Abnormal semen analysis: understanding the results and exploring your options

The semen analysis remains the first test, yet it is poorly understood. A single abnormal result is not enough to draw any conclusions: sperm production takes around three months, and a fever, medication or a period of stress can affect the sample. A second semen analysis, carried out three months later, is standard practice before any decision is made.

Interpreting the results

The World Health Organisation’s reference thresholds, in their sixth edition, describe the fifth percentile of men who have conceived naturally within less than a year. These are not fertility thresholds, but statistical benchmarks:

• Volume: 1.4 ml or more.
• Concentration: 16 million per ml or more; below this, the condition is known as oligospermia.
• Total count: 39 million or more per ejaculate.
• Progressive motility: 30 per cent or more; below this, it is known as asthenospermia.
• Normal morphology: 4 per cent or more; below this, it is known as teratospermia.
• Viability: 54 per cent or more.

Falling below a threshold does not mean infertility, and being above it does not guarantee anything. It is the combination that counts, and ICSI has significantly pushed the boundaries of what is possible.

Sperm DNA fragmentation

This is the test most often missing from the records I receive, particularly when the semen analysis is normal and there is no obvious explanation for the failures. It measures DNA breaks within the sperm nucleus. A high level – generally above 25–30 per cent, depending on the technique used – is associated with an increased risk of miscarriage and repeated implantation failures.

Factors that can sometimes improve the result include: giving up smoking, treating a symptomatic varicocele, treating an infection, reducing exposure to heat, a short period of abstinence before collection, and sometimes antioxidant therapy — the effectiveness of which remains debated. Ways to get round this: collecting sperm directly from the testicle, where fragmentation is lower, or sorting the sperm before ICSI.

Technical solutions

ICSI involves injecting a single sperm into each egg. It is recommended whenever sperm concentration, motility or morphology are significantly impaired, and is included in most Greek treatment packages. Prices are detailed here.

Selection techniques: IMSI, which examines the sperm under very high magnification, or sorting using microfluidic columns. These are considered in cases of high fragmentation or repeated failures, but not as a first-line treatment.

Surgical retrieval: TESA, TESE or micro-TESE when the ejaculate contains no sperm. In cases of obstructive azoospermia, the recovery rate exceeds 90 per cent. In cases of non-obstructive azoospermia, the recovery rate is around 40–50 per cent with micro-TESE, which still represents a real opportunity.

Sperm donation, if no sperm can be retrieved or if a genetic risk justifies it. The Greek framework for sperm donation can be found here.

Further investigations

Before concluding, a man with a markedly abnormal semen analysis should undergo: a clinical examination by a urologist or andrologist, a hormonal assessment (FSH, LH, testosterone), a scrotal ultrasound to check for a varicocele, and, if the concentration is very low, a karyotype and screening for Y-chromosome microdeletions. These last two tests alter the course of action and are carried out in France, where they are reimbursed.

What can really be corrected

Smoking, excessive alcohol consumption, being overweight, prolonged exposure to heat and certain medicines impair spermatogenesis. Three months of genuine lifestyle changes can improve a semen analysis, which is almost never the case for age-related female parameters. This is the part of the assessment where effort yields the best results, and it is also the one that is least frequently requested.

Frequently asked questions

Source: https://fertilitegrece.com/en/blog/abnormal-semen-analysis-dna-fragmentation/ — Triada Baloukoudis, IVF patient coordination in Greece. General information, not medical or legal advice. Printed on

Triada Baloukoudis
Independent IVF patient coordinator in Thessaloniki, with 24 years of experience supporting patients travelling from abroad. More · Contact · Facebook