# Semen analysis: preparing for the test and reading the report > How to prepare for a semen analysis, how the sample is collected, what the report measures, and what the WHO reference limits can and cannot tell you. Source: https://www.ghinashami.com/en/interests/semen-analysis/ Updated: 2026-10-13 Step 1 of 4 · Tests A semen analysis is the basic test of male fertility, and its report is a column of figures that is easy to misread. This page explains how to prepare, how the sample is collected, what each measurement means, and what the WHO reference limits can and cannot say. - 6 min read - Reviewed 13 October 2026 - 4 references ## What the test measures A semen analysis is a laboratory examination of an ejaculated sample. The standard methods are set out in the [WHO laboratory manual](https://www.who.int/publications/i/item/9789240030787) (sixth edition, 2021). The report lists: - **Volume.** The amount of fluid, in millilitres. - **Concentration.** The number of sperm in each millilitre. - **Total sperm number.** The number in the whole sample (the concentration multiplied by the volume), which WHO considers a better reflection of sperm production than the concentration. - **Movement (motility).** The share of sperm that move, and the share that move forwards (progressive motility). - **Vitality.** The share that are alive, which matters when few are moving. - **Shape (morphology).** The share with a typical shape under the microscope, by strict criteria. ## How to prepare **Days without ejaculation.** The WHO manual asks for the sample to be collected after a minimum of two days and a maximum of seven days without ejaculation. The laboratory records the number of days, because it affects the figures. **Illness and medicines.** WHO lists a recent illness, particularly one with fever, among the factors that change a sample, together with medicines: for example alpha-blockers (used for blood pressure or the prostate), some antidepressants and anabolic steroids. NICE adds testosterone treatment and finasteride. Mention any recent illness and everything you take; a prescribed medicine should not be stopped for the test without asking the doctor who prescribed it. ## How the sample is collected WHO recommends collection by masturbation into a clean, wide-mouthed container from the laboratory, in a private room close to it. It does not recommend withdrawal during intercourse, because part of the sample is easily lost, and ordinary condoms must not be used, since they contain substances that affect sperm movement. Lubricants should be avoided. For exceptional circumstances the manual mentions special condoms made for fertility tests; the laboratory can explain what it accepts. **The whole sample.** The sample needs to be complete, and WHO asks men to report any loss. The initial portion of the ejaculate is the richest in sperm, so losing it changes the figures more than losing the last portion. Any difficulty in producing the sample is also worth mentioning: the WHO manual asks laboratories to record it. **Time and temperature.** WHO advises that the examination start within 30 minutes of collection where possible, and within 60 minutes at most, because sperm movement changes with delay and temperature. For a sample collected elsewhere, WHO advises carrying it close to the body, between 20 and 37 °C, and handing it in preferably within 30 minutes and no later than 50 minutes after collection. The laboratory's written instructions are the ones to follow. ## How to read the report The 2021 WHO manual gives these lower reference limits, which NICE and the European Association of Urology (EAU) also use: - Volume: 1.4 ml - Concentration: 16 million sperm per ml - Total sperm number: 39 million in the sample - Total motility: 42%; progressive motility: 30% - Vitality: 54% alive - Normal forms: 4% WHO took these limits from about 3,500 men in 12 countries whose partners conceived naturally within a year: each limit is the fifth percentile of that group, so one in twenty of these fathers had a value below it. WHO states that the limit does not separate fertile from infertile men, and that their values overlap substantially. A value below a limit is therefore not a diagnosis, and a value above it does not prove fertility. The figures are read together, and with the [partner's tests](https://www.ghinashami.com/en/interests/fertility-tests/); the [AUA/ASRM guideline](https://www.auanet.org/guidelines-and-quality/guidelines/male-infertility) on male infertility advises against judging on a single value. Morphology is often misread: in the WHO reference group, half of the fathers had 14% normal forms or fewer. NICE notes that the limits apply only when the laboratory uses the WHO methods. ## A second test, and what the report cannot tell **Why a second test.