Semen analysis results explained: reading your report line by line

Published 22 October 2026

A semen analysis report is a page of numbers and unfamiliar words, and it is easy to read one figure below the reference range as a verdict. It is not one. This guide explains what each line measures, where the WHO 2021 reference values come from, why results vary, and what an abnormal result usually leads to.

What does a semen analysis show?

A semen analysis shows how much semen you produce, how many sperm it contains, how well they move, what proportion are normally shaped and, sometimes, how many are alive and whether white blood cells are present. It describes one sample on one day. The European Association of Urology (EAU) guidelines state that semen analysis alone cannot distinguish fertile from infertile men.

The World Health Organization (WHO) laboratory manual, sixth edition (2021), sets the methods. Most reports are basic examinations; tests for sperm antibodies or DNA fragmentation are extended tests, used when there is a specific reason (see below).

What are the WHO 2021 reference values for semen analysis?

The main WHO 2021 lower reference limits are 1.4 mL volume, 16 million sperm/mL, 39 million in total, 42% total motility, 30% progressive motility and 4% normal forms. They are the fifth centile of results from about 3,500 men in 12 countries whose partners conceived naturally within 12 months. The table adds 95% confidence intervals and the median, a typical value rather than the bottom of the range.

Scroll the table sideways to see every column

pH and white cells are not part of the WHO reference distribution; the EAU guidelines list them separately as consensus thresholds. Laboratories still using the 2010 edition give similar figures, because the 2021 analysis validated the 2010 distribution.

Does a result below the reference limit mean I am infertile?

No. It means your sample falls among the lowest 5% of results from men who had recently fathered a pregnancy, and the WHO manual is explicit that this fifth centile is not a line between fertile and infertile men. Equally, results above every limit do not guarantee fertility. The EAU guidelines say results should be interpreted together and alongside the female partner’s fertility, including ovarian reserve, which they recommend assessing in parallel because it can change the timing and choice of treatment; the 2021 manual notes that combined reference limits have not yet been developed. A slightly low concentration with good volume and motility is a very different picture from a low count, poor motility and few normal forms together.

How do I read each line of a semen analysis report?

Read each line against its reference value, usually the WHO lower limit above, and read the lines together. Most reports follow the laboratory’s working order.

Appearance, liquefaction and volume

Semen is a gel at ejaculation, liquefied by prostate enzymes, usually within 30 minutes. A red-brown colour suggests blood in the semen. Most of the volume comes from the accessory glands, which dilute sperm from the testes, so volume says more about those glands and ejaculation than about sperm production. The WHO lists causes of low volume as losing part of the sample, partial retrograde ejaculation (semen passing back into the bladder), low testosterone, blocked ejaculatory ducts or congenital absence of the vas deferens.

pH

pH reflects the balance between acidic prostatic fluid and alkaline seminal vesicle fluid, and the clinically important finding is a low value. The WHO notes that a pH below 7.0 with no sperm may point to congenital absence of the vas deferens, where the seminal vesicles are often underdeveloped, giving a small, acidic sample.

Concentration and total sperm number

Concentration is sperm per millilitre; the total is concentration multiplied by volume. The WHO regards the total as the better reflection of testicular sperm output, because concentration depends on how much fluid the other glands add.

Motility

Progressive sperm swim actively forwards, non-progressive sperm move without getting anywhere, and immotile sperm do not move; total motility is the first two combined. The 2021 manual reintroduced grades a (fast progressive), b (slow progressive), c (non-progressive) and d (immotile), because fast progressive sperm are considered clinically important. Motility falls with time and with changes in temperature, so the WHO asks for analysis to start within 30 minutes and no later than 60, with the sample kept between 20 °C and 37 °C.

Morphology: why 4% can be normal

Morphology is the percentage of sperm with a normal head, midpiece and tail under the strict Tygerberg criteria the manual recommends. The criteria are deliberately demanding: the median man in the WHO reference group had 14% normal forms, and the lower limit is 4%. The WHO says morphology has limited value in predicting pregnancy; its main use is as a window on how the testes and epididymis are working.

Vitality

Vitality is the percentage of sperm that are alive, moving or not. The EAU notes it only needs measuring when more than 60% are immotile, which is why many reports omit it.

Round cells and white blood cells

Round cells are white blood cells and immature sperm cells, which look alike on a routine preparation; a peroxidase stain picks out the granulocytes, the main type of white cell in semen. The EAU points out that this signals inflammation, not necessarily infection, and that treating it alone, without an identified infection, has not been shown to improve conception.

What do oligozoospermia, asthenozoospermia and the other terms mean?

These labels describe which measurement was outside the reference range; none is a diagnosis or a cause. The EAU states that no single parameter is diagnostic of infertility. The 2021 manual sets no cut-offs for the labels, although the EAU panel still finds them clinically useful.

Scroll the table sideways to see every column

Why do semen analysis results vary, and why is a repeat test usual?

Results vary between samples from the same man, so one abnormal result is rarely the final word. The EAU recommends at least two analyses when the first is abnormal, and the NHS advises that the repeat is usually around three months later.

