Semen Analysis
Semen analysis is the basic test used to assess male fertility.
The male factor is involved in approximately 40–50% of infertility cases, and for this reason male assessment should be carried out promptly and in parallel with the evaluation of the woman.
The clinical value of the test is not limited to numbers. Correct interpretation of the findings determines whether the couple can continue trying naturally, whether intrauterine insemination is indicated, or whether in vitro fertilization (IVF/ICSI) is required.
Semen analysis is therefore the first step in investigating the male factor, but in some cases it needs to be supplemented with specialized tests in order to develop a complete and personalized treatment plan.
What is semen analysis?
Semen analysis is the laboratory assessment of the ejaculate based on internationally defined criteria (WHO). The aim of the test is to evaluate the ability of sperm to move, survive, and fertilize the egg.
The analysis includes macroscopic and microscopic characteristics of the semen, which provide an overall picture of male reproductive function.
Which parameters does it evaluate?
Semen volume
Reflects the function of the accessory genital glands (prostate, seminal vesicles).
Sperm concentration
The number of sperm per ml of semen. Low values may affect the likelihood of natural conception.
Total sperm count
The total number of sperm in the ejaculate sample.
Motility
The ability of sperm to move progressively toward the egg. It is a critical factor for fertilization.
Morphology
The morphological structure of sperm (head, neck, tail). It is evaluated using strict criteria.
Vitality
The percentage of live sperm in the sample.
White blood cells
The presence of increased white blood cells may indicate inflammation or infection.
The test reflects the current state of spermatogenesis. Since the sperm production cycle lasts approximately 72–90 days, factors such as fever, infections, or intense stress during the previous months can affect the result.
When is testing indicated?
Semen analysis is recommended for every couple experiencing difficulty conceiving. Male evaluation should be performed promptly and in parallel with the evaluation of the woman, as delay may unnecessarily prolong the waiting time.
Semen analysis is indicated:
- After 12 months of regular, unprotected intercourse without achieving pregnancy
- After 6 months when the woman is over 35 years old
- Before starting assisted reproduction treatment (intrauterine insemination or IVF)
- In cases with a history of miscarriages of unknown cause
- In cases of known varicocele
- In cases with a history of hormonal disorders or testicular surgery
- In cases of ejaculation disorders or erectile dysfunction
In cases of severe pathology in the first semen analysis, further investigation should be carried out immediately so that the appropriate treatment strategy can be determined.
How is semen analysis performed?
The test is performed in a specialized andrology laboratory. Proper preparation is important for the reliability of the result.
The sample is collected in a special sterile container and analyzed within a specific time frame.
Is a repeat test needed?
Yes. Sperm production is a dynamic process and is affected by many factors. For this reason, in the case of an abnormal result, repeating the test after 4–6 weeks is recommended.
Diagnosis is not based on a single sample, but on repeated evaluation and overall clinical assessment.
What does an abnormal semen analysis mean?
An abnormal semen analysis does not necessarily mean inability to have children. The reference limits of the World Health Organization (WHO) are based on statistical data and are not an absolute criterion of fertility. Evaluation is individualized and considered together with the couple’s history.
The most common abnormalities involve reduced sperm count, reduced motility, abnormal morphology, or a combination of these. In rarer cases, complete absence of sperm (azoospermia) is observed, which requires immediate further investigation.
The severity of each abnormality and its combination with other factors determine whether further investigation or specialized reproductive support is required.
How semen analysis affects treatment planning
The result of the semen analysis is a decisive factor in planning the appropriate treatment strategy. The choice between natural conception, intrauterine insemination, or in vitro fertilization is not based exclusively on numbers, but on the overall assessment of the couple.
Mild abnormalities
In cases of slightly reduced concentration or motility, and provided there is no coexisting female factor, natural attempts may continue or intrauterine insemination (IUI) may be recommended.
The decision depends on:
- The duration of infertility
- The woman’s age
- The presence of other aggravating factors
More severe abnormalities
In cases of severe oligospermia or significantly reduced motility, in vitro fertilization with intracytoplasmic sperm injection (ICSI) is often the indicated option.
ICSI allows the selection and injection of a single sperm directly into the egg, bypassing problems related to sperm count or motility.
What the results mean for the couple
An abnormal result does not necessarily mean inability to have children, just as a normal result does not fully rule out the need for further testing.
Timely and correct interpretation of semen analysis enables realistic planning of the next steps—whether this involves continuing natural attempts or following an organized assisted reproduction approach.
The clinical approach of Ioannis Douliotis, with expertise in the investigation and treatment of infertility, is based on the comprehensive evaluation of both the male and female factors, with the aim of selecting the appropriate reproductive strategy.
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