• The semen analysis is a key tool in diagnosing fertility issues
• There are several relevant parameters used to assess sperm quality
• Often, additional diagnostic methods are offered, such as DNA fragmentation analysis, IMSI, or microfluidic systems
• We also evaluate and explain these options here in a scientific yet easy-to-understand manner
  

If your dream of having a child doesn’t seem to be coming true, there are numerous testing methods to get to the bottom of the causes. The most important test that can provide insight into a man’s fertility is the semen analysis. This involves examining the sperm in the ejaculate, which is why it is often referred to as a “semen analysis.” However, a semen analysis is quite complicated and involves many different parameters. There are also supplementary procedures that may be useful in some cases. Here, you’ll learn what applies to you and how to interpret your semen analysis.

The Sperm Analysis Process

To perform a sperm analysis, sperm or ejaculate is, of course, required. This is typically obtained through masturbation and then examined. According to the WHO (World Health Organization), men should abstain from ejaculation (which for men usually means orgasm) for approximately two to seven days prior to the test. The ejaculate or sperm is usually placed in a container and taken immediately to the lab for analysis.

After the analysis, you’ll receive the results, which can be quite overwhelming. That’s why we’ve compiled the most important parameters and their WHO reference values.

Parameters and results of the semen analysis

Right at the start of the laboratory examination, macroscopic tests—those that can be assessed with the naked eye—are performed. Protocols may vary slightly depending on the laboratory. The most common parameters are:

• Volume: The volume of the semen sample, and possibly its weight, is measured right at the start of the laboratory examination. There should be at least 1.4 ml of ejaculate.
• Color: The semen should be yellowish to grayish. Very clear samples or samples of a different color may indicate diseases or other problems.
• pH value: Here, too, deviations may indicate infections or diseases. Ideally, the pH value is above 7.2 but not above 8.0.
• Liquefaction: “Normal” ejaculate should liquefy within 20 to 30 minutes after ejaculation. Liquefaction is also necessary for the subsequent examinations.

These subsequent examinations are now performed under a microscope and provide more detailed information about the sperm and their quality. We have summarized the most important values for you here as well:

• Sperm count: The higher the sperm count, the greater the chance of successful fertilization. In a healthy man, there should therefore be either 39 million sperm per ejaculate (i.e., semen sample) or more than 16 million sperm per milliliter of ejaculate.
• Sperm motility: Since sperm must embark on what can sometimes be a lengthy journey through the uterus to find the egg, their motility is essential for successful fertilization. Overall, more than 42% of the sperm should be motile, and more than 30% of the sperm should be progressive motile.
• Sperm morphology (shape): Deformed sperm in the head, midpiece, or tail regions are also detrimental to fertility. Ideally, more than 4% of the sperm in the ejaculate should be normally shaped.
• Vitality: Vitality indicates how many sperm are alive. According to the WHO, at least 54% of the sperm should be alive. While this may sound macabre at first, it is actually quite normal—sperm are regularly produced and die off just as regularly.

If your semen analysis doesn’t meet the ideal values, there’s no need to bury your head in the sand. On the one hand, infertility is only diagnosed if at least two semen analyses, taken one month apart, come back negative; on the other hand, your dream baby can still be on the way—even if not always via the easiest path in the world.

At an IVF clinic or fertility center, you may be offered additional diagnostic tests or treatment options right away. To help you make the best decision for yourself, we’d like to share a few more methods, scientific findings, and recommendations with you.

DNA fragmentation analysis

Your sperm contain your DNA—or at least a copy of it. This DNA is essential so that your baby’s DNA can be “combined” with your DNA and the DNA of the child’s biological mother. If there are many breaks in the sperm’s DNA, this can lead to reduced fertility—both in natural conception and in artificial insemination. In addition, many DNA breaks can unfortunately lead to an increased rate of miscarriages (Andrabi, S.W. et al., 2024). An increased rate of DNA fragmentation was also observed in couples who suffered from recurrent implantation failure (McQueen, D. B., et al., 2019).

However, scientists have already found that DNA fragmentation analysis prior to IVF or IUI increases the chances of pregnancy and live birth for certain patients (Stavros, S., et al., 2024).