That gap fits how long sperm take to develop: around two and a half months (often quoted as about 74 days), so today’s sample reflects conditions in the testes over the previous two to three months. The WHO also asks laboratories to take recent illness, particularly with fever, into account, and lifestyle changes take months to show in a semen test.

Practical factors matter too: abstinence time, whether the whole sample was collected, and how quickly and how warm it arrived. The first part of the ejaculate is the richest in sperm, so losing it lowers the count most. And because the epididymis, where sperm are stored, is never fully emptied by one ejaculation, abstinence changes the number and age of sperm in the sample.

How do I give a good semen sample?

Follow your laboratory’s instructions, as details differ. The WHO manual sets out the essentials:

• Avoid ejaculation for at least 2 and no more than 7 days beforehand.
• Collect the whole sample by masturbation into the pot provided, and report any spillage, especially of the first part.
• Do not use lubricants or ordinary condoms, which can affect sperm; ask the laboratory about a special collection condom if needed.
• Keep the pot between 20 °C and 37 °C, close to your body if you travel, and get it to the laboratory quickly: the WHO advises within 30 minutes and no later than 50.
• Mention any recent fever, and any use of testosterone or anabolic steroids, which suppress sperm production.

What do my results mean for natural conception, IUI, IVF or ICSI?

Results are read alongside your partner’s fertility, your history and your examination; no single number decides the route.

Natural conception

By definition, 5% of the men whose partners conceived naturally within a year had results below each lower limit, so mildly abnormal results are compatible with natural conception. Causes such as a varicocele (see varicocele embolisation vs surgery), a hormone problem or a blockage can be treated, aiming to improve natural fertility. Where no cause is found for a combined low count, poor motility and abnormal shape, the EAU reports that weight loss, more exercise, stopping smoking and less alcohol may improve sperm quality and the chance of conception.

IUI

The NHS advises that intrauterine insemination is not likely to help where there is a low sperm count or poor-quality sperm, and it is not routinely offered on the NHS. The EAU adds that high sperm DNA fragmentation is linked to lower pregnancy rates both naturally and with IUI.

IVF and ICSI

Where count or quality is low, the NHS lists IVF or ICSI, and donor sperm if the count is very low. In ICSI a single sperm is injected directly into an egg, so far fewer sperm are needed. When ICSI is genuinely needed is discussed on our honest IVF page.

When no sperm are seen

Even a few sperm found after centrifuging may be usable for ICSI without surgery (EAU). If there are none, the question is whether sperm are made but blocked (obstructive azoospermia) or not made in sufficient numbers (non-obstructive). Obstruction typically goes with a normal FSH, normal-sized testes and an enlarged epididymis. The options are compared on our vasectomy reversal vs sperm retrieval page.

What tests come after an abnormal semen analysis?

A confirmed abnormal result calls for a specialist assessment, not just more semen tests; the full assessment is described on our male fertility treatment page. The EAU recommends a history, examination and hormone tests, with genetic tests and imaging as indicated.

• Hormones. Total testosterone, FSH and LH for every man with a low count or no sperm (the EAU minimum); our hormone tests also include prolactin. FSH tends to be higher when sperm production is low, but the EAU notes some men with a high FSH still have areas of sperm production.
• Scrotal ultrasound. Recommended by the EAU for men with infertility, because they have a higher risk of testicular cancer.
• Genetic tests. A karyotype with genetic counselling for azoospermia or a count below 5 million/mL; Y-chromosome microdeletion testing at 1 million/mL or less, considered below 5 million/mL. A microdeletion would pass to any son conceived with ICSI, and the EAU recommends genetic counselling when an abnormality is found.
• Further imaging. A low volume, acidic pH and very low or absent count suggest a blockage or a congenitally absent vas deferens; the EAU recommends scrotal and transrectal ultrasound, once retrograde ejaculation has been excluded.
• Sperm DNA fragmentation. Recommended by the EAU after recurrent pregnancy loss, failed assisted conception or unexplained infertility.

When should I seek medical help urgently?

A semen result is never an emergency, but some symptoms are. For sudden, severe pain in a testicle, or testicular pain with feeling or being sick, which can be torsion, go straight to A&E or call 999. For a new lump or swelling, ask for an urgent GP appointment or use NHS 111. See our testicular pain page.

Can we review your semen analysis results?

Yes. Bring your report, earlier results and your partner’s tests to a consultation with Mr Maj Shabbir or Ms Raveen Kaur Sandher, Consultant Urological Surgeons. We see patients at HCA at The Shard (SE1 9BS), HCA at Canary Wharf (E14 5NR) and HCA at Guy’s Hospital (SE1 9RT). We will go through it line by line and say plainly when a repeat test is more useful than further investigation. Initial consultations are £350 in person or £300 by video or phone with Mr Shabbir, and £300 with Ms Sandher; tests are quoted separately (see fees and insurance). Self-funding patients need no GP referral; insured patients usually need one plus insurer pre-authorisation. Call +44 7889 318584, Monday to Friday, 8am to 4pm, or contact us.

Frequently asked questions

References and further reading