Mediglobe collaborates with hospitals in Türkiye & Northern Cyprus for IVF Treatments

A semen analysis, also known as a spermiogram or seminogram, is a fundamental test for assessing male fertility. For couples struggling to conceive, this test provides crucial information by evaluating the health and quality of a man’s sperm. It is important to remember that low does not mean zero, and many men with low counts go on to father children naturally or with medical assistance. Therefore, Mediglobe recommends affordable, high-quality treatment plans. Moreover, Mediglobe is in cooperation with hospitals in Türkiye & Northern Cyprus that work to European and American standards and have accreditation.

What is a Normal Sperm Count? Semen Analysis Explained

A semen analysis is a laboratory test that evaluates a sample of semen. It measures several key indicators of sperm health, including the number, movement, and shape of sperm cells. The results help identify potential causes of infertility and guide treatment decisions. According to the World Health Organization (WHO) 2021 reference values, the “normal” ranges for a semen analysis are as follows:

• Semen Volume: > 1.5 mL
• Sperm Concentration: ≥ 16 million/mL
• Total Sperm Count: ≥ 39 million/ejaculate
• Progressive Motility: > 32% actively moving
• Total Motility: ≥ 42%
• Normal Morphology: ≥ 4%

It is crucial to understand that these are population reference ranges, not absolute fertility thresholds. It’s entirely possible for men with sperm parameters below these values to be fertile, and for men with values above them to have difficulty conceiving. The results are one piece of the overall fertility puzzle. Mediglobe recommends you an IVF Treatments package according to your needs.

Sperm Concentration vs. Total Sperm Count

These two terms are often used interchangeably, but they represent different aspects of the ejaculate.

• Sperm Concentration (or Sperm Density): This is the number of sperm found in one millilitre (mL) of semen. Think of it as the “density” of sperm in the fluid.
• Total Sperm Count: This is the total number of sperm in the entire ejaculate. It is calculated by multiplying the sperm concentration by the total volume of the semen sample.

For example, a man could have a low sperm concentration but a normal total sperm counts if he produces a large volume of semen. Conversely, a man with a high concentration but a very low volume might have a low total count. Both numbers are clinically relevant, particularly for assisted reproduction techniques like ICSI, where a higher total count often correlates with better outcomes.

What Does Sperm Motility Mean?

Sperm motility refers to the ability of sperm to move efficiently. This is a critical factor for fertility because sperm must be able to swim through the female reproductive tract to reach and fertilize an egg. The WHO classifies motility into two main categories:

• Progressive Motility (PR): Sperm that are moving actively, either in a straight line or in a large circle, regardless of their speed. This is the most important type of motility for fertility.
• Non-Progressive Motility (NP): Sperm that show some movement but do not progress forward, such as swimming in tiny circles or only vibrating.
• Morphology: Sperm with normal shape are more likely to penetrate the egg’s outer layer.
• Total Motile Sperm Count (TMSC): This is a composite metric (concentration × volume × % motility). A TMSC of >20 million is generally associated with good chances of natural conception, while a TMSC of <5 million significantly reduces it.

The WHO reference value for progressive motility is >32%, and for total motility (progressive + non-progressive) it is ≥42%. Even with a count of 5-15 million/mL, natural pregnancy is still possible, especially in younger couples with no other fertility issues. However, the time to conception may extend beyond the average 6-12 months.

Is Natural Pregnancy Possible If Sperm Count Is Low?

Yes, absolutely. A low sperm count does not mean natural conception is impossible—it simply means it may take longer.

What Should Be the Sperm Morphology Percentage?

Sperm morphology refers to the size and shape of the sperm, particularly the head, midpiece, and tail. Abnormalities can hinder the sperm’s ability to reach and penetrate an egg.

The most current and rigorous standard for evaluating morphology is the Kruger Strict Criteria. Under this strict method, a sample is considered normal if at least 4% of the sperm have a normal shape. This means that a sample can have up to 96% abnormally shaped sperm and still be considered within the “normal” range. A result below 4% is classified as teratozoospermia and may indicate significantly impaired fertility.

How Is the Spermiogram Test Given Correctly?