But what actually triggers an increase in DNA fragments? Studies show that the main causes include varicoceles (varicose veins of the testicles), impaired glucose tolerance, testicular tumors, sexually transmitted infections (STIs), bacterial infections, smoking, being over 50 years of age, exposure to pesticides and insecticides, spinal cord injuries, heroin use, chronic prostatitis, or testicular fixation can contribute to an increase in DNA breaks in sperm (Szabó, A., et al., 2023).

So if any of these factors apply to you, you might want to consider a DNA fragmentation analysis. Fortunately, experts primarily recommend lifestyle changes as treatment, such as regular exercise, reduced stress, a balanced diet, and sufficient antioxidants (Stavros, S., et al., 2024).

When it comes to getting enough antioxidants, we highly recommend VILAVIT Male: a dietary supplement specifically developed for men hoping to conceive and for men with insufficient antioxidant levels.

IMSI

IMSI is widely regarded as an advancement of ICSI and does indeed share several similarities: In ICSI, sperm are examined under a “standard” microscope and then selected for fertilization. In IMSI (Intracytoplasmic Morphologically Selected Sperm Injection), however, sperm are examined at 6,000x magnification and selected based on this observation. This allows for more precise examination and makes structural damage visible even before sperm selection (Lo Monte, G., et al., 2013). In theory, this ensures that only the “best” and “healthiest” sperm are selected, thereby increasing the chances of a successful pregnancy. However, IMSI has not yet generated the hoped-for enthusiasm among scientists:

In studies, some experts were unable to detect any improvement with IMSI over ICSI in terms of implantation rates, clinical pregnancy rates, and live birth rates when used in the first cycle. Therefore, IMSI is not currently recommended as a standard treatment (Moubasher, A., et al., 2021 and Leandri, R. D., et al., 2013).

Other scientists recommend the use of IMSI for men with high sperm aneuploidy, a high DNA fragmentation rate, repeated failed ICSI attempts, and severe testicular disorders (Lo Monte, G., et al., 2013).

Ultimately, however, all studies agree that IMSI requires further investigation before evidence-based recommendations can be made.

Microfluidic Techniques for Sperm Selection

Microfluidic techniques are now also being used for patients seeking to conceive. This technique aims to simulate the female reproductive tract and, through various mechanisms also found in the female body, select only those sperm that promise a good chance of a successful pregnancy in the uterus (Ferreira Aderaldo, J., et al., 2023).

This method is about as new as it sounds crazy—in fact, it has only recently become available outside of clinical trials at some facilities. In studies over the past five years or so, scientists have already developed models that correctly sort up to 100% of the sperm (Sarbandi, I. R., et al., 2021) or have an error rate of no more than 0.6% (Pan, X., et al., 2022).

No matter how impressive these results may be, the reality on the ground is unfortunately quite different:

In the first large-scale meta-analysis of microfluidic techniques involving over 1,600 embryo transfers, no statistically significant benefit was found from using these techniques. However, the authors point out that more studies are definitely needed and that the technique may ultimately prove useful for some couples (Ferreira Aderaldo, J., et al., 2023).

Frequently Asked Questions About the Semen Analysis

What is a semen analysis and what is it used for?

A semen analysis is a basic test of male fertility. Among other things, it evaluates sperm concentration, motility, morphology, and vitality. It can reveal abnormalities but does not always explain the cause.

What is sperm DNA fragmentation?

This refers to damage to the DNA, i.e., the genetic material of the sperm. Even if the semen analysis is normal, elevated DNA fragmentation can impair fertilization, implantation, and embryo development.

Can DNA fragmentation be improved?

Yes, particularly through lifestyle factors such as regular exercise, a balanced diet, or reducing stress. Additionally, sufficient antioxidants are necessary, and, if applicable, measures such as quitting smoking or treating varicoceles or other conditions.

What is IMSI?

In IMSI, sperm are examined under 6,000x magnification and then selected for fertilization. It is also considered an advancement of ICSI.

Is IMSI worthwhile?

The studies on this topic are mixed, and no clear conclusion can be drawn. In individual cases, such as when previous ICSI attempts have failed, IMSI can be helpful—but it is generally not recommended for the first cycle attempt.

