Male Semen Analysis – What Is Measured?

A male semen analysis is helpful when trying to get pregnant

Experts estimate that male factors are to blame in up to 40% of couples who experience fertility issues. A male semen analysis is a valuable tool for couples as they begin their fertility journey.

As a result, many couples find it extremely helpful for the man to take a sperm test at the earliest sign of difficulty in trying to conceive. Compared to many of the female fertility tests, a male semen analysis is non-invasive, relatively inexpensive, and produces results quickly and accurately.

Using the ExSeed Home Sperm Test to check your sperm quality, you can get the same results as analyzing in the clinic using a microscope.

Fig 1 – Male Semen Analysis with ExSeed Health

What do we measure in a male semen analysis?

Firstly, semen is the fluid a man ejaculates during orgasm. The sperm cells within the semen are the cells that can fertilize the woman’s egg. For most semen tests, the man masturbates into a container, which is then delivered to a laboratory for testing. Almost all laboratories performing sperm tests will evaluate the following semen and sperm parameters:

Semen Volume: Semen volume is the total quantity of ejaculated fluid. A normal amount is between 2 and 5 milliliters. Hypospermia is when the volume is less than 1.5 ml, which is due to for example hormonal abnormalities or ductal blockages. Hyperspermia is a large volume of more than 5.5 ml.

Sperm Count: Sperm count is determined by looking at the semen sample under a microscope. It is a measurement of how many million sperm cells there are in each milliliter of semen. In the literature it also called “Sperm concentration”.

A normal sperm count is 15 million or more sperm cells per milliliter. Oligospermia is when there is below 15 million sperm cells per milliliter. Azoospermia is if there are no sperm cells at all, see Figure 2.

Sperm Motility: Sperm movement

Sperm motility is the forward swimming motion of sperm. For a sperm to fertilize the egg, it must travel quickly through the female reproductive system. This requires a strong swimming action. The World Health Organization (WHO) grades motility as follows [1];

Progressive motility (PR): spermatozoa moving actively, either linearly or in a large circle, regardless of speed.

Non-progressive motility (NP): all other motility patterns with absent progression, e.g. swimming in small circles, the flagellar force hardly displacing the head, or only observing a flagellar beat.

Immotility (IM): no movement.

It’s normal to have more than 32% of progressively motile sperm cells (PR) or 40% as a combination of progressive motile and non-progressive motile (PR and NP). Asthenozoospermia (see figure 2) refers to a condition where a great portion of sperms in a semen sample are immotile or have reduced motility, compared to the WHO reference values.

Total Motile Sperm Count (TMSC): refers to the total number of moving sperm cells in the entire ejaculate.

It is calculated by multiplying the volume (ml) by the concentration (million sperm/ml) by the motility (% moving). Ideally, the TMSC should be above 45 million sperm cells.

Fig 2 – What a male semen analysis measures

Fertility clinics consider the above 4 semen parameters as enough for an initial sperm quality assessment. However, if they discover abnormalities or if infertility persists, one may go to a clinic for a more comprehensive analysis. Such analysis may include:

Sperm Size and Shape – Morphology

Also known as sperm morphology. Abnormal sperm cells may be unable to move normally or to penetrate an egg. As a result, too many sperm cells of abnormal size and shape can pose a significant fertility issue.

Most laboratories will evaluate the sperm cells based on the “Kruger” criteria provided by the World Health Organization (WHO). According to the Kruger criteria, a normal sperm cell must have an oval shape with a smooth outline. At least 4% of the sperms must have an oval head with a connecting mid-piece and a long straight tail.

Take a look at figure 3 to see how a normal sperm cell should look. The condition Tetrazoospermia is when under 4% of sperm cells in a sample are normal.

Fig 3: A normal-shaped sperm cell (far left), and abnormal sperm cells (all other cells to the right).

Color and viscosity

A comprehensive semen analysis often includes an evaluation of the color and viscosity (thickness) of the seminal fluid, as well as an analysis of the time until the semen sample liquifies. The color should be grey-opalescent. If it appears red-brown, it may be an indication of red blood cells in the ejaculate (Haemospermia). It’s normal for the semen to liquefy in no more than 20 minutes. If it doesn’t liquefy, it may indicate the presence of an infection of the seminal vesicles and/or the prostate.

Semen pH

Semen is typically a slightly alkaline substance, with a normal pH of 7.2-8.0. An abnormally high or low semen pH can cause sperm death. It can also impact the ability of the sperm to swim quickly and/or effectively penetrate the egg.

Sperm Vitality

Sperm vitality relates to how many sperm cells are alive and intact. Dyeing the semen with color determines sperm vitality. The dye stains the dead sperm cells, since they are not intact anymore. The percentage of live sperm should be above 58% to consider it as normal. If it’s below that level, the diagnose is Necrozoospermia.

White blood cell infiltration

It’s normal for semen to contain some white blood cells. However, many white blood cells in a sample may indicate the presence of an infection, which can decrease semen quality. It’s normal when semen contains below 1 million white blood cells/ml. On the other hand, Leukospermia is when it’s above that.

Presence of zinc, fructose, and glucosidase in the semen

The accessory glands release a range of different nutrients in the male reproductive system. Some of these include zinc, fructose and glucosidase. In order to consider a semen sample as normal, the markers should be above a certain limit:

Zinc: ≥2.4 µmol/ejaculate
Fructose: ≥ 13 µmol/ejaculate
Glucosidase ≥20 µU/ejaculate.

What do we need to assess semen quality?

A sufficient first line sperm quality test needs to assess the following:

• Semen volume
• Sperm concentration
• Sperm motility
• Total Motile Sperm Count (TMSC)

You get all of the above information when you use our Home Sperm Test. According to the scientific evidence, TMSC is the best indicator of how big the chances are for reaching pregnancy. ExSeed is the only home sperm test device that can provide this on the market.

Male semen analysis: what, when, where, and how? 

There is no perfect male semen analysis test. Some men with low sperm counts can achieve pregnancies without assistance. Other on the other hand with normal sperm count are unable to get pregnant with their partner.

In general, men with better semen parameters have a better chance of reaching pregnancy faster in the process. Optimizing these parameters as much as possible is therefore beneficial for fertility.

At ExSeed Health we encourage all men to have an assessment of sperm concentration and motility. If you test as early as possible, you allow time to improve sperm quality in case there are any inconsistencies.