Understanding semen analysis - Fertility Network UK

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Understanding semen analysis



My husband and I have been ttc for 2 years now and have recently been told that we will never conceive naturally due to my severe endometriosis. I've just had a lap a couple of weeks a go to separate various organs and remove any cysts, as we were told an IVF clinic wouldn't even consider seeing us until I'd had this surgery, so we haven't yet been referred. We also have male factor as my husbands SA came back as <1mill count in July. After a repeat test in September our GP told my husband the results were the same as the first, which was devastating as we had been eating healthier, taking supplements and started going to the gym three times a week. However, having asked for a print out of the results to take to the next appointment with the consultant the results look way better, still not in the normal range for sperm concentration but still way higher. I basically wanted to check if I'm miss understanding these results as I'm going by the info at the bottom and what I can find on Google... Am I right that the results look better (top set from Jul, bottom from Sep) and if so, will continuing with the lifestyle changes help improve them more?



15 Replies

Hi Cat

Oh that's annoying that you have not been referred and very stressful for you both.

I have no knowledge of this at all I'm afriad but hopefully ladies here will be able to help and also Diane Arnold too.


in reply to genten

Thank you. Ive been looking through this forum for people's stress relieving tactics as it's amazing how quickly it can take over your life! X

in reply to MediocreMind

Bless you. And yes, it really does take over. This journey never leaves my mind for a minute.



Just thought something was a bit odd. Why wouldn't you be referred for ivf anyway? You don't need to have had a lap to be referred for ivf you just need to meet the criteria set by the ccg (if going for nhs funding). Number of years trying, bmi etc

I did try to insist on being referred first then timing the lap because of the potentially long waiting list for ivf and the endo growing back in that time, but he completely shut me down even though we meet all of the criteria. I'm really hoping we can start the referral in my post op appointment so I might at least be able to find out how long the waiting lists are.

What ccg are you in? Mine doesn't have anything about 'have a lap first'. If you meet the criteria then you should be referred. Is your gp not playing by the rules? It's not for him to decide who does and does not get referred. That's what the criteria is for.

Annoys me as my lap (by a non bgse accredited surgeon) potentially did more harm than good.

Hopefully if you have severe endo you are being treated at a bgse centre.


Hi. Just seen this quickly. At home now on my little iPad. Can I have a good read in the morning and I will get back to you with my thoughts if that’s ok. Diane

Of course, I'd really appreciate your thoughts tomorrow. Thanks.

in reply to MediocreMind

Hi MediocreMind. Right, I have read through it and although the amount of semen collected has gone up, there is no real change in the analysis. There should be at last 20 million sperm per millilitre collected, his is very low. The morphology (shape) of the sperm heads show a high rate of poor shapes and the motility (way they swim) is unfortunately under par too. I feel that the best way ahead for you both, once you are over your surgery is to go down the ICSI route, where they can single out the few good sperm to use. Hope that helps and good luck! Thinking of you. Diane

I have sperm issues and I've had multiple samples tested, and prodded and tested every way!

Reading your partners results I agree its gone up, but its still nowhere near what is considered 'normal sperm' I'm afraid. He of course should continue being healthy and taking Selenium , but most IVF clinics would almost certainly tell him to do ICSI,

I did and it does work for thousands of men with sperm issues.

What you can do is get him to a urologist and get them to check the low amount of good sperm tested for Y microdeletions, CTFR gene and Karyotype testing. It will tell you the good sperm your partner is producing , albeit in small numbers, is good enough to fertilize an egg with no problems.

With ICSI, they just need 1 good sperm, even if he produces 1 million, in the context of ICSI, that;s enough.

Also I would CERTAINLY advise getting some samples frozen. My count , despite being on health supplements , running, etc, declined as I got further into my 40's, it often does for men with sperm count issues, so freeze some now to ensure you have a good 'supply' for future treatment. They can thaw the frozen samples , take a few good sperm for a cycle and refreeze it, that's what they've done for me.

Best of luck for the future x

Also don't worry if for some reason your partner produces zero count in his next sample, they can usually get good quality sperm direct from the testes, my doctor said this was always our back up of back up plans if they did a thaw of my samples and found no decent sperm and I couldn't produce a fresh sample.


The results in the second picture are slightly improved in regards to sperm count, but not significantly so but there's a decline in his sperm motility. My husband managed to slightly improve his sperm count by taking zinc, selenium and folic acid


Just wanted to start by saying no two of us will have the same story, but I can understand how you feel.

We are just starting our first round of IVF with ICSI this month due to male factor infertility. It’s taken 3 and a half years to get to this stage and has been a complete emotional rollercoaster. My gynae consultant insisted on putting me through a barrage of tests (all of which case back totally normal) despite the fact we’ve known since the first semen evaluation that there’s some fairly major issues. My advice is, just keep positive, every step is a step closer to the final goal, despite how much it feels like a marathon at times.

My husbands count has varied from about 2.2million down to 1.8million, but with very poor motility (4%) and with counts so low they could not determine the morphology. Unfortunately the first time we got these results all we got was the following.....

Count 2.2million

Motility 4%

Morphology no normal forms

We were absolutely devastated, and genuinely thought all his sperm were deformed and we wouldn’t even be able to do IVF.

Fast forward another 18 months and we finally got to the IVF clinic. They repeated his tests and looked at it in further detail. Count and motility not great but there are plenty of normal forms there to use for the ICSI process, despite the devastating way the “less specialist” specialist broke the news to us before, which was about as subtle as a battleaxe.

Your husbands count isn’t great, but there’s definitely enough to work with there. Our clinic explained that for counts less than 5 million they would always use the ICSI procedure, our consultant has successfully treated couples where all they may have is 20 or 30 sperm, total, so hold out hope. Your husband also has great motility so the ones he does have swim well. And I would think the situation would be the same as ours where they just didn’t have enough sperm in the sample to take a really good look at the quality and be able to determine the morphology without it being done at a specialist clinic.

Try and keep looking forward. You’ll get there, and it’ll be worth every minute of stress and heartache when you do x

I would continue with the lifestyle changes as you're right, amount of sperm per ml is much better. My hubby had a very low sperm count, also less than 1 million per ml but ours didnt change in future SA. Our clinic went on to checking for issues like karyotyping to rule out a genetic reason but all was ok. Its thought that a childhood injury may have caused issues and this may get worse so our clinic decided to freeze a sample. We havent had to use it as in low sperm counts they tend to opt for ICSI and that means they only need 1 sperm to inject into each egg collected and we always had enough for that and also we still managed to get good fertilisation rates. Overall I think the improvement is good and if he can continue things may even get up to to a normal level through time.xx


Hi - I agree with everything that has been said above. I would continue doing what your are doing as there has been some improvement. My partner has severe male factor issues with count less than 1 mil and motility 0-9% on different SA. We have had two cycles of ISCI and there has always been enough sperm to use. Unfortunately we have had poor fertilisation rates but that is another matter. Good luck.

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