Male Infertility Clinic Guide: Semen Analysis Results Explained

Infertility is often treated as a woman’s problem, but a male factor is involved in around half of couples who struggle to conceive. The good news is that male fertility is usually quicker and less invasive to assess, and many causes can be treated or worked around. A male infertility clinic brings together the tests, specialists and laboratory skills needed to find out what is going on and what to do about it. This guide explains what such a clinic does, how to read a semen analysis report using the WHO 2021 reference values, and what options exist for azoospermia, varicocele and surgical sperm retrieval. For an overview of our services, see male infertility clinic care at Ridge IVF.

What a male infertility clinic actually does

Most men first meet the fertility team when their partner is being investigated. A dedicated male infertility clinic goes further than a single semen test. It typically offers:

• A focused history and examination by an andrologist or urologist: childhood illnesses, undescended testes, mumps, past surgery, infections, medicines, sexual function, occupation and lifestyle, followed by an examination of the testes and scrotum
• Semen analysis in an andrology laboratory, repeated when results are abnormal
• Further tests where needed: hormone levels (FSH, LH, testosterone, prolactin), scrotal ultrasound, sperm DNA fragmentation, and genetic tests
• Treatment of correctable causes, such as hormonal problems, infections, varicocele or ejaculation disorders
• Assisted reproduction when needed: sperm preparation for IUI, ICSI, surgical sperm retrieval and sperm freezing

The aim is not just to label a semen report “abnormal” but to understand why, because the cause decides the treatment.

Before your semen analysis: getting a reliable result

A semen test is only as good as the sample. To make your result meaningful:

• Abstain from ejaculation for 2 to 7 days before the test. Shorter or much longer gaps can distort the count and motility.
• Collect the whole sample into the sterile container provided. The first part of the ejaculate is the richest in sperm, so tell the lab if any was lost.
• Produce the sample at the clinic if possible, or deliver it within about an hour, kept close to body temperature.
• Avoid ordinary condoms and lubricants, which can harm sperm.
• Postpone the test if you have had a fever in the past few weeks, since illness can lower sperm counts temporarily.

Because results vary from sample to sample, one abnormal report is not a diagnosis. Doctors usually repeat the test after a few weeks before drawing conclusions.

Semen analysis results explained: the WHO 2021 reference values

The World Health Organization’s 2021 laboratory manual for semen examination gives lower reference limits drawn from fertile men. A value below these limits does not mean you cannot father a child, and a value above them does not guarantee fertility; they are a guide for interpretation.

The terms on your report

• Oligozoospermia: sperm numbers below the reference limit
• Asthenozoospermia: reduced motility
• Teratozoospermia: fewer normally shaped sperm
• Oligoasthenoteratozoospermia (OAT): all three together
• Azoospermia: no sperm seen, even after the sample is spun down and examined
• Leukocytospermia: raised white cells, which may suggest infection or inflammation

The report as a whole matters more than one number. Mildly reduced values may still allow natural conception or IUI treatment, while severe problems usually point to IVF with ICSI. Our article on when ICSI is needed rather than conventional IVF explains how semen results guide that choice.

Sperm DNA fragmentation

Some men have a normal-looking semen analysis but a high proportion of sperm with damaged DNA. A DNA fragmentation test may be suggested after recurrent miscarriage, repeated IVF failure or unexplained infertility. It is not a routine test for every man, and a high result is often improved by addressing causes such as smoking, heat, infection or varicocele.

Azoospermia: when no sperm are found

Being told there are no sperm in the sample is a shock, but it is not always the end of the road. The first step is to confirm the result on a second, carefully processed sample, and then to find out which of two broad types it is.

Obstructive azoospermia

Sperm are being made, but a blockage stops them reaching the ejaculate. Causes include past infection, previous surgery, vasectomy, or being born without the vas deferens, which is linked to cystic fibrosis gene changes. Hormone levels and testis size are usually normal. Sperm can often be retrieved surgically with a high chance of success.

Non-obstructive azoospermia

Here the testes make very few or no sperm. FSH is often raised and the testes may be small. Causes include genetic conditions such as Klinefelter syndrome, Y-chromosome microdeletions, undescended testes, previous chemotherapy or radiotherapy, and hormonal problems. Some men in this group still have small pockets of sperm production.

Genetic testing, including a karyotype and Y-chromosome microdeletion test, is usually advised before treatment, both to understand the cause and to counsel the couple about passing conditions on to children.

Varicocele: when to treat it

A varicocele is a group of enlarged veins in the scrotum, similar to varicose veins, and is more common on the left side. It is found in many men, including fertile men, so its presence alone does not mean it is the cause. Repair is generally considered when the varicocele can be felt on examination, the semen analysis is abnormal, and the couple are trying to conceive with no significant female factor. Improvements in semen quality, when they happen, usually take three to six months to show. If the female partner is older or there are other fertility problems, moving directly to IVF may be the wiser use of time.

Surgical sperm retrieval: TESA, PESA and micro-TESE

When sperm cannot be obtained from the ejaculate, they can often be retrieved directly and used for ICSI, where a single sperm is injected into each egg. Surgical retrieval is the mainstay of azoospermia treatment when the couple wish to use the man’s own sperm.

• PESA (percutaneous epididymal sperm aspiration): a fine needle draws fluid from the epididymis, the coiled tube behind the testis. Mainly used for obstructive azoospermia.
• TESA (testicular sperm aspiration): a needle takes a small sample of tissue or fluid from the testis itself. Useful in obstruction and some cases of reduced production.
• Micro-TESE (microdissection testicular sperm extraction): an open microsurgical procedure in which the surgeon looks under an operating microscope for the small areas of the testis most likely to contain sperm. It is the preferred technique for non-obstructive azoospermia. Your Ridge IVF andrologist or urologist will advise whether it is appropriate for you and how it is arranged.

PESA and TESA are usually day-care procedures under local anaesthesia or sedation. Retrieved sperm can be frozen for future cycles, and the egg collection is often coordinated with retrieval. If no sperm are found, donor sperm through a registered ART bank is an option the couple can consider with counselling.

Lifestyle changes that genuinely help

Sperm take roughly two and a half to three months to develop, so changes you make today show up in a semen test about three months later. Lifestyle is not a complete low sperm count treatment on its own, but it often makes a measurable difference. The changes with the best support are:

• Stop smoking, including chewing tobacco, and keep alcohol low.
• Never use testosterone or anabolic steroids unless prescribed; they can stop sperm production entirely.
• Keep the testes cool: avoid hot tubs, long saunas, laptops on the lap and very tight underwear.
• Aim for a healthy weight and stay physically active; obesity affects hormones and sperm quality.
• Manage diabetes and blood pressure, and review any long-term medicines with your doctor.
• Limit exposure to pesticides, solvents and heavy metals at work where possible.

Antioxidant supplements are widely sold, but evidence that they improve live birth rates is limited, so ask your doctor before spending on them.

Talk to a Ridge IVF specialist

Our andrologists, urologist and embryologists work alongside the fertility consultants, so both partners are assessed together. You can read more about our treatment for male infertility, then visit us at Jawahar Nagar, the Fortis Ridge Fertility & IVF Centre in Shalimar Bagh, or Burari. Call or WhatsApp +91 88001 00326, or book a consultation.

This article is for general information and is not a substitute for a personal consultation with a fertility specialist.