By Dr. Shweta Agarwal, MBBS, DGO Medically reviewed by Dr. Shweta Agarwal, MBBS, DGO Last updated: June 2026
Information on this page is educational and does not replace a medical consultation. Outcomes depend on individual clinical factors.
Aansh Hospital & IVF Center is a government-registered Level-2 ART clinic (Reg. No. MH/AC/2024/15441/L2/Chandrapur/132), part of a growing chain of fertility centers across Vidarbha and northern Telangana. Our government ART registration covers regulated fertility diagnostic services. Semen analysis at Aansh is performed in our in-house andrology lab by Aayush Agarwal, our senior clinical embryologist. Results are confidential and discussed directly with you.
Most men who walk into our clinic carry a printed semen analysis report they cannot fully interpret. The numbers look alarming or confusing. Terms like "oligospermia," "asthenozoospermia," and "Kruger strict criteria" appear on the page with no explanation. I wrote this guide specifically for that moment — when you have the report in your hand and need to understand what it actually means before your next appointment.
The important thing to know from the outset is this: a semen analysis is a measurement, not a verdict. Results outside the reference range point toward a diagnosis that can then be investigated and, in most cases, addressed. Even results well below the reference values do not mean conception is not possible.
What parameters are measured in a semen analysis?
A standard semen analysis examines several physical and functional properties of the ejaculated sample. Each parameter tells us something different about sperm health and function.
Sperm concentration — the number of sperm cells per millilitre of semen. This is what most people refer to when they say "sperm count," though technically total count is a separate figure.
Total sperm count — sperm concentration multiplied by the total semen volume. This gives the actual number of sperm available in the whole ejaculate, which often matters more clinically than concentration alone.
Total motility — the proportion of sperm that are moving, whether forward or in place. This is expressed as a percentage of the total sperm observed.
Progressive motility — the proportion of sperm moving forward purposefully in a roughly straight line or wide curve. This is the subset of motile sperm that are genuinely capable of reaching and fertilising an egg. It is clinically more meaningful than total motility.
Morphology — the proportion of sperm that appear structurally normal under high-power microscopy. The most widely used assessment method is Kruger strict criteria, which evaluates head shape, midpiece, and tail in detail. Even in fertile men, most sperm are morphologically abnormal — the reference threshold is set accordingly.
Semen volume — the total volume of the ejaculate in millilitres. Very low volume can indicate ejaculatory duct obstruction, retrograde ejaculation (semen entering the bladder), or absent seminal vesicles.
pH — the acidity or alkalinity of the semen. Normal semen is alkaline; a low pH can indicate obstruction of the seminal vesicles or the presence of infection.
Vitality (live sperm percentage) — the proportion of sperm that are alive, regardless of whether they are moving. This test is important when a high proportion of sperm appear immotile: it distinguishes between dead sperm and sperm that are alive but not moving (which can have different implications).
White blood cell count — elevated white blood cells in semen (pyospermia) can indicate infection or inflammation in the reproductive tract. Most guidelines set the threshold at fewer than 1 million white blood cells per millilitre.
These parameters together give a picture of sperm quality and quantity. No single parameter is interpreted in isolation — the clinical significance always depends on the full result, the duration of abstinence before the sample, and the couple's overall fertility picture.
WHO 2021 reference values for each parameter
The gold standard for interpreting a semen analysis is the WHO Laboratory Manual for Examination and Processing of Human Semen, now in its sixth edition (2021). The WHO 2021 values are based on data from fertile men — men whose partners became pregnant within 12 months. They represent the lower fifth percentile of the fertile reference population, meaning 95% of fertile men had values above these thresholds.
| Parameter | WHO 2021 lower reference limit |
|---|---|
| Semen volume | 1.4 mL |
| Total sperm count | 39 million per ejaculate |
| Sperm concentration | 16 million/mL |
| Total motility (progressive + non-progressive) | 42% |
| Progressive motility | 30% |
| Vitality (live sperm) | 54% |
| Normal morphology (Kruger strict criteria) | 4% |
| pH | ≥7.2 |
Source: WHO Laboratory Manual for the Examination and Processing of Human Semen, 6th edition (2021).
A critical point about how to read this table: these are lower reference limits from a population of fertile men. They are not optimal target values. A result slightly below one of these thresholds does not mean you cannot conceive — it means the result falls below what was observed in the bottom 5% of fertile men in the study population. Results must be interpreted in the context of the full report and the couple's clinical history.
The WHO 2021 values represent a revision from the 2010 edition. If an older report uses the 2010 values (sperm concentration ≥15 million/mL, for example), the clinical interpretation is very similar, as the 2021 update made modest adjustments based on a larger reference dataset. The semen analysis interpreter at Aansh allows you to check your parameters against the current WHO 2021 thresholds directly.
