INFERTILITY DIAGNOSIS Article · 25 August 2022

10 questions about semen analysis

What does semen analysis look like? Can a man deliver a sample to the laboratory? Or it needs to be done at the clinic? What’s the cost of the examinations? We will talk to Dariusz Mercik, MD, gynecologist, infertility specialist at Gyncentrum Infertility Clinic.

Doctor, what does the quality of male sperm depend on?


Daily choices made by men, habits, but also lifestyle have a huge impact on the quality of sperm and the condition of the sperm in it. In the multitude of daily obligations, absorbed with  work, we do not even remember about our testicles. Nobody teaches us about them practically, they do not familiarize us with the proper operating instructions. And it is this organ subjected to hormonal contro, whichl is of great importance for the quality of male reproductive cells, without which a new life cannot arise. Sperm production begins with the period of puberty of a young man and continues until his old age. One sperm is formed in> 70 days.


There are several factors that affect the quality of male sperm:


Firstly, overheating. Male testicles will not work properly unless they remain cooler than the rest of the body. Their excessive exposure to heat causes a significant decrease in the number of spermatozoa and negatively affects the very process of their formation. Overheating may result from spending too much time in a sauna or hot tub, wearing regular tight underwear that lifts the scrotal bag to a warm underbelly, using low-ventilated pants, and carrying a warm smartphone in your pocket. Longer bicycle rides also create a less friendly environment for sperm production. The temperature of the testicles can also be lowered using home-made techniques,  or special cooling methods for scrotal glued patches.


Secondly, obesity. Too much fat component in men’s body weight is a known source of female hormones that do not promote the proper functioning of the testicles and reduce sperm count. On the other hand, after 35 years of age, excessive physical exertion may be the cause of low semen parameters.


Thirdly, lifestyle. Any doses of alcohol always have a negative effect on very sensitive male gametes – sperm. The sperm is formed about 74 days, and if something poisons it along the way, then such an improper sperm escapes to the surface. Especially the abuse of alcoholic beverages is a serious factor that damages sperm and strongly affects spermatogenesis in men. Smoking cigarettes, (nicotine) damages sperm chromosomes (DNA) to a very large extent, slows down the sperm’s progressive movement (they do not flow forward) and increases erectile dysfunction. Marijuana is even worse because its smoking reduces the number of spermatozoa, weakens their functioning very much and significantly reduces overall male fertility.


Practice safe sex. Sexually transmitted diseases like gonorrhea, chlamydia, herpes can lead to infertility. You should always use protection or engage in a monogamous relationship with someone you trust while having sex.


Fourthly, stress. Stress increases the percentage of abnormal sperm and generally reduces their concentration in ejaculate. The right amount of sleep, healthy nutrition and relaxation help relieve tension and stress.


Fifth, diet. You should eat so as to reduce the body’s share of free radicals that damage sperm. Take huge doses of vitamin C 1g per day, which “sweep” free radicals out of the body – a lot of them are created after eating meat. Vit. C- use it from citrus fruits and their juices, sweet peppers, kiwi, strawberries, tomatoes, broccoli, brussels sprouts, cabbage, potatoes, dairy products. It is also recommended to take products with zinc – which is of great importance for semen and other dietary supplements to improve the quality of sperm. Zinc 30mg twice a day (oysters, poultry, crustaceans – crab and lobster, healthy breakfast cereals, nuts and beans, whole wheat grain products, dairy products, pumpkin seeds are full of zinc, which is lost with each ejaculation in the amount of a few mg !!!). It is good to eat vit. B (green, leafy vegetables such as spinach, cos lettuce, brussels sprouts and asparagus, fruit and fruit juices, especially oranges and orange juice, nuts, beans and peas, whole grains, healthy breakfast cereals, fortified flour products such as bread and pasta ), vit. B-12 1g per day – fish and seafood, especially mussels, meat and poultry, especially liver, dairy products such as eggs and milk, fortified breakfast cereals, food yeast, but not from beer. Do not forget about the vit. D – fatty fish such as salmon, mackerel and tuna, beef liver, cheese, yolks, fortified milk, yogurt and other dairy products, mushrooms, vit. E – vegetable oils such as sunflower and soybean oil, nuts and seeds, green vegetables such as broccoli and spinach. Remember about coenzyme Q10 10mg daily (meat = poultry, especially chicken, fish, such as herring and trout, vegetable oils, including soybean and rapeseed oil, nuts and seeds, in particular peanuts, sunflower seeds and pistachios), fatty acids omega-3 (fish and seafood, especially salmon, mackerel, tuna, herring and sardines, nuts and seeds, including chia seeds, linseed and walnuts, vegetable oils such as linseed, soybean and rapeseed oil), L -arginine 4g daily (meat and poultry such as turkey and chicken, nuts and seeds, especially pumpkin seeds and peanuts, almonds, beans and lentils, dairy products), fenugreek seeds (600 mg fenugreek seed extract per day for 12 weeks ), ginseng root, in any edible form, selenium 200mg daily (from bananas), L-carnitine 4g daily, linseed oil 1 tablespoon daily.


