Semen Analysis Report Interpretation: Count, Motility, Morphology and What to Do Next

A semen analysis report measures several characteristics of semen and sperm, especially sperm concentration, total sperm number, motility and morphology. The most important thing to understand is that one value marked “low” does not automatically mean infertility, and values within reference ranges do not guarantee pregnancy.

For semen analysis report interpretation, the numbers need to be considered together, along with how the sample was collected, whether the result is reproducible, the man’s reproductive and medical history, and the fertility factors of the female partner.

Current European and UK guidance uses reference values derived from the World Health Organization’s sixth-edition semen laboratory manual. These figures are useful reference points, but they are not pass-or-fail fertility thresholds.

If you have just received a report showing low count, poor motility or abnormal morphology, the aim should therefore be to understand the pattern rather than panic over one number.

Semen Analysis Reference Values at a Glance

The following lower reference values are used in the 2026 NICE fertility guideline and reflect WHO sixth-edition reference data.

Semen parameter	Lower reference value
Semen volume	1.4 mL
Sperm concentration	16 million/mL
Total sperm number	39 million per ejaculate
Total motility	42%
Progressive motility	30%
Vitality	54% live sperm
Normal morphology	4% normal forms
pH	7.2 or higher

These figures need careful interpretation.

The European Association of Urology explains that these lower limits represent approximately the fifth percentile among men whose partners conceived naturally within 12 months. They do not draw a biological line separating “fertile” from “infertile” men.

That is one of the most important facts to understand when reading the report.

Does a Normal Semen Analysis Mean You Are Fertile?

Not necessarily. A semen analysis provides important information about male reproductive function, but it cannot by itself prove that a man is fertile or infertile.

The World Health Organization specifically cautions against treating semen reference values as distinct limits separating fertile from subfertile men. Fertility belongs to the reproductive situation of the couple, not to one laboratory number.

Pregnancy also depends on factors such as:

• ovulation
• egg quality and age
• fallopian-tube function
• uterine conditions
• timing of intercourse
• sperm function that may not be completely captured by a routine semen analysis.

Likewise, a man can have one or more results below the reference range and still contribute to a natural pregnancy.

The report is therefore best understood as a risk and investigation tool, not a fertility certificate.

How to Read a Semen Analysis Report: A Five-Step Approach

A useful way to interpret the report is to follow this sequence:

1. Was the sample collected correctly?
2. Is the semen volume adequate?
3. How many sperm are present?
4. How well do they move and what proportion have normal morphology?
5. What does the whole pattern mean in the couple’s fertility context?

This order prevents a common mistake: concentrating on one percentage before checking whether the sample itself was reliable.

Step 1: Check How the Semen Sample Was Collected

Collection conditions can affect the result.

Many fertility and andrology laboratories ask for several days without ejaculation before testing. Laboratory instructions vary, but guidance commonly uses a window within approximately 2–7 days, and patients should follow the instructions supplied by their own laboratory. NHS andrology services also emphasize collecting the whole ejaculate, using an appropriate sterile container and informing the laboratory if some of the sample was lost.

This is particularly important because the first portion of the ejaculate can contain a high concentration of sperm.

If some of that portion was missed, the reported sperm number can appear lower than it otherwise would.

Other practical details may also matter:

• abstinence duration
• whether the complete sample was collected
• use of inappropriate lubricant or container
• time from collection to analysis
• exposure to excessive heat or cold during transport
• recent illness or medication.

If you suspect the collection was incomplete, tell the laboratory or fertility clinician rather than assuming the reported sperm count accurately reflects your usual level.

At Slavica IVF, semen analysis is listed among the centre’s fertility-assessment services. Patients should follow the specific sample-production and delivery instructions provided by the centre rather than applying another laboratory’s protocol. See Slavica IVF’s semen analysis service

Step 2: Understand Semen Volume

Semen volume is the amount of fluid in the ejaculate.

The current WHO-based lower reference value used by NICE is 1.4 mL.

Volume matters partly because total sperm number depends on both sperm concentration and how much semen was produced.

Low volume can occur for several reasons. Sometimes it reflects incomplete sample collection. In other situations, persistent low volume may lead a clinician to consider ejaculation problems, obstruction or other reproductive conditions.

It should not be diagnosed from one value alone.

