Poor sperm test results? Here’s how to know, and what to do next – according to an MD

We know from experience here at TRB HQ that when it comes to male fertility testing, making head or tail of it all isn’t always straightforward. 

For sperm test results explained, the best and most reliable information and advice comes straight from the experts.

We asked Dr Brian Steixner, board-certified Urologist and Co-Founder and CEO of Popstar Fertility, for the 101 on how to read a semen analysis report, as well as what a normal sperm count looks like. Plus, we’ll do some jargon-busting around ‘poor’ sperm test results, and cover some practical tips for healthy sperm to help improve on your male partner’s numbers.

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Now, over to Dr Steixner.

How does a sperm test usually work? 

A sperm test, also known as semen analysis, is a diagnostic tool to evaluate a man’s sperm quality and overall fertility. 

You’ll be advised to abstain from ejaculation for 2 to 5 days before the test to ensure an optimal sperm sample, and to avoid alcohol, caffeine, and any medications that could affect sperm quality. 

Your semen sample is typically collected through masturbation into a sterile container. This can be done at a clinic or at home, provided the sample can be delivered to the lab within a specified time. 

Your results should be available within 48 hours, to 7 days.

How to read a semen analysis report

Once your semen sample is collected, it is analyzed in a laboratory. The analysis focuses on several key parameters, and the results will be collected in a semen analysis report.

What is a normal sperm count, and what else should we look for in a ‘normal’ report? 

• Sperm count: This measures the number of sperm present in one milliliter of semen. A normal sperm count is over 15 million sperm per milliliter.
• Volume: The volume of the semen sample is measured. Normal ejaculate volume ranges from 2 to 6 milliliters.
• pH Level: The pH of the semen is measured. Normal semen pH ranges from 7.2 to 8.0. Deviations could indicate potential issues such as infections or blockages.
• Motility: The percentage of sperm that are actively moving is assessed. Normal motility is defined as more than 40% of sperm being motile, with more than 32% showing progressive motility, meaning they’re moving forward in a straight line or large circles.
• Morphology: This evaluates the shape and structure of the sperm. According to strict criteria, at least 4% of sperm should have a normal shape, which means they have an oval head, intact midpiece, and uncoiled tail.
• Liquefaction time: Semen is initially thick and coagulated after ejaculation but should liquefy within 20-30 minutes. Delayed liquefaction can indicate potential prostate issues.
• Viscosity: The thickness or consistency of the semen is examined. High viscosity can affect sperm motility.
• Fructose levels: Fructose in the semen, produced by the seminal vesicles, provides energy for the sperm. Low fructose levels might indicate seminal vesicle dysfunction.

‘Poor’ sperm test results explained

Low sperm count 

Also known as oligospermia, a low sperm count means that you have fewer than 15 million sperm per milliliter of semen.

Having a low sperm count can mean your chances of fertilizing an egg are lower, due to insufficient sperm. 

To get clear on some more jargon here, azoospermia means your sample contains no sperm, and a normospermic specimen will contain more than 15-20 million sperm per ml, which is considered normal.

Poor sperm motility

Also known as asthenozoospermia, having poor sperm motility means that less than 40% of your sperm are motile, or less than 32% exhibit progressive motility.

This can mean that the ability of sperm to swim through the female reproductive tract to reach and fertilize the egg is reduced.

Abnormal sperm morphology 

You might see it referred to as teratozoospermia, but in essence, abnormal sperm morphology means that you have less than 4% of sperm with a normal shape.

This can cause fertility problems as abnormally shaped sperm may have difficulty penetrating and fertilizing the egg.

Low semen volume

Having a low semen volume means that your ejaculate volume less than 1.5 milliliters.

Low ejaculate volume may indicate an issue at the level of the prostate, seminal vesicle or ejaculatory duct, such as complete or partial obstruction or retrograde ejaculation. 

Abnormal semen pH

Having a pH less than 7.2 or greater than 8.0 is considered abnormal.

It is known that the secretions from the prostate are acidic, while seminal vesicle fluid is alkaline. 

