In short
The WHO's 2021 lower limits are about 16 million per millilitre, 42 percent total motility and 4 percent normal forms. They are decision limits taken from men whose partners conceived, not a pass mark — and one report below them does not settle anything.
Emergency if: Sudden severe pain in one testis, with or without swelling, nausea or a testis sitting higher than usual, needs emergency care immediately — torsion is treatable only within a few hours.
On your report
Testosterone, Total, FSH (Follicle-Stimulating Hormone), LH (Luteinizing Hormone), Prolactin +1 more
On this page
01
Count, concentration and total motile count — what is the difference?
Three different numbers on the same page all get called "count". Concentration is how many sperm sit in each millilitre; the WHO's sixth-edition lower reference limit is about 16 million per millilitre. Total sperm number is that concentration multiplied by the volume of the whole sample, and its lower limit is 39 million per ejaculate. Total motile count goes one step further and multiplies the total number by the proportion that are actually moving. A report can show a concentration that looks low while the total number is comfortable, simply because the volume was generous.
That is why volume matters more than most people assume. The lower reference limit for volume is about 1.4 millilitres, and a sample collected in a rush, or one where part of the first fraction was spilled, drags every derived number down without saying anything real about sperm production. Fertility units often lean on the total motile count when they discuss what kind of help a couple might need, because it folds quantity and movement into a single figure. Before you compare your report with anything you have read, check which of the three numbers it is showing.
A sensible reading order is volume first, then concentration, then motility, then the totals the lab has calculated from them. If the printout gives only concentration and motility, you can work out the rest yourself, and it is worth doing, because two reports with the same concentration can carry very different total numbers. The laboratory's own reference range is printed beside each value, and that is the range to use, not one from another lab or another edition of the manual.
02
Motility 30 percent — how low is that?
It depends entirely on which motility the report means. The WHO's lower reference limit for total motility — everything that moves, whether it goes anywhere or not — is 42 percent, with a confidence interval of roughly 40 to 43 percent. For progressive motility, meaning sperm that travel forward, the limit is 30 percent. So a progressive motility of exactly 30 percent sits on the reference limit rather than below it, while a total motility of 30 percent is genuinely under it. Many reports list progressive, non-progressive and immotile separately, and the three should add to 100.
Motility is also the parameter most easily damaged between the collection room and the microscope. Sperm are sensitive to cooling, to overheating and to time; a sample that travelled across town in a bag, or sat for two hours, can lose movement that was there when it left the body. If a report shows a striking drop in motility while concentration and volume look ordinary, ask how the sample was transported and how long it took before it was examined.
Low motility on its own is a reason to repeat the test properly, not to conclude anything. Recent fever, a viral illness, a course of certain medicines, or an unusually long or short abstinence gap can all shift it. Vitality testing, which stains the sperm to see how many are alive, is sometimes added when motility is very low, because it separates sperm that are dead from sperm that are alive but not swimming — two situations with quite different explanations.
03
Why morphology is often "3 to 4 percent normal", and why that can be fine
Morphology is scored using strict Tygerberg, or Kruger, criteria, in which a sperm counts as normal only if its head, midpiece and tail all fall inside narrow measured limits. Under those rules the lower reference limit in the sixth edition is 4 percent — meaning that in men whose partners conceived within a year, the lowest 5 percent had fewer than four normal forms in every hundred. Earlier editions of the manual used 30 percent, but they were scoring by a looser definition. The number fell because the ruler changed, not because sperm did.
So a report reading "3 percent normal forms" is not describing a body producing overwhelmingly deformed sperm. It is describing an assessment method under which even highly fertile men typically score in the low single digits to mid teens. Morphology is also the least reproducible part of the analysis: it depends on the stain, the technician and how strictly the criteria are applied, so the same sample can score differently in two laboratories.
Isolated low morphology, with normal volume, concentration and motility, is a weak predictor of whether a couple will conceive naturally. It matters more when it sits alongside low counts or poor movement, or when a specific pattern is described — for example, when nearly every sperm shows the same head defect, which can point to a genetic cause worth investigating. On its own, treat it as one line in the report rather than as the verdict.
04
Does one poor report mean infertility?
No, and the manual itself says so. The WHO's sixth edition is explicit that reference ranges and fifth centiles are not sufficient to diagnose infertility, and that there is substantial overlap between men who father children and men who are investigated for not doing so. The values were drawn from recent fathers in several countries, and even across those groups the fifth centile for concentration ranged from roughly 11 to 36 million per millilitre. They are decision limits that tell a clinician where to look harder, not a line separating fertile from infertile.
Semen output also varies a great deal within the same man from month to month. Sperm take about 74 days to develop, so a fever, a heavy illness, a period of poor sleep or a change in medicines two or three months earlier can show up in today's report. This is the reason an abnormal result is normally repeated: guidelines suggest at least two analyses, taken somewhere between a month and three months apart, with the second timed to reflect a fresh production cycle.
When you repeat it, keep everything else the same — the same abstinence gap, ideally the same laboratory and the same collection method. Comparing a sample given after two days with one given after six, at two different labs, tells you almost nothing. Two consistent reports carry far more weight than one alarming one, and it is entirely common for a second test to land in a different band from the first.
05
How to give the sample: why two to seven days of abstinence matters
The WHO manual asks for two to seven days without ejaculation before the sample, and some laboratories narrow that to three to seven. Too short a gap lowers volume and total count; too long raises the count but tends to increase the proportion of sperm that are dead or damaged. The point of the window is comparability — reference values were built on samples collected inside it, so a sample given after ten days is not being measured against a like-for-like range.
