What does an abnormal semen analysis mean for my fertility?

You may have felt completely healthy before being told that your sperm count, movement or shape was outside the expected range. Faced with a laboratory report full of unfamiliar terms, it is easy to read “abnormal” as “infertile”.

A semen analysis cannot give such a simple answer. It provides information about several features of your semen and sperm that may affect the chance of conception. The result needs to be considered alongside your medical history, any repeat tests and your partner’s fertility assessment.

Some results return to the expected range when the test is repeated. Others need further investigation because they may reflect a condition affecting sperm production or movement. Even a markedly abnormal result does not necessarily mean you cannot father a child.

What does a semen analysis measure?

A semen analysis examines a sample of semen to assess several features that may influence whether sperm can reach and fertilise an egg.

Your report may include:

• Semen volume, which is the amount of fluid produced
• Sperm concentration, which is the number of sperm in each millilitre of semen
• Total sperm number, which estimates how many sperm are present in the whole sample
• Sperm motility, which assesses how many sperm are moving and how effectively they move forwards
• Sperm morphology, which looks at the proportion of sperm with the expected shape
• Sperm vitality, which may be measured to determine how many sperm are alive

Results do not always move in the same direction. You may have a lower sperm concentration but good movement, for example. Another sample may contain an adequate number of sperm but show reduced motility.

The laboratory compares the sample with recognised reference limits. These are not pass or fail marks. They are based on results seen in fertile men and help clinicians judge whether a particular measurement may be contributing to difficulty conceiving.

This is particularly important when reading a morphology result. It is normal for many sperm in a sample not to meet the laboratory’s strict criteria for an ideal shape. A low percentage of normally shaped sperm does not mean that every other sperm is dangerous or incapable of fertilisation.

Your clinician will look at the whole result, how far the measurements differ from the reference limits and whether the same finding appears on a repeat test.

Does an abnormal sperm test mean I am infertile?

No. An abnormal semen analysis may mean that conception is less likely or could take longer, but it cannot tell you with certainty whether you can father a child.

Men with results outside the reference limits can still conceive naturally. A result within the expected range does not guarantee pregnancy either, because fertility depends on several factors involving both partners.

The significance of your result depends on:

• Which measurements are affected
• How far they fall outside the reference limits
• Whether one or several measurements are abnormal
• Whether the finding remains on a repeat test
• Your medical and reproductive history
• Your partner’s age and fertility

The further a result falls below the expected range, or the more measurements that are affected, the more likely it is that fertility may be reduced.

Occasionally, no sperm are found in the semen. This is called azoospermia. Azoospermia describes what was found in the sample, not why it happened.

Some men are making sperm, but a blockage prevents them from entering the semen. In other cases, sperm production within the testicles has been reduced or stopped. Finding no sperm requires prompt repeat testing and further investigation, but it does not automatically mean that biological parenthood is impossible.

Why might my semen analysis be abnormal?

Sperm production can be affected by conditions involving the testicles, hormones or the tubes through which sperm travel. Results may also change temporarily because sperm take several weeks to develop and are sensitive to changes in health.

Possible causes include:

• A recent high temperature or significant illness
• A varicocele, where enlarged veins around a testicle may affect its function
• A current or previous infection affecting the reproductive tract
• Hormonal conditions that interfere with sperm production
• Undescended testicles or a previous testicular injury
• A blockage within the reproductive tract
• Genetic conditions
• Certain medicines or previous chemotherapy
• Testosterone treatment or anabolic steroid use
• Smoking, recreational drugs or excessive alcohol consumption
• Being significantly overweight
• Frequent or prolonged exposure of the testicles to high temperatures

Tell your clinician if you use testosterone or anabolic steroids. Although testosterone is associated with male sexual health, taking it from an external source can suppress the hormones that instruct the testicles to make sperm. Do not start or stop prescribed treatment without medical advice.

Sometimes investigations do not identify a clear explanation. This is known as unexplained or idiopathic male infertility.

The way the sample was collected can also affect the result. Missing part of the sample, collecting it outside the recommended abstinence period or taking too long to deliver it to the laboratory may change what can be measured.

Can a semen analysis be wrong?

A semen analysis is not usually wrong, but one sample may not represent your usual sperm production.

Semen results naturally vary. Recent illness, the time since your last ejaculation and difficulties collecting or transporting the sample can all influence the figures.

Tell the laboratory or your clinician if any of the semen was missed during collection. The first part of the ejaculate can contain a high concentration of sperm, so an incomplete sample may produce a misleadingly low result.