Therefore, an acidic ejaculate may suggest a blockage of the seminal vesicles. Infections are usually associated with an alkaline ejaculate, and an ejaculate pH over 8.0 may indicate the need to treat an underlying disease.

Poor sperm vitality

Poor sperm vitality looks like having a high percentage of dead or non-viable sperm in your sample.

If many sperm are not alive, this reduces your chances of fertilization.

Delayed liquefaction

Delayed sperm liquefaction means that semen does not liquefy within 20-30 minutes after ejaculation, as normal. This can sometimes happen due to prostate issues. 

Thick semen can hinder sperm motility.

High semen viscosity

Finally, if your sperm test results indicate a high semen viscosity, this means that your semen is thick and sticky.

Again, this has fertility implications as it makes it harder for your sperm to move efficiently.

What next steps should male partners take to follow up with their provider after a ‘poor’ result?

If you or your partner have received a ‘poor’ semen analysis report – it’s important to remember that, although it can feel difficult, it’s not your fault.

Being open with your partner about how you’re feeling is so key, as is taking a proactive and structured approach to address potential fertility issues and get answers to any questions you might have.

Here are some of the next steps I’d advise you to take.

1. Consult with a specialist

A urologist or fertility specialist can interpret your semen analysis results in detail and provide guidance on the next steps. They’ll also be able to run a detailed medical history and physical examination, to help identify any underlying health issues that could affect your fertility.

2. Repeat the semen analysis

Since sperm quality can vary, a repeat semen analysis may be recommended to confirm the initial findings. It’s typically done after 2-3 weeks. Ensure you follow the guidelines for abstinence and sample collection accurately.

3. Identify underlying causes

Conditions such as varicocele, infections, hormonal imbalances, or genetic issues can affect sperm quality. Your fertility specialist should help you rule these out.

Additionally, lifestyle factors like smoking, alcohol consumption, drug use, poor diet, and stress, as well as environmental factors such as exposure to toxins, radiation, or heat, can negatively impact sperm health and production.

4. Consider medical treatments

Treatments for improving sperm quality include medications like antibiotics for infections, hormone treatments for imbalances, and medications to enhance sperm production. 

Surgical options like varicocelectomy can help correct varicoceles and improve sperm quality. 

Again, your fertility specialist will help guide you here, and can also guide the conversation toward IUI or IVF treatment options, if they think it’s right for you. 

Plus, you can also start to make lifestyle changes right away to help positively impact your sperm health.

5 proactive tips for healthy sperm

1. Adopt a healthy diet. A balanced diet rich in essential nutrients can have a really positive effect on your sperm quality. Focus on antioxidant-rich foods like berries, citrus fruits, leafy greens, choose healthy fats, and opt for whole grains and lean protein sources like chicken, turkey, and legumes.
2. Supplement like you mean it. Even if you follow a healthy diet and lifestyle, most men need extra nutrient support. Folic Acid, Zinc, Vitamin C, Vitamin E and Coenzyme Q10 are all key for sperm health – read our wrap up of what vitamins should a man take when trying to conceive for more on this. While each of these vitamins can be taken separately, Popstar Fertility combines the correct amount of each, with several other known vitamins and minerals to make sperm health easy.
3. Maintain a healthy weight. Being overweight or underweight can negatively impact sperm production and quality. Regular exersie like brisk walking, swimming, or cycling for at least 30 minutes most days of the week, a balanced diet that avoid high-sugar and high-fat foods, and avoiding struct dieting can positively affect sperm production.
4. Avoid harmful substances. Exposure to certain substances can adversely affect sperm health. Smoking reduces sperm count and motility, and increases the risk of DNA damage, so just don’t do it. Excessive alcohol consumption can lower testosterone levels and reduce sperm production, so stick to no more than two drinks per day. Avoiding recreational drugs reducing exposure to environmental toxins like pesticides, heavy metals, and industrial chemicals is key too.
5. Finally, stay cool. High temperatures can impair sperm production and function. Keep things cool by avoiding hot baths and saunas, choosing loose-fitting underwear made of breathable fabrics like cotton, and using a desk or a cooling pad when working with a laptop, rather than using a laptop directly on your lap.

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