To get the most accurate results, the sample must be collected and handled properly. Key steps include:

1. Abstinence Period: A period of sexual abstinence of 3 to 6 days is generally required before the test. Too short an abstinence period can lower the total count, while too long can reduce motility.
2. Sample Collection: The sample should be obtained by masturbation directly into a sterile, wide-mouthed container provided by the lab. Do not use a condom or lubricant, as these can be toxic to sperm.
3. Complete Collection: It is essential to collect all of the ejaculate, as the first part of the ejaculate contains the highest concentration of sperm.
4. Timely Delivery: The sample must be delivered to the laboratory within one hour of collection and kept at body temperature (e.g., close to the body) during transport. Long or cold transport can negatively affect motility.

To account for natural biological variation, it is often recommended to repeat the test two or three times over a period of a few months.

Why Is Sperm Test Variable?

One of the most common frustrations with semen analysis is that results can vary significantly from one sample to the next. This variability is normal and stems from a combination of biological and external factors.

• Biological Variation: Sperm production is not constant. Day-to-day variations can be influenced by stress, illness, diet, sleep, and even the length of abstinence.
• External Factors (Sample Collection & Handling): As mentioned earlier, an incomplete collection, stress during collection, exposure to cold or heat, and a long delay in transporting the sample to the lab are all major sources of error that can artificially lower results.

Because of this inherent variability, a single “bad” result is often not a cause for alarm. Most experts advise that if multiple tests are performed, the best result is usually the most representative of a man’s true fertility potential, as it was likely unaffected by the adverse external or biological factors that can skew results lower.

Possible Causes of Low Sperm Count

Low sperm count can stem from a wide range of medical, lifestyle, and environmental factors. Identifying the underlying cause is the first step toward effective management.

Medical Causes

• Varicocele: An enlargement of the veins within the scrotum. This is the most common reversible cause of male infertility and can impair sperm production by raising testicular temperature.
• Infections: Sexually transmitted infections (e.g., gonorrhoea, chlamydia), prostatitis, or mumps orchitis can temporarily or permanently affect sperm production.
• Hormonal Imbalances: Low testosterone, high prolactin, or thyroid disorders can disrupt the hormonal signals needed for spermatogenesis.
• Genetic Conditions: Klinefelter syndrome, Y-chromosome microdeletions, or cystic fibrosis mutations can cause severe oligospermia or azoospermia (no sperm).
• Obstruction: A blockage in the reproductive tract (e.g., from prior surgery, injury, or congenital absence of the vas deferens) can prevent sperm from being ejaculated.
• Retrograde Ejaculation: Semen flows backward into the bladder instead of out through the penis, often due to diabetes, spinal cord injury, or certain medications.

Lifestyle & Environmental Causes

• Heat Exposure: Frequent use of saunas, hot tubs, or wearing tight underwear can raise scrotal temperature and suppress sperm production.
• Substance Use (include steroids)
• Medications: Certain drugs, including chemotherapy, radiation, testosterone replacement therapy, and some antibiotics, can impair sperm production.
• Weight & Diet: Obesity is linked to hormonal changes that reduce sperm count. Poor nutrition—especially deficiencies in zinc, selenium, and vitamin C—can also play a role.
• Occupational Hazards: Prolonged exposure to heavy metals, pesticides, solvents, or radiation can damage sperm-producing cells.

When Do IUI, IVF, and ICSI Come into Play?

When natural conception does not occur within a reasonable timeframe (typically 12 months for couples under 35, or 6 months for those over 35), assisted reproductive technologies (ART) become the next step. The choice of treatment depends largely on the severity of the low count.

• Mild oligospermia (10-15 million/mL): Recommended Treatment, IUI or IVF
• Moderate oligospermia (5-10 million/mL): Recommended Treatment, IUI (if motility is good) or IVF/ICSI
• Severe oligospermia (<5 million/mL): Recommended Treatment, ICSI (with or without IVF)
• Azoospermia (zero sperm): Recommended Treatment, ICSI with TESE/TESA (sperm surgically extracted from the testicle)

Intrauterine Insemination (IUI):

IUI involves collecting a semen sample, “washing” it in the lab to concentrate the best motile sperm, and then injecting that concentrated sample directly into the woman’s uterus around the time of ovulation.

• Best for: Mild to moderate low count (typically >5 million motile sperm after washing) and good motility.
• Success rate: ~10-20% per cycle.

In Vitro Fertilization (IVF):

IVF involves retrieving eggs from the woman’s ovaries, fertilizing them with sperm in a laboratory dish, and then transferring one or more resulting embryos into the uterus. In conventional IVF, thousands of sperm are placed around each egg, and fertilization happens naturally.