Concentration and volume are different

A man could have:

• relatively high sperm concentration but low semen volume
• lower sperm concentration but a larger semen volume.

This is why the total sperm number per ejaculate can sometimes be more informative than looking only at sperm per millilitre.

Step 3: Understand Sperm Concentration and Total Sperm Count

These two terms are commonly confused.

What is sperm concentration?

Sperm concentration is the number of sperm in one millilitre of semen.

The current lower WHO-based reference value is approximately:

16 million sperm per mL.

What is total sperm number?

Total sperm number estimates how many sperm are present in the whole ejaculate.

It is calculated using the semen volume and sperm concentration.

For example, imagine a hypothetical sample with:

• volume: 3 mL
• concentration: 20 million/mL.

The approximate total sperm number would be:

3 × 20 million = 60 million sperm in the ejaculate.

The current lower reference value is approximately:

39 million sperm per ejaculate.

This example illustrates why “sperm count” can be ambiguous. Some reports or conversations use the phrase for concentration, while others mean total sperm number.

When reading your report, check which measurement is actually being reported.

What does low sperm concentration mean?

A sperm concentration below the laboratory reference range may be described as oligozoospermia.

But the degree matters.

A slightly reduced value has different implications from extremely low numbers, and the significance becomes greater when low concentration occurs together with poor motility or morphology.

The AUA/ASRM male infertility guideline emphasizes that semen abnormalities become more clinically significant when multiple parameters are abnormal, rather than interpreting concentration, motility or morphology in isolation.

Step 4: Understand Sperm Motility

Sperm motility describes how many sperm are moving and how they move.

Your report may divide motility into:

Progressive motility

These sperm move forward.

The current WHO-based lower reference value is approximately:

30% progressively motile sperm.

Progressive movement matters because sperm need to travel through the reproductive tract to reach the egg during natural conception.

Non-progressive motility

These sperm move but do not make useful forward progress.

They may move in small circles or show limited displacement.

Immotile sperm

These sperm do not show movement.

Total motility

Total motility combines progressively and non-progressively moving sperm.

The current lower reference value is:

42% total motility.

Reduced sperm motility may be described as asthenozoospermia.

Again, the word is descriptive. It does not tell you the cause and does not by itself determine whether natural pregnancy, IUI or IVF will be required.

Step 5: Understand Sperm Morphology

Morphology describes sperm shape and structure.

The sperm head, midpiece and tail are assessed according to defined laboratory criteria.

One of the most misunderstood numbers on a semen report is:

4% normal morphology.

A patient may look at that result and think:

“Does that mean 96% of my sperm are defective?”

That interpretation is misleading.

Modern strict morphology assessment classifies sperm against very specific shape criteria. Even semen samples from fertile men contain many sperm that do not meet every strict morphological criterion.

The current WHO-based lower reference value is therefore only about:

4% morphologically normal forms.

A morphology value below the reference level may be described as teratozoospermia.

Morphology is relevant, but the AUA/ASRM guideline cautions that individual semen parameters such as morphology, concentration or motility are generally not diagnostic of infertility on their own.

Is 4% morphology enough for pregnancy?

Pregnancy cannot be predicted from morphology alone.

A clinician also needs to consider:

• sperm numbers
• motility
• reproductive history
• female-partner factors
• how long the couple has been trying
• whether previous fertilization problems have occurred.

This is why treatment should not be selected only because the report says “3% morphology” or “4% morphology.”

What Is Sperm Vitality?

Vitality estimates the percentage of sperm that are alive.

The current lower reference value is approximately:

54% live sperm.

Vitality can be particularly useful when many sperm appear immotile.

An immotile sperm is not necessarily dead. Vitality testing can help distinguish living but non-moving sperm from non-viable sperm.

EAU guidance notes that vitality testing is particularly relevant when a high proportion of sperm are immotile rather than as a mandatory measurement in every sample.

What Does pH Mean?

The semen report may also show pH.

A WHO-based reference level is generally:

pH 7.2 or higher.

Abnormal pH can sometimes contribute to the investigation of reproductive-tract or gland-related issues, but pH should not be used in isolation to diagnose infection or obstruction.

It is supporting information rather than one of the main fertility measures.

What Do the Medical Terms on a Semen Report Mean?