Indian Society of Assisted Reproduction (ISAR) guidelines align with WHO 2021 values for the purpose of clinical interpretation and treatment decision-making in the Indian context.
What does low sperm count (oligospermia) mean?
Oligospermia is the clinical term for a sperm concentration below the WHO 2021 lower reference limit of 16 million sperm per millilitre, or a total sperm count below 39 million per ejaculate.
Oligospermia is classified by severity:
- Mild oligospermia — sperm concentration 10–16 million/mL
- Moderate oligospermia — concentration 5–10 million/mL
- Severe oligospermia — concentration below 5 million/mL
The severity classification matters because it influences which treatment path is most appropriate. Mild oligospermia, if all other parameters are adequate, often responds well to intrauterine insemination (IUI) — a procedure that places a prepared sperm sample directly into the uterus at the time of ovulation, bypassing the cervical barrier and reducing the distance sperm must travel. Severe oligospermia is more commonly addressed with ICSI (intracytoplasmic sperm injection), where a single sperm is selected and injected directly into each egg in the laboratory.
Common causes of oligospermia include varicocele (enlarged veins in the scrotum that raise testicular temperature), hormonal imbalance (low FSH, LH, or testosterone), genetic factors, previous infection, and lifestyle factors including smoking, heavy alcohol use, and anabolic steroid use. In some cases the cause remains unclear after investigation.
One result does not make a diagnosis. Before any conclusions are drawn, a repeat semen analysis is recommended — usually after a four-to-six-week interval, with two to five days of abstinence before the sample. Sperm production can fluctuate significantly in response to illness, fever, or stress in the preceding weeks.
What does poor motility (asthenozoospermia) indicate?
Asthenozoospermia is the term for reduced sperm motility. The WHO 2021 reference values define the lower limits as 30% progressive motility and 42% total motility. When either of these is below the reference limit, the result is classified as asthenozoospermia.
Within the motility categories, progressive motility is the clinically more meaningful figure. Sperm that are moving but not progressing forward — circling, trembling, or oscillating in place — are counted in total motility but not progressive motility. For fertilisation to occur naturally or with IUI, sperm need to travel through the cervical mucus and fallopian tube to reach the egg. Non-progressive movement has limited utility for this purpose.
The causes of asthenozoospermia overlap with other sperm parameter abnormalities. Oxidative stress — an imbalance between reactive oxygen species and antioxidant defences in the seminal environment — is one of the most commonly identified contributors and can be assessed with a separate antioxidant or oxidative stress test. Genital tract infections or past infection history, varicocele, and sperm DNA fragmentation are among the other recognised causes.
Sperm DNA fragmentation is worth mentioning separately. It is not a standard semen analysis parameter — it requires its own test — but it is relevant when motility is poor and a cause is not identified from the basic profile. Elevated DNA fragmentation can impair fertilisation and embryo development even when sperm count and motility appear adequate.
When asthenozoospermia is present alongside an otherwise acceptable sperm count, IUI may still be considered. When it is severe or combined with low count, ICSI is typically the more appropriate pathway. The male infertility treatment page outlines how the treatment pathway is individualised.
What does abnormal morphology (teratozoospermia) mean?
Teratozoospermia is defined as a normal morphology percentage below the WHO 2021 lower reference limit of 4% using Kruger strict criteria.
This is the parameter that causes the most confusion for patients reading their own reports. A figure of 4% sounds extremely low — it means that 96% of sperm in the sample could be abnormally shaped and still technically fall within the WHO 2021 reference range. This can seem alarming until the context is understood.
Human sperm morphology, even in men with no fertility issues, is characterised by a high proportion of abnormal forms. Kruger strict criteria — the standard used in most accredited fertility labs — is deliberately stringent. Only sperm with a perfectly oval head, normal midpiece, and intact tail of the correct length are classified as normal. Small deviations result in a sperm being counted as abnormal. This is why the reference limit sits at just 4% rather than the 50–70% normal range one might expect from other blood or tissue tests.
What matters clinically is the entire picture. Isolated mild teratozoospermia — with normal count and motility — is often not clinically significant for couples attempting natural conception or IUI. It tends to be most relevant when it is severe (very near zero normal forms) or when it is combined with reduced count and motility (a condition called oligoasthenoteratozoospermia, or OAT syndrome).
Morphology is also not a fixed, static characteristic — it can change in response to the same lifestyle and environmental factors that affect count and motility.
What does azoospermia (no sperm) mean?
Azoospermia is the finding of no sperm in the ejaculate after the sample has been centrifuged and the pellet carefully examined by an experienced embryologist. It is confirmed on two separate samples before a definitive diagnosis is made.
Azoospermia falls into two fundamentally different categories, and distinguishing between them determines the entire investigation and treatment path.
