can therefore have an impact on hormones, which regulate or influence fertility, including the quality of sperm and eggs. You can see then that having a good night’s sleep isn’t just important for your rest, but also for your long term health and potential your fertility.

What can you do to improve your sleep? Having a bedtime routine is key – you want to give yourself all the signs that it’s time to rest. Here are some ideas that you can start with today.

– Have a regular bedtime and wake time
– Make sure you get morning daylight (preferably outside) on your face to reset your internal clock
– Reduce exposure to blue light in the evening (phone, tablet, computer, tv)
– Turn off blue light emitting devices at least one hour before your bedtime, and keep them out of your bedroom
– Make sure your sleeping place is cool and dark enough – blackout blinds behind curtains help on light mornings and evenings, or if you have to sleep during the day
– Avoid caffeine 4 -6 hours before bedtime (tea, coffee, fizz, and chocolate) as it acts as a stimulant
– If you work nights, see if you can switch to a daylight pattern for at least a three month period before you start trying to conceive

Why is the gut/vaginal microbiome important for fertility?

What is a microbiome? ‘A microbiome is the community of micro-organisms living together in a particular habitat.’ We have these communities throughout our bodies, about 29% of them live within the gut and around 9% within the vagina.

There are good (helpful) and bad (unhelpful) communities of bacteria within these microbiomes, and getting the balance to swing in favour of the helpful kind will contribute to your physical and mental wellbeing, as well as improving the vaginal/uterine environment and your fertility.

Poor gut health can:

– lead to inflammation within the body, affecting the reproductive organs
– lead to nutrient deficiencies which affect all aspects of wellbeing affecting hormones, egg and sperm quality
– affect the hormonal balance of oestrogen – poor gut health can affecting how it’s regulated which may lead to an oestrogen dominance affecting menstrual cycle health and fertility
– lead to insulin resistance, which can lead to a rise in insulin which has a negative effect on egg quality and menstrual cycles

To support a healthy microbiome, try to incorporate a wide variety of vegetables into your diet. The advice to ‘eat the rainbow’ is a great place to start. You’ll find a few ideas on this page from BBC Food to get you started. Eating what’s called the Mediterranean diet can also be a great support to a healthy gut. It includes a broad range of fresh fruit and vegetables that include oils, good fats, slow-releasing carbohydrates and protein. which all support nutrient absorption, blood sugar and rich in antioxidant which help protect cells (including egg and sperm) from damage, whilst the good fats improve cell membrane quality and help protect against inflammation in the body.

A healthy gut biome will also support a good vaginal biome, but you can also consider adding in a quality supplement designed to support specific vaginal bacteria (such as Nua Fertility). Sensible things to help externally include reducing the use of conventional sanitary products as they contain many chemicals which are very unfriendly for a health vaginal environment. Try to choose organic, non-bleached products, or go re-useable for pads, period pants or menstrual cups. I’ll add a few more tips further down in the ‘avoiding toxins’ section.

Why are lifestyle choices important for fertility?

Unfortunately, many of the things you choose to do are likely to have an impact on your fertility – and not always a positive one. The main culprits are smoking, alcohol use, drug usage and weight. Let’s have a closer look – and remember, I am casting no blame, just aiming to educate you on factors that YOU can change to improve your overall health and fertility.

Men who smoke have lower sperm counts, poor motility, and higher numbers of malformed sperm. Nicotine also interferes with absorption of vitamins and minerals, causing increased free-radicals, this is damaging to the developing sperm cells and increases the likelihood of DNA fragmentation. The effect of nicotine in women: as well as being highly toxic, it reduces blood flow to the endometrium (the uterus lining); these two things in themselves are a good enough reason to stop smoking. Alongside that it has a direct impact upon fertility, and increases the chances of miscarriage, still births and abnormalities.

This is the most socially acceptable ‘drug’, and is used more and more to manage stress levels in today’s society. However, it can have devastating impacts on sperm morphology (formation) and motility (ability to swim).
The effects of alcohol upon pregnancy and the developing baby are very well documented, but include increased chance of stillbirth, miscarriage and foetal abnormalities, together with prematurity and life affecting debilities. Alcohol has a direct impact upon the quality of the egg. General advice is now to stay alcohol free whilst trying to conceive and during pregnancy because the effects on development of babies has truly devastating effects.

