The answer to the question of what the sperm count should be is not just a single number. In the spermiogram, semen volume, sperm concentration per milliliter, total sperm count, motility, viability and morphology are evaluated together. Even if the number is above the reference, mobility may be too low; It is also possible to have enough motile sperm when the number is low.
The World Health Organization laboratory guideline for the examination of human semen, 6th edition, provides lower reference values based on distributions obtained from men who have had children. These values are not the limit of “pregnancy will not occur below, it will definitely occur above”. Fertility is under the combined influence of the couple’s age, ovulation, tubes, egg reserve, timing of sexual intercourse and sperm parameters.
Sperm values according to WHO references
| Parameter | Approximate lower reference value | What does it say? |
|---|---|---|
| semen volume | 1.4mL | Ejaculate volume released in a single sample |
| sperm concentration | 16 million/mL | Number of sperm in one milliliter |
| Total sperm count | 39 million/ejaculate | Total result of volume and concentration |
| total mobility | %42 | The sum of forward motile and in situ motile sperms |
| forward mobility | %30 | Proportion of sperm moving forward |
| vitality | %54 | Proportion of live sperm cells |
| normal morphology | %4 | Proportion of normally shaped sperm according to strict criteria |
The method and reference range used may also be written in your laboratory report. Rounding off figures or using different guide pressures may result in slight variations. Evaluate the results with a reproductive health specialist instead of diagnosing yourself with an internet chart.
Difference between sperm concentration and total sperm count
Concentration indicates how many sperm are present in one milliliter of semen. For example, if there are 20 million sperm per milliliter in a 2 mL volume, the total number is approximately 40 million. In a sample with the same concentration but lower volume, the total sperm count may be less.
Therefore, it is not enough to just look at the “million/mL” value in the report. The total number of motile sperm can be calculated by using volume, concentration and motility together. The number of motile sperm after washing may be important, especially when deciding on vaccination.
What does sperm motility mean?
In order for the sperm to reach the egg, they must not only be alive but also move in the appropriate direction. Forward motility refers to sperm moving in linear or wide circles. Sperm that move in situ may be viable, but their ability to reach the egg is more limited. Some of the immobile sperm may be dead, while some may be living but non-moving cells.
Total mobility and forward mobility results are evaluated separately. Low motility may be called asthenozoospermia. Infection, varicocele, heat exposure, smoking, oxidative stress, or sample delay may affect the result. A medical history and examination is required to determine the cause.
What should be the sperm morphology percentage?
Morphology is the study of the shape of the sperm head, midpiece and tail according to strict microscopic criteria. Approximately 4 percent normal form is used as the lower reference value. This figure seems low at first glance; because the evaluation criteria are quite strict and small shape differences can be classified as abnormal.
Morphology results may vary between laboratories and observers. The difference between 3 percent and 4 percent alone should not make a definitive treatment decision. Total number, mobility, female age, gestation period and previous treatment results are evaluated together. In case of severe teratozoospermia, ICSI may be considered; However, not every low morphology automatically requires in vitro fertilization.
How is the spermiogram test given correctly?
Duration of sexual abstinence
The abstinence period recommended by the center should be followed; An interval of several days is often required. Too short a diet may reduce volume and number, while too long a diet may negatively affect mobility and DNA integrity. Similar abstinence duration in each repetition makes comparison easier.
Considering the entire sample
The first part of the ejaculate may be denser with sperm. If a part of the sample is not taken into account, the result may be lower than it is. If such a situation occurs, it must be reported to the laboratory; The report is interpreted accordingly or the test is repeated.
Transport time and temperature
If the sample is to be given at home, the time and temperature conditions accepted by the laboratory must be observed. Delay may reduce mobility. A sterile container provided by the laboratory should be used; Lubricants that may be harmful to sperm should not be preferred.
Why is sperm test variable?
Sperm production is affected by a cycle of approximately several months. Fever, COVID or other infections, severe stress, sleep disturbance, use of certain medications, anabolic steroids and testosterone may temporarily impair the result. Test day sample conditions also make short-term differences.
Therefore, permanent infertility may not be diagnosed with a single miscarriage. The physician may want to repeat the borderline or significantly low result at appropriate intervals. The comparison becomes more meaningful when the tests are performed in the same reliable laboratory and with a similar abstinence period.
