The (Dreaded) Semen Test: How it Works & What to Do


When I think back to all of the experiences I expected to have in life, this never quite made the list. After years of avoiding fatherhood, here I am, trying to conceive with the missus. Thus far we haven’t had any big news to break to the folks, and avoid it as I may, the time has come to check things out with the boys downstairs.

With one in six couples having infertility issues – and half of those diagnoses attributed to the male – there is a possibility that I may be a contributor to our current situation. Luckily there are simple options to privately solve that mystery. Unfortunately, they involve the slightly demoralizing action of ejaculating into a cup. But with Tom Arnold and Chef Gordon Ramsay going public about their low sperm count, it appears that this issue is no longer kept in the closet.

An at-home sperm test can check semen count in the privacy of your home, a new convenience offered at a local chain drugstore by you (as of April). Test results are simple to follow but require stringent rules for accuracy, a variable that can make the at-home tester a bit nervous. A reddish line indicates you are fertile, or have 20 million sperm per milliliter, while no line indicates a negative result. An at-home test provides a snapshot of semen count, but it doesn’t touch on the two other important factors – motility (movement) and morphology (appearance), both of which are evaluated in a laboratory semen analysis.

Dr. Ed Marut of Fertility Centers of Illinois was able to enlighten me further as to the particulars of male fertility, a topic that I – quite frankly – didn’t know where to start with. He advises that sperm count is a large factor and that 15 million sperm per milliliter is considered the standard for a fertile level of concentration.

When evaluating morphology, or the appearance of sperm, he explains that a healthy sperm has an oval head and long tail, allowing for sperm to be propelled forward effectively. When a sperm has a small, large, misshapen, crooked or tapered head, its ability to fertilize an egg is decreased. Sperm with tails that are doubled, curled or kinky are also unlikely to fertilize an egg. Fertile men have a normal shape and structure to 14 percent of their sperm, but at least four percent is thought to be the lower limit of male fertility.

Motility, or movement, is the ability of a sperm to propel itself and move forward. Sperm that are immobile, slow or have inhibited motility due to morphology abnormalities are unable to reach the egg for fertilization. Fertile men have 40 percent or more of their sperm exhibiting healthy motility.

Should any of these factors come into play as a fertility issue, men need not worry as the capabilities of science provide solutions. To optimize conception odds, doctors can explore treatment options such as such as semen processing for intrauterine insemination (the placement of healthy sperm in the uterus) and In Vitro Fertilization (IVF) using intracytoplasmic sperm injection or ICSI (the injection of a sperm into an egg.) A urologist visit can also help find a simple solution to a fertility issue, and I am not talking about the typical “change from briefs to boxer shorts” remedy.

As overwhelming as it may be, truth be told, this information is good to know. The habitual standby of avoiding the issue is no longer an option. Dr. Marut reassures that a proper evaluation will help provide the blueprint to move forward.

“The power of modern medicine and advancements in reproductive endocrinology can provide any couple with hope, however dire the circumstances,” says Dr. Marut. “While men may feel reluctant to pursue testing, why waste time wondering when you could be moving forward?”

I can’t argue with that.

– Steve Johnston