Male fertility is affected by being either underweight or overweight. Maintenance of a sensible body weight makes sense. Females that are over- or underweight will also see an impact upon their fertility, as this can create changes in hormone levels, which may restrict your chances of conceiving, and your chances of carrying a baby to full-term. Being overweight changes oestrogen levels, interfering with the menstrual cycle. Being underweight will often impact on ovulation and general menstrual health – both will have a knock-on effect on your general wellbeing.

Cannabis/Recreational Drugs/Prescribed medication
Marijuana lowers blood testosterone diminishing libido, and increasing the likelihood of impotence. It also affects sperm motility and morphology. Recovery time from stopping use is at least 6 weeks. For women using any recreational drugs, understand that they are extremely toxic and have negative impacts on your fertility, libido and the ability to carry a baby to term and in good health. Cocaine increases heart rate, suppresses appetite, and raises body temperature, which is unhelpful when trying to conceive. Frequent use also causes depression.  Steroids are used by some men to enhance their muscle strength, but this does not aid fertility and is incredibly damaging to sperm. Unfortunately, many prescribed medications interfere with fertility. Antibiotics/Anti-Depressants/Beta-blockers – these prescribed medications interfere with the production of healthy, functioning sperm and eggs and may also have negative effects on menstrual cycles. If you are taking any prescription drugs, please check with your GP to ask if they are absolutely necessary, or if there are fertility-friendly alternatives available.

Why is toxin exposure important for fertility?

Unfortunately in today’s world, toxins are all around us. Most of them are generally bad for us, some have particularly nasty effects on your fertility. Elimination of as many as possible (within reason, budget and sanity) will add to the overall impact on your bodies – it may seem a lot to digest at first, but my advice is to take it steady, try and change one or two things a week and that way will be less overwhelming. You will be reading labels more carefully!

What to look out for?

Xenobiotics are the chemicals found in cosmetics, pesticides, food preservatives and cleaning products, they affect sperm function, production and testosterone levels. Looking for organic or environmentally friendly products will help here – many of them have had the irritants and preservatives that can cause issues removed. Start with washing liquid/powder (please try to stop using fabric conditioner – it’s full of hormone disrupting chemicals), cleaning sprays and toilet cleaner. Sanitary products can also hide some pretty unpleasant chemicals, and I would suggest that this is an easy place to start making changes (as above), reduce the use of very perfumed, coloured or antibacterial bathroom products – toilet paper, wet wipes for personal hygeine, bubble bath, shower gels, shampoo etc., and try more natural alternatives like hand made soaps or solid products (more likely to contain fewer dangerous chemicals). Storing food and cooking (eg in microwaves) food in plastic can also add to toxin exposure. If you can, use glass or china to store and heat food, reduce the use of non-stick pans and trays, and keep drinks in china, stainless steel or glass rather than plastic bottles.

Phytoestrogens are naturally occurring oestrogens found in foods such as soya. Soya is found in many prepared foods, including pizza bases, and it would be sensible to reduce this as much as possible from the diet. If you’re following the gut health advice above, you’ll be eating fewer processed foods and will hopefully have lower exposure from these.

Oestrogens are a bit more tricky. The oral contraceptive pill has been responsible for allowing higher levels of oestrogen to contaminate our water supplies, creating havoc with men’s fertility by skewing hormone levels, and impacting on sperm production. There is little that can be done about this currently, but remember, tap water is generally safe to drink (in the UK) and bottled water in plastic is much worse for both you and the planet in the wider scheme of things.  It may be worth considering a water filtering jug whilst you are trying to conceive – this one has a glass jug and refillable filters, which are much more eco-friendly than throw-away cartridges.

Anything else to consider?

Yes, of course, there is always going to be more! However, the four factors that can have an affect on fertility that I have outlined above are all things that you can make changes to. The power is within your hands to make a start. Hopefully you don’t feel completely overwhelmed, but better informed.

If you want to make a start on incorporating these changes, but need someone to help you along the way, then please get in touch. I offer differing levels of support depending on what your needs and budget are – ranging from a 2 hour Zoom consultation with advice tailored to your specific situation, up to three month plus programs which include sessions of holistic therapies, lifestyle and nutrition information, tailored natural products and email support, both in person or via Zoom or as a blended version which makes my services easier to access if you can’t visit me in person.  Send me an email to find out how I can help you, book a free discovery chat, or contact me via my social media channels on Instagram or Facebook.