Obstructive azoospermia (OA) — sperm are being produced normally in the testes but cannot reach the ejaculate because a duct is blocked or absent. Causes include previous vasectomy, congenital bilateral absence of the vas deferens (which is associated with CFTR gene mutations, the same gene involved in cystic fibrosis), previous infection, or injury. In OA, testicular volume is typically normal and FSH is within normal range. Because sperm are present in the testes and epididymis, surgical retrieval — either PESA (percutaneous epididymal sperm aspiration) or TESE (testicular sperm extraction) — can obtain sperm in the large majority of cases for use with ICSI.
Non-obstructive azoospermia (NOA) — sperm production itself is impaired or absent. Causes include genetic conditions (Klinefelter syndrome — 47,XXY — is the most common; Y-chromosome microdeletions are another), hormonal failure, and cryptorchidism (undescended testes). In NOA, FSH is typically elevated and testicular volume may be reduced. Surgical sperm retrieval is still possible in a proportion of cases using micro-TESE (microsurgical testicular sperm extraction), which uses an operating microscope to identify and sample tubules that may contain active sperm production. The likelihood of finding sperm with micro-TESE depends on the underlying genetic and hormonal findings.
A hormonal panel (FSH, LH, testosterone) and genetic testing (karyotype, Y-chromosome microdeletion analysis) are standard parts of the azoospermia workup. These results — together with testicular volume on ultrasound — distinguish OA from NOA and guide whether surgical retrieval is appropriate to attempt.
Azoospermia is not a closed door to biological parenthood. It does require a careful, stepwise evaluation, but the distinction between obstructive and non-obstructive types is made precisely because the treatment pathways differ. For more detail, the conditions page on azoospermia and the surgical sperm retrieval guide explain each approach in depth.
What should you do if your results are abnormal?
The first step is to not act on a single result. Semen parameters can vary substantially from sample to sample in the same individual. Illness or fever in the six to twelve weeks before the sample can suppress sperm production — because it takes approximately 70–74 days to complete a full sperm production cycle. A high-grade fever three weeks before the test will often produce a notably worse result that resolves on a repeat sample a few weeks later.
Standard clinical practice is to confirm any abnormal finding with a repeat analysis, with two to five days of abstinence, at least four to six weeks after the first.
If the second result confirms the abnormality, further investigation is guided by what the result shows. Common next steps include:
- Hormonal panel — FSH, LH, testosterone, prolactin — to assess whether the cause is testicular or originates in the pituitary signalling pathway
- Scrotal ultrasound — to look for varicocele, assess testicular volume, and check the epididymis
- Sperm DNA fragmentation test — especially if parameters are borderline or if a couple has unexplained infertility despite adequate count and motility
- Genetic testing — karyotype and Y-chromosome microdeletion analysis, primarily for severe oligospermia and azoospermia
I review abnormal semen analyses in the context of the couple's full picture — the duration of trying, the female partner's age and ovarian reserve, and the hormonal and structural findings — before recommending a treatment path. The same result in two different couples can lead to quite different treatment recommendations depending on these surrounding factors.
If you have an existing report and want a preliminary review before booking a full consultation, you can send it confidentially via WhatsApp or schedule a fertility checkup and we will advise on the appropriate next step. You can also explore our fertility tests overview.
How is semen analysis done at Aansh — what to expect?
The semen analysis at Aansh is performed in our in-house andrology laboratory, which means the sample is processed on site by Aayush Agarwal, our senior clinical embryologist, under WHO-standard conditions.
Before the test
Abstain from ejaculation for two to five days before providing the sample. Fewer than two days means fewer sperm have accumulated; more than five days is associated with a higher proportion of non-motile sperm. The abstinence period should be consistent between samples if you are doing a repeat test for comparison.
Providing the sample
The sample is produced by masturbation into a sterile container. Our Chandrapur and Nagpur centres have a private, designated room for sample production. If you prefer to produce the sample at home, this is also acceptable — the sample needs to reach the laboratory within 30–60 minutes and should be kept at body temperature during transport (a pocket or inner jacket works well). Do not use a regular condom, as the lubricants in standard condoms affect sperm viability.
Processing and results
Aayush Agarwal processes the sample within one hour using WHO-standard methods. The analysis takes approximately 30–60 minutes after liquefaction. Results are typically available the same day. On occasions when additional assessments (such as vitality testing or a second look at morphology) are required, results are ready within 24 hours.
Confidentiality
Your sample, results, and clinical discussion are handled with complete confidentiality. The report is shared only with you, and with your partner if you specifically consent to this. Our team understands that male fertility evaluation involves a degree of vulnerability, and we treat every consultation accordingly.
If you have questions about the test before booking, Dr. Shweta Agarwal leads the clinical consultation and can review your report with you. Alternatively, bring your existing report to your first fertility consultation and we will go through it together.