** The AUA/ASRM guideline describes semen values as highly variable from one test to the next, so one abnormal analysis is not a diagnosis. NICE advises repeating an abnormal analysis, ideally three months later to allow a full cycle of sperm production, or as soon as possible if no sperm or very few were found. The AUA/ASRM guideline speaks of at least two analyses a month apart; the EAU asks for at least two without setting an interval, and regards a single normal analysis as sufficient. **What it does not measure.** The analysis does not test whether sperm can fertilise an egg: WHO notes that measurements on the whole sample cannot define the fertilising capacity of the few sperm that reach the egg. Sperm DNA is not part of the standard analysis; NICE advises against DNA fragmentation testing, and the EAU reserves it for selected situations. Causes and further tests are explained under [male infertility](https://www.ghinashami.com/en/interests/male-infertility/). ## Questions worth asking your doctor 1. 1 Does the laboratory use the WHO methods? NICE notes that the reference limits apply only to analyses done by the WHO methods. 2. 2 Which figures matter in our situation? One value just below a limit is read differently from several low values, and always with the partner's findings. 3. 3 Should the test be repeated, and when? NICE advises about three months and the AUA/ASRM guideline one month; ask which applies to you. Dr. Ghina Shami ## Risks and limits **A test on a sample.** A semen analysis is a laboratory test on a sample, not a procedure on the body. Its limits are in what the figures can show and in how much they vary: one report is a single reading. **What an abnormal finding can and cannot mean.** A value below a limit is a reason to repeat the test and sometimes to look further. It does not name a cause, and it does not rule out a pregnancy: the AUA/ASRM guideline notes that some men with abnormal values have fathered a child naturally. A report within the limits does not prove fertility either. **Stress.** Producing a sample on request and waiting for the report can be stressful. NICE recognises that the investigation of fertility problems can cause psychological stress and advises that counselling be offered. Your doctor can explain what the findings mean in your situation. ## Common questions **How many days of abstinence before a semen analysis?** The WHO laboratory manual asks for at least two days and no more than seven without ejaculation before the sample. The laboratory records the number of days. **My report shows 4% normal forms. Is that abnormal?** Not by that figure alone. In the 2021 WHO manual, 4% is the reference limit for normal forms, because the criteria for a typical shape are strict. Morphology is read together with the other values. **Do home sperm tests replace a laboratory analysis?** No. The AUA/ASRM guideline notes that home and mail-in kits may give some information, but that their accuracy varies and that they do not replace an analysis in a specialised laboratory. **Evidence basis:** This page is based on the WHO laboratory manual for the examination and processing of human semen (sixth edition, 2021) and on clinical guidelines (NICE 2026, the European Association of Urology 2026, and the American Urological Association and American Society for Reproductive Medicine, AUA/ASRM, 2024); where the guidelines differ or the evidence is limited, the page says so. ## References 1. WHO laboratory manual for the examination and processing of human semen, sixth edition, World Health Organization (2021) — [who.int](https://www.who.int/publications/i/item/9789240030787) 2. Fertility problems: assessment and treatment, National Institute for Health and Care Excellence (NICE), guideline NG257 (2026) — [nice.org.uk](https://www.nice.org.uk/guidance/ng257) 3. EAU Guidelines on Sexual and Reproductive Health: 11. Male Infertility, European Association of Urology (EAU) (2026) — [uroweb.org](https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility) 4. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline (2020, amended 2024), American Urological Association and American Society for Reproductive Medicine (2024) — [auanet.org](https://www.auanet.org/guidelines-and-quality/guidelines/male-infertility) Written and reviewed by [Dr. Ghina Shami](https://www.ghinashami.com/en/about/), Consultant, Reproductive Medicine and Infertility · 13 October 2026 · [How these pages are prepared](https://www.ghinashami.com/en/legal/#accuracy)