Male fertility: the semen analysis, what affects sperm, and what improves it

The semen analysis

A sample given after two to five days without ejaculation, examined within an hour. It measures volume, sperm concentration, total count, motility (how many move and how well), morphology (shape), and looks for white cells suggesting infection.

Broadly, current reference values consider around 15 million sperm per millilitre and above, with roughly 40 per cent moving, to be within normal range — but these are population reference points, not a pass mark. Men with lower numbers father children and men within range sometimes do not.

One abnormal result means little. Sperm production varies with illness, fever, stress and abstinence, and the test is normally repeated after several weeks before any conclusion. Sperm take around three months to develop, so anything you change today shows up in a test three months later.

What harms sperm

Tobacco in any form, including chewed tobacco and gutkha, which is enormously common in India and directly reduces count and motility. Alcohol in quantity. Anabolic steroids and testosterone supplements — these shut down natural sperm production and are a growing cause of infertility in young men who took them at the gym.

Heat: prolonged hot baths and saunas, laptops resting on the lap, long hours of driving, and jobs beside furnaces or ovens. The testes sit outside the body for a reason.

Weight at either extreme, uncontrolled diabetes and thyroid disease, untreated infections including sexually transmitted ones, some medicines (certain blood pressure drugs, chemotherapy, some hair-loss treatments), and industrial or pesticide exposure.

Varicocele — enlarged veins in the scrotum — is a common, correctable cause found in a substantial minority of men with abnormal results, and it is worth an examination.

What improves it

Stop tobacco entirely and cut alcohol. Reach a healthy weight. Control diabetes and thyroid disease. Stop anabolic steroids and tell the doctor if you have taken them — recovery is possible but needs specialist management.

Keep the testes cool: loose clothing, no laptops on the lap, avoid saunas and very hot baths, and take breaks on long drives.

Eat a diet with enough zinc, selenium, folate and antioxidants — from food first: nuts, seeds, eggs, dals, greens and fruit. Supplements have modest and inconsistent evidence and are not a substitute for stopping tobacco.

Sleep properly, treat infections, exercise moderately, and give it three months before retesting. And have sex every two to three days rather than saving up — long abstinence does not improve quality.

Treatment when the test is abnormal

Depending on the cause: antibiotics for infection; hormone treatment where a specific deficiency is found; surgery for varicocele or for a blockage; and for very low counts, sperm can often be retrieved surgically from the testis for use in ICSI.

ICSI — injecting a single sperm directly into an egg — has transformed treatment for male-factor infertility, and it works with very small numbers of sperm.

Where no sperm are found at all, the causes are worth pursuing properly: obstruction (often treatable) versus failure of production (genetic testing is relevant, and donor sperm or adoption become the routes). A urologist or andrologist rather than a general fertility package is the right referral here.

When to see a doctor

Get a semen analysis at the start of any fertility investigation, and earlier at any point if there is: a history of undescended testes, testicular surgery or injury, mumps after puberty, chemotherapy or radiotherapy, anabolic steroid use, difficulty with erections or ejaculation, or a lump or swelling in the scrotum.

Same-day: sudden severe testicular pain — testicular torsion is an emergency and delay costs the testis. Also same-day: a painful, hot, swollen scrotum with fever.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions