How to Read Your Semen Analysis Report, Line by Line: WHO 2021 Normal Values

By Dr. Neha Yadav, Associate Consultant at Renew Healthcare

A semen analysis report can contain several numbers, percentages, and medical terms that may be difficult to understand at first. If you have recently received your report, you may be wondering whether your sperm count is normal, whether your sperm are moving properly, or whether the results could affect your chances of conceiving.

The important thing to remember is that a semen analysis is not simply a pass-or-fail test.

The World Health Organization (WHO) 2021 Laboratory Manual, 6th edition, provides lower reference limits for several semen parameters. These limits represent the 5th centile of results among men whose partners conceived naturally within one year. In other words, approximately 5% of the reference population had values below these limits.

A result below a reference limit does not automatically mean infertility, just as a result above every limit does not guarantee pregnancy.

In this guide, we explain how to read the main lines of your semen analysis report, understand the WHO 2021 reference values, prepare for repeat testing, and know when to seek professional advice.

At Renew Healthcare, fertility assessment focuses on understanding the individual circumstances of each person and couple. If you are concerned about male fertility, our fertility services provide an overview of the care options available.

Key Takeaways

• A low result is not a diagnosis. WHO reference limits are not absolute boundaries between fertility and infertility.

• Read the entire report. Sperm concentration, total sperm number, motility, morphology, volume, and other parameters should be considered together.

• Temporary factors can affect results. Recent fever, illness, medication changes, and collection problems may influence a semen analysis.

• Repeat testing may be necessary. Your doctor may recommend another test to confirm an abnormal result.

• Both partners matter. Fertility assessment should consider the couple's medical history and relevant test results.

Your Semen Analysis Report, Line by Line

The following table summarises the WHO 2021 lower reference limits covered in this article.

Important: These figures are lower reference limits, not guaranteed fertility targets. Your doctor should interpret them in the context of the complete report, collection conditions, medical history, and your partner's fertility assessment.

1. Semen Volume: Is the Amount of Semen Normal?

Semen volume measures the amount of fluid collected during ejaculation. The WHO 2021 lower reference limit is 1.4 mL.

A low volume may occur if the sample was not collected completely. In some circumstances, it may also be associated with an underlying reproductive issue that requires further assessment.

If any part of your sample was spilled or missed during collection, inform the laboratory. This information can help your doctor decide whether the result is reliable or whether repeat testing is appropriate.

Semen volume should not be interpreted in isolation. It needs to be considered alongside the other parameters and your medical history.

2. Sperm Concentration: How Many Sperm Are Present?

Sperm concentration measures the number of sperm in each millilitre of semen.

The WHO 2021 lower reference limit is 16 million sperm per millilitre.

A result below this value may be described as low sperm concentration, or oligozoospermia. However, concentration alone does not tell you the total number of sperm in the sample or how effectively they move.

For example, two men may have the same sperm concentration but different total sperm numbers because their semen volumes differ.

Your doctor will therefore consider concentration alongside semen volume, total sperm number, motility, and the other findings before recommending further assessment.

3. Total Sperm Number: How Many Sperm Are in the Entire Sample?

Total sperm number refers to the estimated number of sperm in the complete ejaculate.

The WHO 2021 lower reference limit is 39 million sperm per ejaculate.

It is calculated by multiplying sperm concentration by semen volume.

This measurement can provide additional information because a concentration result does not account for the volume of semen collected. A lower total sperm number may warrant further assessment, depending on the complete report and your circumstances.

4. Total Motility: Are the Sperm Moving?

Total motility measures the percentage of sperm that show movement, including sperm that move forward and those that move without effective forward progression.

The WHO 2021 lower reference limit is 42%.

Sperm movement is important because sperm must travel through the female reproductive tract to reach an egg. However, the percentage of moving sperm cannot predict the outcome of conception by itself.

Your doctor will assess total motility together with progressive motility, sperm concentration, morphology, and other relevant findings.

5. Progressive Motility: Are the Sperm Moving Forward?

Progressive motility refers to sperm that move forward rather than simply moving in place or following an ineffective movement pattern.

The WHO 2021 lower reference limit is 30%.

