How to Read A Semen Analysis Report

Chances are, if you are struggling to conceive, your partner has completed a semen analysis. (If they haven’t, it’s probably time to order one). Now, although Hollywood loves to dramatize the experience of heading to a sterile doctor’s office with a freshly sanitized TV remote and a variety of dirty magazines, the reality is, many collections can be done from the comfort of your home. So, whether you are currently working with your doctor who ordered the test directly, or you are wanting to take a proactive approach and ordered the test yourself (using companies like Meet Fellow), understanding what the heck a semen analysis means is so important. At NMD Wellness of Scottsdale, we know that it takes two to tango and it is important we evaluate your partner's health at the same time we are evaluating yours. Although a semen analysis can be helpful, it shouldn’t be the only test that is run on your male counterpart. In fact, some of the causes associated with abnormal semen analysis can include other conditions including obesity, diabetes, medications like testosterone, levothyroxine (thyroid medication) and opioids, to name a few. A semen analysis can also be abnormal due to other lifestyle factors including sedentary lifestyle, alcohol and marijuana use. Now today, I wanted to walk you through a typical semen analysis so you have a good understanding of what exactly is being tested and what it means in terms of your fertility journey. 

A semen analysis generally consist of a few important markers: 

  • Semen Volume and pH

  • Sperm Concentration, count, motility and morphology 

  • Debris and Agglutination 

  • Leukocyte Count 

  • Immature Germ Cells 

This is important to mention because if you recently ordered a semen analysis online and it only tests to confirm that there is in fact sperm in the sample, this is NOT a detailed enough evaluation for fertility. You will also want to make sure that if you are ordering an at-home semen analysis evaluation that it comes from a CLIA certified lab. 

How To Collect Sample 

A semen sample should be collected after 2-7 days after abstaining from ejaculation. If your doctor would like you to complete the collection from home, make sure to follow all instructions provided by your doctor, including when the sample must be returned. For most clinics, the same must be delivered to the lab within one hour of collection. 

It is also important to remember that if you do have an abnormal semen analysis, especially an abnormal sperm concentration, another sample should be collected, at least 1 week apart. 

Reference Ranges 

The reference ranges for most semen analyses is based on recommendations published by the WHO, which were derived from a study that included over 1900 men. Although the originally reference ranges were published in 1980, since then the manual has been updated four times with the latest being in 2010. The reason this is so important to mention is because what used to be considered “abnormal” in 1980, could be considered “normal” in the most updated guidelines. 

As you can see many of the original parameters have changed. This is particular interesting for couples who have been told their semen analysis was “normal”. 

Abnormal Semen Analysis 

If a man does experience an abnormal semen analysis, the abnormalities are most likely due to abnormalities in sperm concentration, morphology and motility. If your partner is experiencing a sperm concentration <10million/mL, they should be evaluated for a condition known as Klinefelter syndrome and should have additional testing including serum total testosterone (collected between 8-10am), serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels measured as well. 

  • If your partner is experiencing low semen volume with otherwise normal sperm concentration this is most likely due to an incomplete collection or a partial retrograde ejaculation. Repeating the semen analysis is usually our next step. Now, this time, we will ask patients to collect their repeatsemen sample after emptying their bladder. A post-ejaculation urine same can also be collected to help assess whether there is a retrograde ejaculation. 

  • Low semen volume and low sperm concentration can be associated with testosterone deficiency. (serum testosterone <225pmol/L). 

  • A low volume with azoospermia (no sperm) or severe oligozoospermia (subnormal sperm concentration) could suggest genital tract obstruction (including congenital absence of the vas deferens and seminal vesicles or ejaculatory duct obstructions). 

  • Low sperm concentration can indicate retrograde ejaculation, as well as congenital causes.   

Ways to Support Male Fertility 

Now, although I would like to mention a few ways to support male fertility, it is really important we first address what the root cause is. If your partner has a genetic or endocrine disorder, adding “male fertility” supplements, isn’t going to magically improve their sperm production. Make sure to consult with your doctor directly. 

Environmental Matters

Just like you, your partner is equally at risk to the same environmental toxins, processed foods, chronic stress, alcohol and a sedentary life that you are. All of which can impact male fertility and sperm count. Reducing your exposure to unnecessary environmental toxins, especially BPA, is just as important for your partner’s fertility as it is for you. Our indoor air is also often more toxic than our outdoor air, so starting with optimizing your indoor air and environment is key.

