Male infertility & semen analysis: what the values mean
When a couple struggles to conceive, attention often turns first to the woman. Yet a male factor is involved in about half of infertility cases.
The first and most important test for the man is the semen analysis. Interpreting it correctly — without overstating things in either direction — is decisive.
How common is the male factor?
A male factor is responsible, alone or combined with a female factor, in about 50% of infertile couples. That is why the work-up must always involve both partners from the outset.
The good news is that assessing the man is simple, painless and begins with a single test.
What does the semen analysis measure?
The semen analysis assesses semen volume, sperm concentration and total count, motility (total and progressive), morphology (shape) and vitality.
The sample is collected after 2–5 days of abstinence. Because sperm production takes about three months and is affected by fever, medication or stress, a single measurement is not enough for firm conclusions.
What are the normal values?
The current reference limits come from the 6th edition of the World Health Organization manual (WHO, 2021). The lower reference limits are: volume 1.4 ml, concentration 16 million/ml, total count 39 million, total motility 42%, progressive motility 30%, vitality 54% and normal morphology 4%.
A crucial point: these limits are the 5th centile of men whose partners conceived naturally within a year. They are statistical reference points, not a “pass/fail” line. Men with values slightly below these limits can perfectly well father a child.
What does a “low” value mean?
A single abnormal result does not make a diagnosis. The first step is to repeat the test after about 2–3 months, ideally at the same reliable laboratory.
If a low value is confirmed, its degree matters: a mild reduction is managed differently from severe oligospermia or the absence of sperm (azoospermia).
What further tests may be needed?
Depending on the result and history, hormonal testing (mainly FSH and testosterone), scrotal ultrasound to detect a varicocele, and in severe cases genetic testing (karyotype, Y-chromosome microdeletions, cystic-fibrosis screening) may be needed.
Clinical examination by a urologist–andrologist completes the picture and identifies reversible causes.
How is the male factor treated?
Treatment is stepwise. First, lifestyle factors (smoking, weight, excess heat, alcohol) and reversible causes are corrected. For a mild-to-moderate problem and under the right conditions, intrauterine insemination (IUI) may be an option.
In more severe cases, IVF with intracytoplasmic sperm injection (ICSI) offers a solution even with very few sperm, while azoospermia may require surgical sperm retrieval (TESE).
Summary
A male factor is involved in about half of infertility cases, so the work-up always concerns both partners. The semen analysis is interpreted against the WHO 2021 limits — which are statistical reference points, not an absolute threshold. A single low value is not a diagnosis; it needs repeating. Treatment is stepwise, from lifestyle improvement to IUI, ICSI or surgical sperm retrieval, according to severity.
Sources: World Health Organization, “WHO laboratory manual for the examination and processing of human semen”, 6th edition, 2021; European Association of Urology (EAU), Guidelines on Sexual and Reproductive Health (Male Infertility).
⚕ Medically reviewed by Prof. Stratis Kolibianakis · Thessaloniki Medical Association Reg. No. 16340
ARTICLE 5 · INFERTILITY & DIAGNOSIS