Reports frequently contain unfamiliar terminology.

Term	General meaning
Normozoospermia	Main measured semen parameters fall within reference ranges
Oligozoospermia	Reduced sperm concentration/number
Asthenozoospermia	Reduced sperm motility
Teratozoospermia	Reduced percentage of sperm meeting normal morphology criteria
Oligoasthenozoospermia	Low sperm number plus reduced motility
Oligoasthenoteratozoospermia (OAT)	Low number, low motility and low normal morphology
Azoospermia	No sperm detected in the ejaculate after appropriate laboratory examination

These terms describe laboratory findings. They do not explain why the abnormality occurred.

That requires clinical evaluation.

What If More Than One Parameter Is Abnormal?

Several abnormal semen parameters generally deserve more attention than one mildly abnormal value.

AUA/ASRM guidance states that results have greater clinical significance when multiple semen abnormalities occur together.

For example:

Pattern	Possible interpretation	Typical next question
Low count only	Reduced sperm numbers	Does it persist on repeat testing?
Low motility only	Reduced movement	Are count and morphology adequate?
Low morphology only	Fewer strict normal forms	Is this persistent and clinically important with other factors?
Low count + motility	Stronger male-factor signal	Is further male evaluation indicated?
Count + motility + morphology low	OAT pattern	What is the cause and which conception options remain practical?
No sperm found	Azoospermia	Is it obstructive or due to impaired sperm production?

The report does not make those diagnoses by itself.

It tells the clinician where further investigation may be needed.

A Hypothetical Semen Analysis Example

Consider this fictional educational example:

• volume: 2.5 mL
• concentration: 12 million/mL
• total sperm number: 30 million
• total motility: 48%
• progressive motility: 34%
• morphology: 5%.

How should it be read?

The concentration and total sperm number are below the current WHO-derived lower reference levels, while total motility, progressive motility and morphology are above their respective lower reference values.

The useful interpretation is not:

“This man is infertile.”

A better interpretation would be:

“This sample shows reduced sperm numbers, while measured motility and morphology are within reference ranges. Because semen parameters vary, the clinical importance should be assessed with reproductive history and, if appropriate, repeat testing.”

That is the difference between reading the report and diagnosing the person.

Why One Abnormal Semen Analysis May Not Be the Final Answer

Semen parameters can vary between ejaculates.

The AUA/ASRM guideline describes them as highly variable biological measures. EAU guidance recommends at least two semen analyses when the baseline analysis is abnormal.

The current NICE fertility guideline similarly recommends a confirmatory semen analysis after an abnormal first result. For most abnormalities, it recommends repeating the test ideally around three months later, while azoospermia or severe oligozoospermia may justify earlier confirmation.

The exact timing should be determined by the treating clinician.

A repeat test is especially useful when:

• part of the sample was lost
• abstinence instructions were not followed
• the result is unexpectedly abnormal
• there was recent illness
• more than one semen parameter is reduced.

Do not assume that repeating the test means the first laboratory made an error. Biological variation itself is one of the reasons confirmation can be useful.

What Can Affect a Semen Analysis Result?

Semen findings may be influenced by reproductive conditions, health factors, medications, exposures and sample-collection conditions.

A male fertility assessment may therefore ask about:

• previous fertility and pregnancies
• sexual and reproductive history
• testicular problems or surgery
• undescended testes
• infections
• chemotherapy or radiation
• current medications
• anabolic steroid or testosterone use
• smoking and other lifestyle factors
• occupational or environmental exposures.

AUA/ASRM guidance recommends taking a reproductive history and considering relevant lifestyle, medication and environmental factors during male-infertility evaluation. It also notes that evidence for the effect of many individual lifestyle factors remains limited, so patients should be cautious about simplistic claims that one food or supplement will “fix” a semen report.

A particularly important point about testosterone

Men trying to conceive should not start or continue testosterone purely to “improve male health” without discussing fertility consequences with an appropriate clinician.

AUA/ASRM guidance states that testosterone monotherapy should not be prescribed to men interested in current or future fertility, because external testosterone can suppress the hormonal signals required for sperm production.

Do not stop prescribed medication without medical advice. Instead, discuss the fertility implications with the clinician who prescribed it.

What Happens If the Repeat Semen Analysis Is Abnormal?