Progressive movement is relevant to the sperm's ability to travel through the reproductive tract. A lower result may need further evaluation, but it does not automatically mean that natural conception is impossible.

Low sperm movement is sometimes described as asthenozoospermia. This term describes a laboratory finding rather than a complete diagnosis.

6. Sperm Morphology: What Does a 4% Normal Forms Result Mean?

Sperm morphology describes the shape and structure of sperm. The WHO 2021 lower reference limit for normal forms is 4%, using strict assessment criteria.

Seeing a result of 4% can be worrying, especially if you interpret it as meaning that the other 96% of sperm cannot fertilise an egg. That conclusion is not correct.

Strict morphology criteria classify many sperm as abnormal in men who are fertile, too. A morphology result must be interpreted alongside sperm concentration, motility, the couple's medical history, and other fertility findings.

A low morphology result alone does not establish infertility or determine which treatment, if any, is appropriate.

7. Sperm Vitality: Are the Sperm Alive?

Sperm vitality measures the proportion of sperm that are alive.

The reference value listed in this guide is 54% alive.

Vitality can be particularly useful when sperm motility is very low. It helps distinguish sperm that are alive but not moving from sperm that are no longer alive.

Your clinician may recommend additional assessment if the vitality result is abnormal or if other semen parameters raise concerns.

8. Semen pH: What Does It Tell You?

Semen pH measures how acidic or alkaline the sample is. The reference value listed in this guide is 7.2.

pH is rarely decisive on its own. It should be interpreted alongside semen volume, sperm concentration, and the rest of the report.

If your pH result is outside the laboratory's reference range, your doctor can determine whether it needs further investigation in the context of your other findings.

Medical Terms You May See on Your Semen Report

Your laboratory report may use specific medical terms to describe the findings.

• Azoospermia: No sperm are detected in the semen sample.

• Oligozoospermia: Sperm concentration is low.

• Asthenozoospermia: Sperm motility is low.

• Teratozoospermia: A low proportion of sperm meet normal morphology criteria.

More than one term may apply to the same report. These terms describe particular findings; they do not, by themselves, explain the underlying cause or determine the best treatment.

If your report contains one of these terms, a fertility consultation can help you understand its significance and whether additional tests are necessary.

What Changed in the WHO 2021 Values Compared With WHO 2010?

The WHO 2021, 6th edition, updated several lower reference limits compared with the 2010 edition.

A report using the WHO 2010 reference values is not automatically wrong. The edition used by the laboratory should be considered when interpreting your results.

If you are comparing reports from different laboratories or different years, ask your doctor to explain any differences in reference ranges and testing methods.

Semen Analysis: Common Myths vs Facts

Myth 1: “If only 4% of my sperm have a normal shape, I am infertile.”

Fact: Four per cent is the WHO 2021 lower reference limit for normal forms. Strict morphology criteria classify many sperm as abnormal in fertile men, too. Morphology should be interpreted alongside the rest of the report.

Myth 2: “A normal semen analysis means there cannot be a male fertility problem.”

Fact: A routine semen analysis measures characteristics such as sperm concentration, movement, and shape. It does not directly assess every aspect of sperm function, sperm DNA quality, or the ability to fertilise an egg.

A normal report can be reassuring, but it cannot rule out every possible male fertility factor.

Depending on your medical history and the findings, a specialist may consider additional evaluation, including advanced sperm function testing.

Myth 3: “One abnormal result means I need fertility treatment immediately.”

Fact: A single result may be influenced by collection conditions, recent illness, fever, or other temporary factors.

Your doctor may recommend repeating the test before making decisions. The timing depends on the abnormality, your clinical circumstances, and whether a recent event may have affected the result.

Myth 4: “A low sperm count means natural conception is impossible.”

Fact: Natural conception may still be possible when sperm concentration or another parameter falls below the reference limit.

The likelihood of conception depends on the complete semen analysis, the female partner's age and fertility assessment, how long the couple has been trying to conceive, and other individual factors.

Myth 5: “I can interpret my report using only the normal values table.”

Fact: Reference values are useful for understanding your results, but they are not a substitute for medical assessment. Your doctor will consider the pattern across the report and decide whether further testing or treatment is appropriate.

How to Prepare for Your Next Semen Analysis

Correct collection and sample handling help the laboratory interpret your results reliably.