What are microfluidic systems?

These systems attempt to mimic the female body and, based on this, select the sperm most likely to lead to successful fertilization and pregnancy. They use various factors for this purpose, which vary depending on the system.

References

• World Health Organization. (2021). WHO laboratory manual for the examination and processing of human semen (6th ed.). https://www.who.int/publications/i/item/9789240030787
• Andrabi, S. W., Ara, A., Saharan, A., Jaffar, M., Gugnani, N., & Esteves, S. C. (2024). Sperm DNA Fragmentation: causes, evaluation and management in male infertility. JBRA assisted reproduction, 28(2), 306–319. https://doi.org/10.5935/1518-0557.20230076
• McQueen, D. B., Zhang, J., & Robins, J. C. (2019). Sperm DNA fragmentation and recurrent pregnancy loss: a systematic review and meta-analysis. Fertility and sterility, 112(1), 54–60.e3. https://doi.org/10.1016/j.fertnstert.2019.03.003
• Stavros, S., Potiris, A., Molopodi, E., Mavrogianni, D., Zikopoulos, A., Louis, K., Karampitsakos, T., Nazou, E., Sioutis, D., Christodoulaki, C., Skentou, C., Gerede, A., Zachariou, A., Christopoulos, P., Panagopoulos, P., Domali, E., & Drakakis, P. (2024). Sperm DNA Fragmentation: Unraveling Its Imperative Impact on Male Infertility Based on Recent Evidence. International journal of molecular sciences, 25(18), 10167. https://doi.org/10.3390/ijms251810167
• Szabó, A., Váncsa, S., Hegyi, P., Váradi, A., Forintos, A., Filipov, T., Ács, J., Ács, N., Szarvas, T., Nyirády, P., & Kopa, Z. (2023). Lifestyle-, environmental-, and additional health factors associated with an increased sperm DNA fragmentation: a systematic review and meta-analysis. Reproductive biology and endocrinology : RB&E, 21(1), 5. https://doi.org/10.1186/s12958-023-01054-0
• Lo Monte, G., Murisier, F., Piva, I., Germond, M., & Marci, R. (2013). Focus on intracytoplasmic morphologically selected sperm injection (IMSI): a mini-review. Asian journal of andrology, 15(5), 608–615. https://doi.org/10.1038/aja.2013.54
• Moubasher, A., Abdel-Raheem, T., Ahmed, H., Salem, A., Doshi, A., & Abdel Raheem, A. (2021). An Open Prospective Study on Whether Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) Offers a Better Outcome Than Conventional Intracytoplasmic Sperm Injection (ICSI). Cureus, 13(11), e19181. https://doi.org/10.7759/cureus.19181
• Leandri, R. D., Gachet, A., Pfeffer, J., Celebi, C., Rives, N., Carre-Pigeon, F., Kulski, O., Mitchell, V., & Parinaud, J. (2013). Is intracytoplasmic morphologically selected sperm injection (IMSI) beneficial in the first ART cycle? a multicentric randomized controlled trial. Andrology, 1(5), 692–697. https://doi.org/10.1111/j.2047-2927.2013.00104.x
• Ferreira Aderaldo, J., da Silva Maranhão, K., & Ferreira Lanza, D. C. (2023). Does microfluidic sperm selection improve clinical pregnancy and miscarriage outcomes in assisted reproductive treatments? A systematic review and meta-analysis. PloS one, 18(11), e0292891. https://doi.org/10.1371/journal.pone.0292891
• Sarbandi, I. R., Lesani, A., Moghimi Zand, M., & Nosrati, R. (2021). Rheotaxis-based sperm separation using a biomimicry microfluidic device. Scientific reports, 11(1), 18327. https://doi.org/10.1038/s41598-021-97602-y
• Pan, X., Gao, K., Yang, N., Wang, Y., Zhang, X., Shao, L., Zhai, P., Qin, F., Zhang, X., Li, J., Wang, X., & Yang, J. (2022). A Sperm Quality Detection System Based on Microfluidic Chip and Micro-Imaging System. Frontiers in veterinary science, 9, 916861. https://doi.org/10.3389/fvets.2022.916861