Persistent abnormalities may justify a more complete male fertility evaluation.

AUA/ASRM recommends that men with abnormal semen parameters or suspected male infertility receive appropriate history, examination and directed investigations.

Depending on the pattern, evaluation may involve:

• medical and reproductive history
• physical examination
• review of medication and exposures
• hormone testing
• examination for testicular or reproductive-tract abnormalities
• selected genetic investigations
• additional sperm testing in particular clinical situations.

Not every patient needs every investigation.

The testing should follow the abnormality and clinical history.

For example, azoospermia needs a different work-up from a slightly reduced isolated morphology result.

Does an Abnormal Semen Report Mean You Need IVF?

No. An abnormal semen analysis does not automatically mean IVF is required.

Treatment selection depends on:

• severity of the semen abnormality
• whether it persists
• how long the couple has been trying
• female-partner age
• ovulation
• fallopian-tube status
• ovarian reserve where clinically relevant
• previous fertility treatment
• previous fertilization history
• the couple’s reproductive goals.

Some couples may still try naturally.

Some may be candidates for IUI.

Others may benefit from IVF or IVF with ICSI.

This is why a fertility evaluation should consider both partners rather than treating sperm concentration as the only decision variable.

Slavica’s broader guide to male fertility assessment also explains why male fertility should be evaluated as part of the couple’s fertility picture.

What Does the Report Mean for IUI?

During intrauterine insemination (IUI), semen is processed so that a concentrated preparation of motile sperm can be placed into the uterus around ovulation.

Learn about IUI at Slavica IVF

No single raw semen-analysis number guarantees whether IUI will succeed.

However, sperm numbers and motility become clinically relevant when determining whether enough motile sperm remain after processing.

AUA/ASRM guidance says couples may be counselled that repeatedly low total motile sperm counts can reduce IUI success. The guideline notes particularly limited IUI chances when the post-processing total motile sperm count is below about 5 million, although treatment decisions should still consider the complete couple-level situation.

Importantly, a post-wash total motile sperm count used for IUI decision-making is not necessarily the same number as “sperm concentration” on your original report.

Ask your fertility team which measurement they are discussing.

What Does the Report Mean for IVF?

During in vitro fertilization, eggs are collected and fertilization occurs in the laboratory.

Read about IVF treatment at Slavica IVF

A semen analysis helps the laboratory and fertility team plan how sperm should be prepared and whether conventional insemination or ICSI should be considered.

Again, this is not decided by a single mildly abnormal number.

Age, egg number and quality, previous treatment history and fertilization outcomes are also important.

When Might ICSI Be Considered?

Intracytoplasmic sperm injection (ICSI) involves injecting an individual sperm directly into a mature egg.

ASRM’s 2026 committee opinion describes ICSI as particularly useful for overcoming fertilization problems where there is a clear male-factor abnormality or previous low or failed fertilization, while cautioning against assuming it is automatically beneficial for all IVF patients without male-factor indications.

Poor sperm concentration, motility or morphology may therefore contribute to an ICSI discussion when abnormalities are clinically significant.

But “abnormal morphology = ICSI” is too simplistic.

The decision should consider the whole semen pattern and previous reproductive history.

For a more detailed treatment discussion, see Slavica’s guide to when ICSI may be recommended.

What If the Report Shows No Sperm?

The absence of sperm in the ejaculate is called azoospermia.

This finding needs further evaluation rather than assuming biological parenthood is impossible.

Azoospermia can result from different mechanisms, including obstruction preventing sperm from entering the ejaculate or severely impaired sperm production.

AUA/ASRM recommends evaluating azoospermic men using clinical history, physical examination, hormone testing and other directed investigations to distinguish possible causes.

In selected cases, sperm may be recoverable directly from the male reproductive tract or testicular tissue for assisted reproduction.

Treatment options depend entirely on the cause.

Should Both Partners Be Evaluated?

Yes, when a couple is experiencing infertility, evaluation should generally consider both partners.

AUA/ASRM recommends concurrent assessment because infertility may involve male factors, female factors or a combination of both.

A semen result therefore should not be interpreted without considering factors such as:

• female age
• ovulation
• tubal patency
• uterine conditions
• duration of infertility
• previous pregnancies.

