How to read a spermiogram and WHO reference limits
The spermiogram is an analysis of male sperm which evaluates the quality, quantity and motility of the sperms. It is now a routine examination that males must undergo to verify their fertility after about a year of unsuccessful targeted intercourse. Male infertility represents about 50% of the causes of couple infertility and it is therefore important that these tests are among the first checks to be made when a child does not arrive .
The spermiogram is performed on a biological sample collected by the patient through masturbation, in a container provided by the analysis laboratory. The examination must be performed with a minimum of 3 and a maximum of 5 days of abstinence from sexual intercourse. It is better to collect the sample in the rooms set up in the analysis laboratory so that it is immediately stored at the right temperature.
Once the result has been obtained, the spermiogram must always be read by the referring doctor. Only he will be able to better interpret any negative results also on the basis of the patient’s clinical history.
WHO reference data
Each spermiogram is compared with reference values (see the table below) to understand the patient’s overall fertility status.
The references for the spermiogram have been defined in the “WHO laboratory manual for the Examination and processing of human semen” published in 2010.
Lower limits of normal for male semen
The value at the 5th percentile is given as a lower reference limit and indicates that an individual can still be potentially fertile even if with reduced probabilities. These values therefore should not be understood as normal values but must be thought of as minimum values of fertilizing potential by natural means.
For this reason, to fully understand the outcome of the spermiogram it is important to evaluate the 50th and 95th percentiles. This will be done by the andrologist to whom the spermiogram must always be reported for a correct interpretation.
| Parameter _ | Lower reference limit (5th percentile) |
| Semen volume (ml) | 1.5 (1.4-1.7) |
| Total sperm count (10 6 per ejaculate) | 39 (33-46) |
| Sperm concentration (10 6 per mL) | 15 (12-16) |
| Total motility (PR + NP,%) | 40 ( 38-42) |
| Progressive motility (PR,%) | 32 (31-34) |
| Vitality (live sperm,%) | 58 (55-36) |
| Sperm morphology (normal forms,%) | 4 (3.0-4.0) |
| Other threshold values | |
| pH | ≥7.2 |
| Peroxidase-positive white blood cells (10 6 per mL) | <1.0 |
| Mar Test | <50 |
| Immonobead test | <50 |
| Zinc | ≥2.4 |
| Fructose | ≥13 |
| Glucosidase | ≥20 |
The reference values found in the WHO manual were obtained by relating semen quality and fertility. Fertile men were defined as men whose partners conceived a child within 12 months of cessation of contraceptive methods (Cooper et al. 2010).
Obviously, the study participants represent a select group of people and their semen parameters may be different from those of the general population.
The characteristics of the seminal fluid can be variable, both in the same man and between men and it is not the only determinant of a couple’s fertility. The ranges simply provide a guide for interpreting male fertility .
All spermiograms must also be evaluated bearing in mind the patient’s clinical history (for this reason it is important that your doctor reads it).
There may be geographical differences in semen quality, or differences in methods between laboratories. Some laboratories will have their own specific benchmarks against which the outcome should be compared.
It should also be remembered that the spermiogram is not the only male infertility control exam as there are other pathologies and problems that must be evaluated.
The terms present in the spermiogram
At the bottom of the exam some terms are given describing the situation of the spermiogram. For example, a normal spermiogram is indicated with the term Normozoospermia.
The possible results are as follows:
- Aspermia : total absence of sperm
- Asthenozoospermia: percentage of progressive motility (PR) of sperms below the reference values
- Asthenoteratozoospermia : percentage of progressive motility (PR) and percentage of normal morphology of spermatozoa below the reference limits
- Azoospermia : Absence of sperm in the ejaculate
- Cryptozoospermia : spermatozoa absent in fresh preparations but present in centrifuged
- Hemospermia : presence of erythrocytes in the seminal fluid
- Leucospermia : presence of leukocytes in the seminal fluid above the threshold value
- Necrozoospermia : low percentage of viable sperm cells and high percentage of immotile sperm cells in semen
- Normozoospermia total number (or concentration, depending on the result reported) of sperm, percentage of progressive motility (PR), percentage of normal sperm morphology, equal to or greater than the lower reference limit.
- Oligoasthenozoospermia : total number (or concentration, depending on the result reported)* of sperm and percentage of progressive motility (PR) of sperm, below the lower reference limit
- Oligoasthenoteratozoospermia : total number (or concentration, depending on the result reported) * of sperm, percentage of progressive motility (PR) and percentage of morphology of normal sperm below the lower reference limit
- Oligoteratozoospermia: total number (or concentration, depending on the reported result)* of sperm, and percentage of morphologically normal sperm, below the lower reference limit
- Oligozoospermia : total number (or concentration, depending on the reported result)* of sperm cells below the lower reference limit
- Teratozoospermia : Percentage of morphologically normal sperm below the lower reference limit
* The total number should always be preferred, as this parameter takes precedence over the concentration
The andrologist answers your questions
“Dear doctor, we have been married for a year and a half and for 13 months we have been looking for a baby but it hasn’t arrived: I have done all the tests and everything is ok while my husband the urologist after the ultrasound and repeating the spermiogram prescribed the recruitment for 4 months of p. in sachets cause slow and weak sperm , and my gynecologist prescribed us c. and c. of which he has already taken 70 sachets but we have not yet had good results. I would like to ask how long does it take to get good results? do these products really work?”
Dear reader,
the therapies prescribed to your husband can certainly be effective, however it would be necessary to understand the reason why the spermatozoa are slow and weak (varicocele, infection, edema of the seminal tract, presence of antibodies, genetic alterations?) for any more targeted therapies. In any case, it may take some time to obtain a response to the therapy given that the cycle of spermatogenesis is three months.
If there are no benefits, I suggest you go back to an andrologist for any diagnostic insights and more targeted therapies.
“Dear Doctor, I am writing to ask you a question. My husband performed 1 spermiogram where there was little sperm fluid and little mobility. He performed a treatment to “strengthen” the sperm, arginine, but after another spermiogram the results did not improve. I just wanted to ask you if it’s even minimally possible that the low percentage that exists can reach my ovum. Thank you and best regards.”
Dear reader,
before treating with arginine, which could have positive effects, it should be understood why there is little sperm therefore I recommend carrying out an andrological examination for further diagnostic investigations and any more specific pharmacological treatment.
The low number of sperm does not exclude that one can reach their destination but certainly the chances of this happening are reduced compared to a subject with a normal number of sperm.
Kind doctor,
my husband and I have been looking for a pregnancy for 10 months and a few days ago we had a spermiogram to see if the difficulties could depend on him.
Today we had the results and they don’t seem bad to me in terms of morphology, motility, vitality and number of spermatozoa (80% of normal forms with a motility of 80% after 120′ for a number of 400,000,000 spermatozoa ejaculated and a vitality of ‘85%) while what leaves me a bit perplexed is the reduced volume (1 ml) ph 8.2 with a slightly increased viscosity and a slightly decreased fluidization. Furthermore, there are some agglutination zones and rare aggregation zones, spermatogenic cells and leukocytes. Could the low volume be the reason for the failure? thank you very much.
Good morning ,
DIY Male Fertility Test
The spermiogram is a complete examination. There are also tests to do at home that evaluate some of the parameters of the sperm and visualize them as happens with ovulation tests or pregnancy tests. Obviously their sensitivity is in no way comparable to that of a spermiogram.
Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.
Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.