Quality over Quantity

Optimizing your partner’s nutrient status is an essential way to make sure your partner not only has enough sperm but, more importantly, has high quality sperm. This is where providing sperm with optimal nutrients is key. Eating a clean, anti-inflammatory styled diet is one of the best ways to help your partner get the nutrients they need. You also want to make sure they limit their red meat intake to no more than 2-3 times per week. High red meat intake has not only been linked to cancer but it can also lead to elevated Iron, ferritin and uric acid levels, which can impair sperm function. Make sure your partner understands that eating a high quality diet is important for both of you.


It is also important to know that there are a variety of medications that can not only directly impact sperm count and quality but they can deplete our body of important nutrients. Although some medications are absolutely necessary, be mindful of what medications you are taking and how they may impact your nutrient status. If the medication is necessary, vitamin and/or mineral supplementation may be a good idea. Always consult with your doctor before starting any supplement, herb or medications as they may interact with the medications you are already taking. Some of the common medications known to deplete sperm count or testosterone levels include:

  • Chemotherapy

  • Certain anti-fungal and antibiotics

  • Protein Pump Inhibitors (including Omeprazole or Zantac)

  • Anabolic Steroid Use

Studies have shown that the use of proton pump inhibitors 6-12 months before a semen analysis revealed a 3X higher risk of low Total Motile Sperm Count (TMSC).

If you or your partner are on medications, I highly recommend completing a Micronutrient test. This is an extremely useful test that breaks down all of your micronutrients, evaluating your absorption and intake. This is something I often recommend couples do during their preconception appointments.


For the majority of us, stress is a natural hazard of modern life. But, did you know that chronic low grade stress can be detrimental to fertility, in both men and women? In fact, cortisol, the hormone released by the adrenal glands in response to stress, can interfere with a variety of hormones required to produce sperm, lowering not only the number of sperm but the quality of sperm. So although we can’t always escape the stress in our life, we CAN control our response to stress. Implementing stress management techniques can be extremely beneficial for our overall health and fertility. Some of the most common forms of stress management include: 


    Breath work 




Using these stress management techniques only work when they are used consistently. Try implementing one stress management tool a day. This can be as easy as plugging into a 10 minute guided meditation (my favorite app is Insight Timer) while you have your lunch or while you sit in traffic. Find the tools that work best for you and incorporate these tools into your daily life, making them a habit rather than another to-do. 


If your partner smokes whether that be cigarettes, marijuana or any other form of tobacco, it is affecting his sperm. Smoking not only decreases sperm concentration but increases sperm DNA damage, and motility. Getting your partner to quit smoking is a top priority during preconception. 

Sugar Control

Although we have known for years that diabetes can negatively impact sperm health, a new study is pointing to the fact that even prediabetes can impact male fertility. A recent study found that men with prediabetes (higher than normal blood sugar levels) had a higher level of damage to sperm and were more likely to have unexplained azoospermia (no sperm in the ejaculate). They also were found to have lower levels of testosterone than men with normal glucose control.

Nutrients to Improve Sperm Quality

Before you start buying a ton of supplements, I suggest focusing on the basics. Make sure your partner is lowering their stress, has stopped smoking, limits their environmental exposure to toxins and eats a healthy diet BEFORE going out and spending a ton of money on supplements. Don’t get me wrong, supplements can be extremely powerful and is something I use in my practice every day but, remember supplements should supplement a healthy lifestyle not replace it. Spending a ton of money on supplements, if your partner isn’t willing to do the basics, isn’t worth your time or money. That being said, there are a variety of powerful nutrients we can use to improve sperm quality.


A variety of studies have suggested that sperm is extremely sensitive to our environment especially, oxidative stress. Oxidative stress occurs when harmful molecules, known as free radicals, damage sperm. Antioxidants are one of the major ways our body fights against oxidative stress. This would explain why, it is no surprise that a variety of studies have shown that adding antioxidants to your supplement routine can not only reduce the level of oxidative stress but can improve sperm quality.

Best Nutrients to Support General Sperm Health

  • Zinc - functions on sperm include effects on lipid flexibility and sperm membrane stabilization.

  • Lycopene - A recent study revealed that the red pigment compound found in sun-ripened tomatoes can increase sperm count by up to 70%.

  • Selenium -  selenium supplementation in sub-fertile men with low selenium level can improve sperm motility.

  • Vitamin E - a fat-soluble vitamin that helps protect the sperm's cell membrane from damage.

  • Vitamin C -can increase sperm motility by 92% and sperm count by more than 100%.

Best Nutrient to Support Sperm Motility

  • CoQ10 - plays a critical role in the production of cellular energy, which is essential in sperm motility.

  • L-Carnitine - also plays a critical role in cellular energy.

  • Vitamin D- maintaining adequate Vitamin D levels have been associated with better sperm motility. Ask your doctor to test your Vitamin D levels, at the very least, annually.

About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...