This prevents two opposite mistakes:

Mistake 1: blaming every fertility problem on a mildly abnormal semen value.

Mistake 2: assuming there can be no male factor because the report is technically within reference ranges.

Questions to Ask After Receiving Your Semen Analysis Report

Take the actual laboratory report to your appointment and ask:

1. Were the collection conditions adequate?
2. Is sperm concentration or total sperm number the main abnormality?
3. Is progressive motility reduced?
4. How significant is the morphology result?
5. Are several parameters abnormal together?
6. Should the semen analysis be repeated?
7. When should it be repeated?
8. Do I need a male reproductive examination or hormone testing?
9. Are there medications or health conditions that could be relevant?
10. Does my partner also need fertility evaluation?
11. Are natural attempts still reasonable?
12. Is IUI appropriate?
13. If IVF is recommended, why?
14. If ICSI is recommended, what specific finding supports it?

Those questions convert a confusing laboratory sheet into a structured fertility discussion.

Semen Analysis and Fertility Assessment in Kathmandu

Slavica IVF & Research Center in Sinamangal, Kathmandu lists semen analysis as part of its fertility-assessment services and provides related fertility treatments including IUI, IVF and ICSI.

Its fertility team includes Dr. Ajaya Jang Kunwar, PhD, Chairman and Clinical Embryologist, and Dr. Nikita Dhakal, MD, Obstetrics & Gynaecology, IVF Specialist.

If a semen report is abnormal, the useful next step is not to choose IVF from the report alone.

The next step is to establish:

• whether the sample was reliable
• whether the abnormality persists
• whether one or several parameters are affected
• whether an underlying male reproductive problem needs evaluation
• what fertility factors are present in the partner
• which treatment, if any, is appropriate.

Patients can book a fertility consultation with Slavica IVF and bring their semen report and previous fertility investigations for clinical interpretation.

Key Takeaways

A semen analysis report is a fertility assessment tool, not a pass-or-fail test.

Current WHO-based lower reference values include approximately 16 million sperm/mL for concentration, 39 million sperm per ejaculate, 42% total motility, 30% progressive motility and 4% normal morphology. These numbers describe the lower end of measurements observed in a reference population of fertile men; they do not define the minimum values required for conception.

Count, motility and morphology should therefore be considered together.

One unexpectedly abnormal analysis commonly needs confirmation, particularly when the result may affect treatment decisions.

Most importantly, do not ask only:

“Is my sperm report normal?”

Ask:

“What does this pattern mean for us, does it need confirmation, and what is the most appropriate next step for our fertility situation?”

That question leads to a far more useful clinical decision.

FAQs

Is 16 million sperm per mL normal?

Sixteen million sperm per mL is the current WHO-derived lower reference value for sperm concentration, not a guarantee of fertility. Values need to be interpreted alongside total sperm number, motility, morphology and the couple’s wider fertility circumstances.

Is 4% sperm morphology normal?

Four percent normal forms is the current lower reference value under strict morphology assessment. This does not mean the remaining 96% make conception impossible. Morphology should be interpreted with sperm count, motility and reproductive history rather than alone.

What sperm motility is considered normal?

Current WHO-based reference values use approximately 42% total motility and 30% progressive motility as lower reference points. They are not absolute fertility thresholds.

Can you get pregnant with low sperm motility?

Yes. Pregnancy may still occur with reduced sperm motility depending on sperm numbers, the severity of the motility problem, female fertility factors and other circumstances. Persistent significant abnormalities should be professionally evaluated.

Does one abnormal semen analysis mean infertility?

No. Semen measurements vary between ejaculates, and current guidelines recommend confirming an abnormal result with repeat testing.

How soon should an abnormal semen analysis be repeated?

Timing depends on the abnormality and clinical context. NICE’s 2026 guidance recommends repeat confirmation ideally around three months for most abnormalities, but recommends earlier confirmation when azoospermia or severe oligozoospermia is found.

What is a good total sperm count?

The WHO-derived lower reference value is about 39 million sperm per ejaculate. This should not be interpreted as a minimum count required for pregnancy.

Does low sperm count always require IVF?

No. Treatment depends on the severity and persistence of the abnormality plus both partners’ fertility factors. Some couples may continue trying naturally or use IUI, while IVF or ICSI may be appropriate in other situations.