Possible causes of low sperm count
- Varicocele and increase in testicular temperature
- hormone disorders
- Past infections or testicular inflammation
- History of undescended testicles
- Genetic or chromosomal causes
- Channel blockages
- Chemotherapy, radiotherapy or certain medications
- Testosterone and anabolic steroid use
- Smoking, heavy alcohol, obesity and sleep problems
- Occupational heat or toxin exposure
Using supplements without knowing the reason can waste time. Urology and andrology evaluation is important, especially in cases of very low concentration, small testicular volume, hormonal disorder or absence of sperm.
Is natural pregnancy possible if sperm count is low?
A result below the reference does not make natural pregnancy impossible. Pregnancy may take longer and the probability depends on the total number of motile sperm, the woman’s age, ovulation and the condition of the tubes. In cases of mild miscarriage, scheduled intercourse and treatment of the cause may be considered.
If the couple has not been able to achieve pregnancy despite unprotected intercourse for a year; If the woman is over 35 years of age, earlier evaluation may be recommended. If there is a very low sperm count or known female factor, the waiting period is shortened. The decision is not based solely on the male result.
When do IUI, IVF and ICSI come into play?
For insemination, sufficient motile sperm and at least one open tube are required after the procedure. IVF may be considered if the sperm count is very low, the woman is older, or previous IUI attempts have been unsuccessful. In ICSI, the embryologist injects a single sperm into the egg; This method can assist fertilization with serious number, motility or morphology problems.
If there is no sperm in the ejaculate, the diagnosis is confirmed and an obstruction, hormone or production problem is investigated. In appropriate cases, sperm can be obtained by PESA, MESA, TESE or micro-TESE. If sperm cannot be found, the donation option can be discussed separately within the framework of personal and legal circumstances.
What can be done to support sperm quality?
Quitting smoking, maintaining a healthy weight, regular sleep, avoiding extreme heat, limiting alcohol, and regular physical activity can support overall reproductive health. Testosterone or anabolic steroids can severely suppress sperm production. It should not be used without medical supervision.
There is no certainty that antioxidant and vitamin supplements provide the same results for everyone. Instead of using numerous supplements without a deficiency or specific medical reason, a urological evaluation should be performed. If a treatable cause such as varicocele or hormone disorder is detected, a targeted approach is more meaningful.
Evaluate your results with an expert
If there is a low number, motility or morphology in your spermiogram report, it is necessary to evaluate the entire report. The woman’s age, ovarian reserve, tubes and how long the pregnancy has been desired change the treatment method. One should not conclude “I cannot have children” or “There is no problem” just by looking at a number.
You can request an online preliminary meeting by sending your spermiogram and urology reports, if any, to Vita Altera IVF Center. The team can explain to the couple whether repeat testing is required and under what circumstances IUI, IVF, ICSI, or advanced male infertility evaluation may be considered.
What is done to confirm the spermiogram result?
Sperm values can be affected by febrile illness, stress, medications, sample collection conditions and abstinence period. For this reason, instead of making a definitive decision based on a single result, the test can be repeated at appropriate intervals with the doctor’s recommendation. It should be ensured that the entire sample is taken into the container and delivered to the laboratory within the specified time.
Review the reference ranges used with the result, the difference between concentration and total sperm count, and the assessment of advanced motility and morphology. An abnormal value does not mean that natural pregnancy is impossible, and normal values do not guarantee pregnancy; Female factors and the couple’s entire history are evaluated together.
How many million should the normal sperm count be?
In the WHO 6th edition reference distributions, lower reference values of approximately 16 million/mL for sperm concentration and approximately 39 million/ejaculate for total sperm count are used. These are not exact fertility limits.
What should be the sperm morphology percentage?
In strict morphology criteria, approximately 4 percent normal form is used as the lower reference value. Morphology result alone does not determine the success of natural pregnancy or in vitro fertilization.
Why is the sperm test repeated?
Sperm production and sample results can be affected by febrile illness, abstinence period, stress, medications and sample conditions. Borderline or low results can be reconfirmed with appropriate interval.
Can in vitro fertilization be done with low sperm count?
In many cases yes. IUI, IVF or ICSI can be evaluated according to the total motile sperm count and other findings. In case of very low sperm count or absence of sperm, urological examination and surgical methods may be required.