You can increase sperm ejaculation with diet and supplementation by always taking zinc in combination with folic acid. A pair of these supplements increases the sperm count (1 mg of folic acid and 15 mg of zinc sulfate consumed per day).


You should drink more fluids (but not sparkling water, soda) – water is the base of the semen. Alcohol dehydrates and reduces sperm count and reduces sperm quality.

If you want to have more sperm in the ejaculated semen, you should refrain from orgasm for one or two or three days because typical sperm production is about 1,500 units per second (130 – 200 million sperm per day).


Men should avoid bisphenol (it highly poisons sperm) contained in plastic bottles, PET packaging.


Men should also avoid eating phytoestrogens, there are a lot of them in soy products and beer.


Is there a correlation between the quality of male sperm and age? Is it similar to the case with women, that the older a man is, the lower his fertility can be?


A man’s “biological clock” is not as obvious as in women, and the age-related decrease in male fertility is more gradua. The statistical dependencies we have obtained, based on several thousand sperm samples tested, clearly show that the age of the man who’s trying for a child begins to be significant after 35 years of age. Then, the quality of sperm, described by several parameters, including: sperm concentration, ejaculate volume, sperm motility and vitality, the presence of correct forms (one correct head with an acrosome, strong insertion, long, single and strongly working switch) naturally decreases. Generally speaking, the later you start trying for children, the harder it is (worse semen quality, lower potency, lower reproductive potential, more chromosomal defects). In addition, apart from age, everything mentioned above is significant, including type of diet, lifestyle, occurrence of fever, inflammation (teeth, joints), infection, taking anabolic steroids, deficiencies required for the production of sperm supplements and the type of work performed (especially for steel worker, welder, railwayman, miner).


However, just lowering sperm parameters in older men does not exclude the possibility of having children.


While for women, potential fertility problems can often be seen, e.g. ovulation does not occur. And how is it with men? When can you suspect that something might be wrong? When is it worth carrying out diagnostic tests for male infertility?


When, despite strenuous attempts of conceiving naturally, pregnancy doesn’t occur (after trying for over a year, without contraception, among young people). When the penile erection is weak or sperm donation does not occur despite of stimulation, it may not occur in practice. When the presence of varicose veins is suspected, which impeding the flow of blood through the testicles increases their temperature and significantly reduces sperm production. When the mammary glands grow – this may be a clue to run the hormonal profile (prolactin, testosterone, etc.). When orgasm occurs, but there is no sperm ejaculation (suspected retrograde ejaculation due to, among others, anatomical defects in the paths leading to semen from the testicles). When you know that the testicles did not descend into the scrotum before 3 years of age (risk of complete infertility).


If only sperm production in the testes takes place, then the chance of having your own offspring obtained from own germ cells exists; in the absence of sperm in ejaculation, they can be microsurgically taken directly from the testicles.


Every man should examine his semen at least once in a while. Finding out whether they have sperm, whether they are alive or flowing straigh. It’s something that you should be interested in, you cannot be ignorant in this aspect.


Is a semen test sufficient or should a man receive a referral for other tests too?


General basic semen examination can be extended with more in-depth sperm analysis, including full examination, with sperm morphology, or MSOME examination looking for high magnification of undesirable vacuoles in sperm heads, or fragmentation of DNA contained in sperm heads:


Lack of erection – sexologist.

Painful ejaculation – urologist.

Suspected malfunction of the endocrine system – endocrinologist.

Malfunction of the genitourinary system – urologist, andrologist.

Varicose veins of the spermatic cord – urologist, surgeon.

Bacteria in a sperm smear – urologist.


What does semen analysis look like? Can a man deliver a sample to the laboratory? Or it needs to be done at the clinic?


Each month, hundreds of men from a group of patients or donors donate semen for testing at Gyncentrum. Routinely, sperm is donated in a specially adapted intimate room of the Clinic. ‘Sperm donation’ is nothing more than normal ejaculation (after masturbation) of the sperm produced in the testicles and associated glands:


– seminal vesicles (of which fructose feeding the sperm + substances increasing viscosity and gelatinization to keep the sperm in the vagina after ejaculation),

– Cowper’s glands and urethral glands (lubricant, as a specific “smear” + anti-sperm antibody that can have a negative effect on fertility,

– prostate (several chemical compounds, including the PSA enzyme – prostate antigen, sperm liquefaction catalyst = sperm release),

– the epididymis (where the spermatozoa matures for 14 days and the sperms do not move yet), through the vas deferens and the penis outside the body.