• Best for: Moderate low count where some sperm can still fertilize an egg on their own in the lab.
• Success rate: ~30-50% per cycle (varies strongly with female age).

Intracytoplasmic Sperm Injection (ICSI):

ICSI is a specialized form of IVF where a single, carefully selected sperm is injected directly into the centre of a mature egg using a microscopic needle. This bypasses the need for the sperm to penetrate the egg on its own.

• Best for: Severe low count, poor motility, or abnormal morphology. ICSI is also used when sperm is surgically retrieved from the testicle.
• Success rate: Similar to IVF (~30-50% per cycle), as fertilization rates are high (70-80% of eggs injected), but ultimate success still depends on embryo quality and the woman’s age.

IUI is a simpler, less invasive, and cheaper first-line option for milder cases. IVF with ICSI is the gold standard for moderate-to-severe male factor infertility. Mediglobe collaborates modern hospitals with Türkiye & Northern Cyprus, experienced specialists, and recommend personalised treatment plans.

What Can Be Done to Support Sperm Quality?

While not all causes of low sperm count are reversible, many are. Lifestyle modifications and medical treatments can significantly improve sperm parameters over a period of 2 to 3 months—the time it takes for a new batch of sperm to mature.

Lifestyle Changes

• Maintain a Healthy Weight: Even a 10% reduction in body weight can improve hormone levels and sperm count.
• Quit Smoking & Reduce Alcohol: Both have direct, negative effects on sperm DNA and count.
• Manage Stress: Chronic stress elevates cortisol, which can suppress testosterone.
• Get Regular, Moderate Exercise: Over-exercising (e.g., intense endurance training) can actually lower testosterone, so aim for balanced activity.
• Keep the Testicles Cool: Switch to boxer shorts and avoid prolonged sitting, laptops on laps, or frequent hot baths/saunas.

What Is Done to Confirm the Spermiogram Result?

Because sperm counts fluctuate significantly from day to day, a single abnormal result should never be the final word. Confirmation is a multi-step process:

Repeat Testing: The most important step is to repeat the semen analysis. Experts recommend at least two, and often three, separate samples, each collected 2-3 weeks apart, to confirm a diagnosis. A diagnosis of low sperm count is generally only made if low values are found in at least two samples.

Hormonal Blood Tests: If the repeat test confirms a low count, your doctor will often order blood tests to check levels of:

• Testosterone and Oestradiol
• Follicle-Stimulating Hormone (FSH): High FSH suggests a primary testicular problem; low FSH suggests a hormonal signalling issue from the brain.
• Luteinizing Hormone (LH)
• Prolactin

Physical Examination: A urologist will examine the testicles, epididymis, and vas deferens to check for varicoceles, masses, or obstructions.

Scrotal Ultrasound: Often performed to confirm the presence and severity of a varicocele or to check for other structural abnormalities.

Genetic Testing (if indicated): In cases of severe oligospermia or azoospermia, tests for Y-chromosome microdeletions or karyotype analysis may be performed to identify genetic causes.

Sperm DNA Fragmentation Test (optional): This measures the integrity of the sperm’s genetic material. High fragmentation can cause miscarriage or failed fertilization even if count, motility, and morphology appear normal.

Conclusion

A low sperm count is a common, treatable condition, not a definitive verdict on your fertility. Natural conception is still possible in many cases, and when it’s not, a stepwise approach—starting with lifestyle changes, moving to IUI, and progressing to IVF/ICSI—offers a clear, effective path to parenthood. If you’re considering IVF Treatments, consult Mediglobe team to discuss your goals and determine the best approach. A detailed contact with Mediglobe team is essential to determine if IVF Treatment is right for you. As a result, Mediglobe offers you access to high standard and quality service to meet your treatment needs. Treatments are always client centred and providers have in-debt experience, are highly qualified, and use the latest technology, all within well maintained hospitals.

Mediglobe medical tourism packages that include airport transfers, accommodation, translation services, and aftercare. This all-in-one approach helps international patients feel more at ease, especially those who may be visiting for the first time. There is no waiting period and healthcare personal can speak different languages.

This article is for informational purposes and is not a substitute for professional medical advice, diagnosis, or treatment recommendation.