Semen analysis

Analysis of seminal fluid should be the first step in the investigation of infertility since, in the absence of sperm, investigation of the female is futile.

Procedure:

• 3 days abstinence from intercourse
• collection of specimen of semen in a sterile plastic container after masturbation
• examine within 2 hours

NICE state that normal results are:

• Semen analysis
  • the results of semen analysis conducted as part of an initial assessment should be compared with the following World Health Organization reference values:
    • semen volume: 1.4 ml or more (95% confidence interval [CI] 1.3 to 1.5)
    • pH: 7.2 or more
    • sperm concentration: 16 million spermatozoa per ml or more (95% CI 15 to 18)
    • total sperm number: 39 million spermatozoa per ejaculate or more (95% CI 35 to 40)
    • total motility (percentage of progressive motility and non-progressive motility): 42% or more motile (95% CI 40 to 43)
    • progressive motility: 30% or more (95% CI 29 to 31)
    • vitality: 54% or more live spermatozoa (95% CI 50 to 56)
    • sperm morphology (percentage of normal forms): 4% or more (95% CI 3.9 to 4.0)
• note that the reference ranges are only valid for the semen analysis tests outlined by the World Health Organization - see the WHO laboratory manual for the examination and processing of human semen
• if the result of the first semen analysis is abnormal, offer a repeat confirmatory
  • undertake repeat confirmatory tests ideally 3 months after the initial analysis to allow time for the cycle of spermatozoa formation to be completed
    • however, if a gross spermatozoa deficiency (azoospermia or severe oligozoospermia) has been detected, undertake the repeat test as soon as possible

Reference:

• NICE (March 2026).Fertility - Assessment and treatment for people with fertility problems