The semen donation room is equipped with a comfortable couch, armchair, audio video set, lubricants, personal hygiene products, etc. You can stay there for any length of time alone or with a partner. You can donate semen in a dedicated container or a special condom (without spermicides). Semen can also be delivered to the Clinic within 1-2 hours, keeping the container with the sperm sample at +/- body temperature.


How long does it take to get the result?


The test result can be released very quickly. 30 minutes after donation, the sperm liquefies, which allows you to perform basic sperm analysis.


Basic, general examination whether we can see live or mobile sperm cells and the concentration: the result is ready after several dozen minutes.


Detailed examination, with morphology, sperm structure: usually the result is ready the next day after donation.


DNA fragmentation determining the degree of “shredding” of chromosomes: one day after donation.


What’s the cost of the examinations?


Below are the sperm test costs according to the current Gyncentrum price list:


  • Sperm Analysis (Computer Assisted Sperm Analysis – CASA) – €25
  • Complete sperm analysis – €60
  • DNA sperm fragmentation – €70
  • Bacteriology assessment of sperm – €10
  • MSOME examination – €70


Is it worth to repeat the test? When?


The quality of semen changes over time and under the influence of various external factors (stress, diseases, diet, stimulants, low physical activity, harmful factors related to work, etc.). Therefore, the diagnosis should be based on several results. A single sperm test result (even indicating azoospermia = no sperm at all) does not yet qualify the patient as infertile. Also, the result of a study ordered during an earlier visit to a specialist (which took place e.g. a year ago) does not entitle the doctor to make the final diagnosis.


The semen test should always be repeated from time to time. If the cause of the reduced fertility lies deeper, the semen tests should be repeated at least several times at longer intervals, after the doctor’s recommendations. One-time semen analysis, although recommended for everyone, will never give a picture of a certain biological whole work and functioning of the testicles.


If abnormalities are found as a result of sperm testing, they should be repeated within the next 3 months (which includes the time of subsequent sperm maturation).


And what are the norms of male sperm today? Is it true that norms are lowered every year because the quality of semen of modern men is much lower than a dozen / dozen years ago?


The semen is usually white or gray, occasionally yellowish. Pink or red semen suggests the presence of blood.


It solidifies almost immediately after ejaculation, forming a viscous, gelatinous liquid. It takes 5 to 40 minutes to liquefy again.


The World Health Organization (WHO) defines “normal” sperm parameters:


Ejaculate volume ≥;; 1.5 ml.

Total sperm count in ejaculate ≥;; 39 million.

Sperm concentration (number of spermatozoa in 1 ml of semen) ≥;; 15 million.

Overall percentage of motile sperm (progressive and non-progressive motion) ≥;; 40%.

Percentage of spermatozoa with progressive movement ≥;; 32%.

Sperm viability (percentage of live sperm) ≥;; 58%.

Sperm pH ≥;; 7.2.

Sperm morphology (percentage of completely normal sperm) ≥;; 4%.

Leukocytes (test) with preoxidase <1 million may also be tested in semen (if the semen contains a large number of white blood cells, this may indicate an existing infection or inflammation).

Immunobead test (its purpose is to detect sperm antibodies in an amount that disrupts sperm function) <50%.

Fructose (energy resource for sperm) ≥;;13 mmol / ejaculate.


It should be noted that these are not reference values ​​(based on statistics). These values ​​do not set a threshold below which a man is infertile and cannot have children – his reproductive chances may simply be lower.


Similarly, a correct semen test result does not mean that a man can become a father 100%. It is estimated that 40% of male infertility cases are caused by reduced sperm production or poorer semen quality. Other causes of male infertility may include, for example, damage to the testicles or vas deferens as a result of infection (e.g. gonorrhea) or mechanical or thermal trauma or other types of radiation, or even heart, lung or kidney disease. In turn, the results of the semen test, in which the parameters are significantly below normal, do not mean male infertility. A patient with significant sperm parameters, e.g. sperm count below normal, has a chance of becoming a father.


Modernity and civilization have clearly left its mark on the quality of men’s sperm, regardless of the country of origin. Currently, among typical representatives of the male population, the quality of semen is particularly low, compared to the semen of our even close ancestors (those from 50 years ago). Only some of them manage to obtain satisfactory semen parameters, contained in the cited “standards”.


Finally, could you please name a few ways to improve the quality of male sperm?


As already mentioned above.