Male Infertility: When to Get a Semen Analysis and What the Results Mean
By Dr. Christopher Vendryes, MD · Board-Certified Urologist · · 5 min read
Quick answer: A male factor contributes to roughly half of infertility cases, so both partners should be evaluated together. Couples should seek evaluation after 12 months of trying, or after 6 months if the female partner is 35 or older. The first test for men is a semen analysis, which measures sperm count, movement, and shape. Many causes of male infertility, such as a varicocele, hormone imbalance, or medications, are treatable. Testosterone therapy suppresses sperm production, so men trying to conceive shouldn't use it.
Why should men be tested early?
Infertility evaluation often focuses on the female partner first. But according to the American Urological Association, a male factor plays a role in about half of couples who have trouble conceiving. A semen analysis is simple, noninvasive, and can save months of time.
What does a semen analysis measure?
| Measure | What it means | WHO lower reference limit |
|---|---|---|
| Volume | Amount of semen | 1.4 mL |
| Concentration | Sperm per milliliter | 16 million per mL |
| Total motility | Percent of sperm moving | 42% |
| Morphology | Percent with normal shape | 4% |
These come from the World Health Organization's 2021 laboratory manual. Results below these limits don't mean you can't father a child, and normal results don't guarantee fertility. Because sperm counts vary, an abnormal result is usually repeated.
How do I prepare?
- Abstain from ejaculation for 2 to 5 days beforehand
- Collect the full sample
- Get it to the lab within the time window they give you
- Mention any recent illness or fever, which can lower counts for weeks
What causes male infertility?
- Varicocele: enlarged veins in the scrotum, the most common correctable cause. See Varicocele and Fertility.
- Hormone imbalances, including low testosterone or pituitary problems
- Testosterone or anabolic steroid use, which shuts down sperm production
- Blockages, including from prior vasectomy or infection
- Genetic conditions
- Lifestyle factors: smoking, heavy alcohol, marijuana, obesity, and heat exposure
- Certain medications
Why does testosterone therapy cause infertility?
Taking testosterone signals the brain to stop producing the hormones that tell the testicles to make sperm. Sperm counts can drop to zero. Men who want children and have low testosterone have other options. Read Low Testosterone Treatment.
What does a full male fertility evaluation include?
A urologist reviews your history, examines you, reviews semen analysis results, and may order hormone tests, genetic testing, or a scrotal ultrasound.
Is male infertility treatable?
Often, yes. Treatment may include repairing a varicocele, adjusting medications, treating hormone problems, lifestyle changes, or sperm retrieval for assisted reproduction.
Frequently Asked Questions
Talk to a Board-Certified Urologist
Dr. Vendryes sees patients in Plantation and across Broward and Palm Beach Counties for men's health, fertility, kidney stones, urologic cancers, and bladder problems.
References
- American Urological Association / American Society for Reproductive Medicine. Diagnosis and Treatment of Infertility in Men. 2020, amended 2024.
- World Health Organization. Laboratory Manual for the Examination and Processing of Human Semen, 6th edition. 2021.
- Urology Care Foundation. Male Infertility.