You should also follow the laboratory’s instructions about:

• How long to avoid ejaculation before the test
• Which collection container to use
• Whether lubricants can be used
• How quickly the sample must reach the laboratory
• How the sample should be kept during transport

If your first analysis is abnormal, you will usually be offered a repeat test. This is ideally carried out around three months later, allowing time for another cycle of sperm production. If very few sperm or no sperm are found, your clinician may arrange the repeat test sooner.

The second result helps show whether the abnormality is persistent or whether the first sample was affected by temporary circumstances or natural variation.

What further tests might I need?

If repeat testing confirms an abnormality, your GP, fertility clinician or urologist may investigate why it has occurred.

You will usually be asked about:

• How long you and your partner have been trying to conceive
• Previous pregnancies
• Childhood conditions such as undescended testicles
• Testicular injuries, infections or operations
• Erections, ejaculation and sexual function
• Current medicines and previous medical treatment
• Testosterone, anabolic steroids and recreational drug use
• Smoking and alcohol
• Fertility problems within your family

A physical examination may be recommended to assess the size and position of your testicles and look for conditions such as a varicocele.

Further investigations may include hormone blood tests, genetic tests or an ultrasound scan. Genetic and hormonal investigations are particularly important when the sperm count is extremely low or no sperm are found.

Not everyone needs the same tests. A mildly reduced measurement requires a different approach from persistent azoospermia, so the investigation should be based on your individual result.

Can poor sperm quality be improved?

That depends on why the result is abnormal.

Where a clear cause is found, treating it may improve semen results or influence the fertility treatment recommended. This could involve managing a hormonal condition, treating an infection, stopping testosterone or anabolic steroids under medical guidance, or considering treatment for a varicocele in selected men.

Improving your general health may also support sperm production. Depending on your circumstances, this may include:

• Stopping smoking
• Avoiding anabolic steroids and recreational drugs
• Limiting alcohol
• Working towards a healthy weight
• Eating a varied, balanced diet
• Exercising regularly
• Avoiding frequent, prolonged exposure to excessive heat

These changes cannot guarantee that an abnormal result will return to the reference range. They are most useful as part of a wider assessment and should not replace investigation of a marked abnormality.

Any improvement will also take time to appear on a semen analysis because a new cycle of sperm production takes around three months.

There is no single supplement proven to correct every form of male infertility. Evidence for many products marketed as sperm boosters remains limited or inconsistent. Large doses of vitamins or antioxidants are not automatically harmless, so discuss supplements with your clinician before taking them.

When natural conception remains unlikely, fertility treatment may be considered. Depending on the sperm result and both partners’ circumstances, options may include IVF or intracytoplasmic sperm injection, known as ICSI. During ICSI, an embryologist injects one sperm directly into an egg as part of IVF treatment.

An abnormal semen analysis does not mean you will automatically need IVF or ICSI. The next step depends on the severity of the abnormality, whether a cause can be treated and the results of both partners’ fertility assessments.

When should I see a male fertility specialist?

Speak to your GP or fertility team if a semen analysis is abnormal, particularly if the same finding appears on a repeat test.

Expert assessment and health optimisation for the male partner improves the chances of both natural and assisted conception success but also maintenance of the pregnancy and early childhood development and is often a window on long term health and wellbeing. You may especially benefit from assessment by a urologist or another clinician specialising in male fertility if:

• No sperm or very few sperm are found
• More than one semen measurement is significantly abnormal
• You have pain, swelling, a lump or another change in a testicle
• You have difficulty with erections or ejaculation
• You previously had undescended testicles, testicular surgery or a significant injury
• You have received chemotherapy or another treatment that may affect fertility
• You use testosterone or anabolic steroids
• You and your partner have been trying to conceive for a year without success

Seek advice sooner if your partner is aged 36 or over, or if either of you already has a condition that could affect fertility.

Fertility assessment usually involves both partners. An abnormal semen analysis can understandably make you feel responsible for the difficulty conceiving, but it is a medical finding rather than a personal failing.

An abnormal result is not a final verdict on your fertility. Repeat testing may show that the change was temporary. When it persists, further assessment can help identify the cause and guide the next step for you and your partner.

About the author

Mr Stephen Gordon is an experienced Consultant Urologist specialising in kidney stones, prostate conditions and modern urological diagnostics. He has led one of the UK’s largest kidney stone treatment units and has extensive expertise in laser treatment, shock wave lithotripsy, keyhole surgery and HoLEP for prostate enlargement. He also provides assessment and treatment for urological cancers, urinary symptoms, male fertility concerns and sexual health, with a strong focus on personalised, evidence-based care.