The rest of the instructions matter as much as the abstinence. Collect the whole sample, including the first portion, which carries most of the sperm; if any is lost, say so, because the report is otherwise misleading. Use the sterile container the lab provides rather than an ordinary condom, since most contain agents that immobilise sperm. Keep the container close to body temperature on the way in, avoid leaving it in a cold car or in direct sun, and get it to the laboratory within an hour of collection.
Mention anything that might affect the result on the request form: fever in the past three months, recent illness, current medicines, and how long the abstinence gap actually was. A good laboratory records liquefaction time, volume, pH and the time from collection to analysis. If your report does not show those, it is fair to ask for them, because they change how the numbers should be read.
06
Which lifestyle factors genuinely change the results
The honest summary is that a few things have a clear effect and many have a small or uncertain one. Testosterone taken as an injection, gel or supplement is the clearest: it suppresses the hormonal signal that drives sperm production and can push counts towards zero, which is why guidelines advise men trying to conceive not to take it. Anabolic steroids do the same. Both effects usually reverse after stopping, but recovery can take many months and is not certain. If testosterone was prescribed for you, this is a conversation to have with the prescriber rather than a medicine to stop on your own, since there are treatments that raise your own testosterone without switching off sperm production.
Smoking, heavy alcohol use and obesity are consistently associated with poorer semen parameters, and stopping smoking and losing weight are reasonable to do on their own merits, though the size of the fertility benefit in trials is modest. Heat has a plausible and repeatedly observed effect: the testes work a couple of degrees below core temperature, so prolonged hot baths, saunas and long hours sitting with a laptop on the lap are worth reducing while you are being investigated. Recent high fever is a common and temporary cause of a poor report.
What is not supported is the idea that any single change will transform a report in a few weeks. Because a production cycle runs about 74 days, nothing you start today can show up in a test taken next week. If you are going to change something, change it and retest after about three months, so the comparison actually measures what you did.
07
When to see a urologist or andrologist
A specialist assessment is warranted when no sperm are found at all, when the concentration is very low — under about five million per millilitre — or when two properly collected samples are consistently abnormal. Guidelines advise that men with abnormal parameters be evaluated by someone with expertise in male reproduction rather than treated on the report alone, because a physical examination frequently finds something the numbers cannot show, such as a varicocele, absent vas deferens or small testes.
Hormone testing is indicated in specific situations rather than routinely: low libido, erectile difficulty, very low or absent sperm counts, shrunken testes, or other signs suggesting a hormonal cause. When no sperm are found, the first steps are a physical examination together with semen volume, semen pH and serum FSH, because the combination separates a blockage from a production problem. Very low counts with a raised FSH or small testes prompt genetic testing: a karyotype when the concentration is under about five million per millilitre, and Y-chromosome microdeletion analysis when it is around a million per millilitre or less.
On varicocele, guidelines suggest surgery may be considered for men who are trying to conceive, have a varicocele that can be felt on examination and have abnormal semen parameters — and advise against operating on a varicocele found only on a scan. Timing also depends on the female partner's assessment, which is why fertility is usually investigated as a couple: the plan after an abnormal report often depends more on her age and test results than on the exact number of sperm.
08
Which supplements have evidence and which do not
Antioxidant supplements are the most studied and the most oversold. A Cochrane review pooling 90 randomised trials in over 10,000 subfertile men found that antioxidants may increase live births, but rated the certainty of that evidence as very low. In the trial populations, about 16 of every 100 couples had a baby without antioxidants, against somewhere between 17 and 27 per 100 with them — a wide range that reflects how uncertain the estimate is. Critically, when trials at high risk of bias were removed, the apparent benefit disappeared.
Professional guidance reflects that uncertainty: the joint urology and reproductive-medicine guideline advises counselling men that the benefit of supplements such as antioxidants and vitamins is of questionable clinical value, and that the evidence is not strong enough to recommend any specific product. That is not the same as saying they are harmful, but it does mean a supplement is not a substitute for finding out why a report is abnormal.
Two practical points. First, correcting a documented deficiency — of vitamin D, or of thyroid function, for example — is a different matter from taking a general fertility blend, and is worth doing on its own terms. Second, a supplement bought instead of an examination costs time, and in fertility, time is usually the thing that matters most. Get the repeat analysis and the physical assessment first, then decide whether anything else is worth adding.
When a semen report is not the urgent part
Routine — see a doctor
An abnormal report with no symptoms: arrange a repeat analysis after about three months and a physical examination, and have your partner assessed at the same time rather than in sequence.
Same-day — call promptly
A new lump or firm swelling in a testis, a testis that has become noticeably smaller or harder, or blood in the semen that does not settle — these need examining now, not after the fertility work-up.
Emergency — act now
Sudden severe pain in one testis, with or without swelling, nausea or a testis sitting higher than usual, needs emergency care immediately — torsion is treatable only within a few hours.
Values mentioned in this story
Each one opens a visual guide with its normal range and what moves it — upload a report and we place your own numbers on the same scale.
Sources
- WHO laboratory manual for the examination and processing of human semen, sixth edition (2021)who.int
- The sixth edition of the WHO manual: reference values and how to interpret thempmc.ncbi.nlm.nih.gov
- Critique of the WHO sixth-edition reference population and centilespmc.ncbi.nlm.nih.gov
- AUA/ASRM guideline: diagnosis and treatment of infertility in menauanet.org
- Semen Analysis — StatPearls, NCBI Bookshelfncbi.nlm.nih.gov
- Cochrane review: antioxidants for male subfertility (2022)cochrane.org
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