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Interpreting your sperm count test results: what do the numbers signify?

Fertility can create some unexpected twists and turns along the path to parenthood, and it’s important to investigate and address any underlying issues you might encounter when trying to conceive.

One of the most effective ways to do this is through a semen analysis – a comprehensive test used to highlight potential fertility problems you might be having.

In this blog post, we explain everything you need to know about what the results of these tests mean and make it easy to understand the numbers on your report.

What is a detailed semen analysis (sperm test)?

In up to half (50%) of heterosexual couples, the main cause of fertility issues is related to sperm – whether that be due to a lower-than-average number in your semen, motility issues or another complication.

The simplest and most effective way to identify problems with your sperm is by having a detailed semen analysis carried out.

This male fertility test is used to assess and analyse a sample of your semen and is often recommended to all men – even if they have had children already.

Depending on the clinic you choose, you will either need to provide a sample on-site or produce a sample at home and drop it off to us.

Your sperm sample will be assessed using a microscope before being cross-compared against various reference centile values set by the World Health Organisation (WHO) in 2010 to discover any possible fertility issues. Your results will then be curated into a full report to help you understand the status of your reproductive health.

What is the WHO centile value?

A ‘centile’ is a comparative measurement which shows what your results look like against the rest of the population. The centile values set by WHO work in the same way – they are comparative points of measurement used to help determine how the results of your semen analysis test compare to a reference population.

In a detailed semen analysis, the centiles are created based on data from recent fathers who have conceived children naturally within 12 months or less. A normal result will typically fall above the 5th centile.

If your results are within the 5th centile, this means that if you were in a group of 100 fertile men, five would have a lower result than you and the remaining 95 would be higher.

The 50th centile is the most common result. If you fall into the 50th centile, this means half the population would have a higher result and the other half lower. Anything above the 50th centile is considered a higher than average score and means you have a better chance of having a natural conception.

Nearly all of your semen analysis results will be compared against the WHO centile value.

Understanding semen analysis reports

Semen analysis reports contain a wide range of results. While the results may seem confusing at first, once you understand how the WHO centile values work, they're relatively straightforward to understand.

Semen volume

Your semen volume result will show how much semen you produced in your sample in millilitres. The average amount is less than half a teaspoon.

If you notice a reduced amount of semen when you ejaculate, or your results show that you are below the 5th centile, seek advice from your doctor.

Sperm concentration

Your sperm concentration, or sperm count, measures how many sperm are in each millilitre (ml) of your sample. On average, there are between 15 million and over 200 million sperm per ml of semen. Therefore, having less than 15 million sperm per ml is considered a low concentration.

Total count

The total count in your semen analysis results shows the total number of sperm in your entire sample. Anything less than 39 million is considered low or below average.

Progressive motility

Progressive motility demonstrates how many of your sperm are swimming forward as they should, or progressively. The WHO reference range for progressive motility is between 40% and 81%.

Normal forms

Sometimes known as sperm morphology, normal forms measure the shape and size of your sperm within the sample. Normal results range from 4% to 48%, but it's unusual to see more than 8% of your sperm having normal forms in your sample. The cause of abnormal sperm morphology is often unknown, but if you have consistently low normal forms it is recommended that you seek advice from your doctor to investigate underlying causes such as varicocele (an enlarged vein in your testicles) or lifestyle factors.

Antisperm antibodies (spermMAR test)

Antisperm antibodies occur when your immune system reacts against your sperm, this can lead to decreased sperm motility and cause sperm to stick together. While rare, spermMAR results are more common if you have had a vasectomy reversal or a severe groin injury.

Your antisperm antibody results will be shown as a percentage and, unlike your other results, will not be compared to the WHO centile value. Anything above 40% is considered an abnormal result and could explain why you are struggling with your fertility.

What it means when the results are abnormal

When you receive your results, they may be in the lower WHO centile value. If one or more of your results are below the 5th centile, you may want to repeat the test in three months. It takes three months to produce a new batch of sperm.

Repeating the test solidifies the results and can determine if the abnormalities are a recurring problem. It can also provide you with an accurate diagnosis and rule out any anomalies.

Supporting your fertility after a semen analysis

If your semen analysis determines a problem with your sperm, such as poor progressive motility, you may need a bit of extra support when trying to conceive. Fertility treatments such as ICSI, or intra-cytoplasmic sperm injection, may be the added help you need to start or grow your family.

ICSI is where your sperm is injected directly into an egg to promote fertilisation. The best single sperm will be selected from your sample, so even if you fall into the lower centiles for normal forms, there may be a higher chance of fertilisation. You can find out more about ICSI in our latest blog post, ‘ICSI treatment: a breakthrough in assisted reproduction’.

If you are unable to produce sperm, surgical sperm recovery may be recommended. This is where your sperm is collected through either percutaneous surgical sperm aspiration (PESA) or testicular sperm extraction (TESE). After collecting sperm with a fine needle, these are then frozen for use in future fertility treatments, such as ICSI.

Book a detailed semen analysis at The Bristol Centre for Reproductive Medicine

Receiving your semen analysis results can be nerve-wracking but, at the Bristol Centre for Reproductive Medicine (BCRM), we make sure your results are laid out simply and in a way that's easy to understand. We want to provide you with the knowledge and support you need to begin or continue your fatherhood journey.

If you want to check your reproductive health or are having problems trying to conceive, book a detailed semen analysis with BCRM. Our team of dedicated fertility specialists are here to provide you with unparalleled levels of care and guidance.