Semen Analysis Guidelines

Standard Parameters and Reference Values

The American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) recommend a lower reference limit of 1.4 mL for semen volume, with a range of 1.3-1.5 mL 1
The AUA/ASRM guidelines suggest a lower reference limit of 39 million per ejaculate for total sperm number, with a range of 35-40 million 1
The AUA/ASRM guidelines recommend a lower reference limit of 16 million/mL for sperm concentration, with a range of 15-18 million/mL 1
The AUA/ASRM guidelines propose a lower reference limit of 54% live spermatozoa for sperm vitality, with a range of 50-56% 1
The AUA/ASRM guidelines suggest a lower reference limit of 30% for progressive motility, with a range of 29-31% 1
The AUA/ASRM guidelines recommend a lower reference limit of 42% for total motility, with a range of 40-43% 1
The AUA/ASRM guidelines propose a lower reference limit of 4.0% for morphologically normal forms, with a range of 3.9-4.0% 1
The American Academy of Family Physicians recommends a pH greater than 7.2 for semen analysis 2

The American Academy of Family Physicians suggests that patients should abstain from sexual activity for 2-3 days before collection 2
The American Academy of Family Physicians recommends masturbation or intercourse using specialized semen collection condoms for collection methods 2
The American Academy of Family Physicians advises that the specimen should be kept at room or body temperature if collected at home 2
The American Academy of Family Physicians recommends that examination should occur within one hour of collection 2

The AUA recommends that low volume ejaculate (<1.4 mL) with acidic pH (<7.0) suggests ejaculatory duct obstruction or absence of seminal vesicles 1
The AUA suggests that azoospermia (absence of sperm) requires differentiation between obstructive and non-obstructive causes 1
The AUA recommends that severe oligospermia (<5 million/mL) may warrant genetic testing including karyotype and Y-chromosome microdeletion analysis 1
The American Academy of Family Physicians advises that post-ejaculatory urinalysis should be performed if ejaculate volume is less than 1 mL to rule out retrograde ejaculation 2

The AUA/ASRM guidelines support that a single properly performed semen analysis is often sufficient for initial evaluation 1, 3
The AUA/ASRM guidelines recommend that if abnormalities are detected, a second confirmatory analysis should be performed at least one month after the first 2, 3

The AUA suggests that fructose testing can help identify seminal vesicle dysfunction or ejaculatory duct obstruction, though considered relatively unreliable 1
The American Academy of Family Physicians recommends sperm antibody testing for suspected immunological infertility 2

The American Academy of Family Physicians warns that inadequate abstinence period can significantly affect volume and concentration 2
The American Academy of Family Physicians advises that improper collection technique can invalidate results 2
The American Academy of Family Physicians recommends that delayed analysis affects motility assessment 2
The European Society of Human Reproduction and Embryology (ESHRE) suggests that failure to follow WHO standardized procedures leads to high variability between laboratories 3
The AUA recommends that the entire profile should be considered when evaluating fertility potential, to avoid over-reliance on a single parameter 1

The American Urological Association suggests that acidic pH (<7.0) with low volume suggests distal obstruction in the genital tract 4

Aspermia is defined as the complete absence of semen in ejaculate, according to the American Urological Association 4
Azoospermia is characterized as the absence of spermatozoa in the semen, requiring centrifugation of the sample to confirm, as stated by the American Urological Association 4
Oligozoospermia is described as low sperm concentration by the American Urological Association 4
Asthenozoospermia is defined as reduced sperm motility by the American Urological Association 4
Teratozoospermia is characterized as abnormal sperm morphology by the American Urological Association 4
Normozoospermia is defined as normal semen parameters by the American Urological Association 4
Retrograde ejaculation is described as semen flowing backward into the bladder, with post-ejaculatory urinalysis recommended if ejaculate volume is less than 1 mL by the American Urological Association 4

For azoospermia, laboratories should centrifuge the ejaculate and examine the pellet for rare sperm, as recommended by the American Urological Association 4
The American Urological Association recommends karyotype testing for males with primary infertility and azoospermia or sperm concentration <5 million/mL when accompanied by elevated FSH or testicular atrophy 4
Y-chromosome microdeletion testing should be considered for severely oligospermic males, found in 5% of males with sperm concentrations 0-1 million, according to the American Urological Association 4