Before your next test, follow these steps:

• Follow the laboratory's abstinence instructions. The guidance in this article is to abstain for 2–3 days. Tell the laboratory the exact duration.

• Collect the complete sample. Inform the laboratory if any part is spilled or missed, especially the first portion.

• Deliver the sample promptly. Follow the laboratory's instructions for transport and temperature.

• Mention recent fever or illness. These may affect semen parameters.

• Tell your doctor about medicines and supplements. Provide details of anything you currently take or have recently started.

• Ask whether a repeat test is needed. Your doctor can advise on the appropriate timing based on the findings and your clinical history.

Do not stop prescribed medication without speaking to your doctor.

What Should You Do If Your Semen Analysis Is Abnormal?

An abnormal semen analysis does not automatically mean that IVF or another fertility procedure is necessary.

The next step depends on which parameters are affected, how far they differ from the reference limits, whether the result is confirmed on repeat testing, and your medical history.

Your doctor may recommend a repeat semen analysis, a review of relevant health factors, or additional investigations when indicated.

Depending on the findings, a specialist may discuss different options, including addressing an underlying medical issue or considering fertility treatments such as intrauterine insemination (IUI) or in vitro fertilisation (IVF). These treatments are not interchangeable, and the appropriate approach depends on the couple's individual assessment.

You can explore the fertility services offered by Renew Healthcare to learn more about the available care options.

Frequently Asked Questions About Semen Analysis

Can we conceive naturally if sperm concentration is below 16 million/mL?

Yes, natural conception may still be possible. The result needs to be interpreted alongside total sperm number, motility, morphology, the female partner's age, and other fertility factors. The WHO reference limit is not a strict boundary between fertility and infertility.

Does a normal semen analysis rule out male infertility?

No. A normal report provides information about the parameters measured, but it cannot assess every aspect of sperm function or guarantee that conception will occur. Further assessment may be appropriate if pregnancy has not occurred despite trying.

Should I repeat an abnormal semen analysis?

Your doctor may recommend repeating the test to confirm the result and account for temporary influences such as fever, illness, or collection problems. The timing depends on the specific findings and your clinical circumstances. Since sperm production and maturation take roughly two to three months, your doctor may consider this when planning a repeat test.

Does a low morphology result mean IVF is necessary?

Not necessarily. Morphology is only one part of the semen analysis. Your doctor will consider the complete report, your partner's assessment, how long you have been trying to conceive, and any previous fertility history before discussing suitable options.

Can a recent fever affect my semen analysis?

Yes, a recent fever or illness can affect semen parameters. Inform your doctor about recent health changes, medications, and supplements. Your doctor can advise whether a repeat test is appropriate and when it should be performed.

When should we consult a fertility specialist?

Consider seeking medical advice if you are concerned about your semen analysis, have a known reproductive or testicular health issue, or have been experiencing difficulty conceiving. A consultation can help you understand the findings and determine whether further investigations are necessary.

A Note From Dr. Neha Yadav

A number below the reference limit can be unsettling, but it is the beginning of a conversation—not a verdict on your fertility.

If you would like help understanding your semen analysis alongside your partner's results, you can learn more about Dr. Neha Yadav, Associate Consultant at Renew Healthcare.

For further information about fertility assessment and available care options, visit Renew Healthcare or explore the clinic's fertility services.

The aim is to understand the complete picture, explain what your results mean, and recommend further assessment only when appropriate.

References

1. World Health Organization. WHO Laboratory Manual for the Examination and Processing of Human Semen. 6th edition. Geneva: World Health Organization; 2021.

2. Campbell MJ et al. Distribution of semen examination results 2020. Andrology. 2021;9:817–822.

3. Boitrelle F et al. The sixth edition of the WHO manual for human semen analysis: a critical review and SWOT analysis. Life. 2021;11:1368.

4. Fertility and Sterility. 2022;117(2):237–245. doi:10.1016/j.fertnstert.2021.11.037.

Medical disclaimer: This article is for educational purposes only and is not a substitute for personalised medical advice, diagnosis, or treatment. Semen analysis results should be interpreted by a qualified healthcare professional in the context of your individual circumstances.