A sperm test — formally known as a semen analysis — is the single most important first step in investigating male fertility. It is straightforward, non-invasive, and provides a detailed picture of sperm health. Yet for many men, the idea of having one feels daunting or even threatening.
This guide explains exactly what a semen analysis involves, how to prepare, what is measured, and how to understand your results — so you can move forward with clarity and confidence.
Related reading: Male Infertility: Causes, Tests & Treatments for the full diagnostic and treatment picture. What Is ICSI? for treatment options when sperm parameters are abnormal. Infertility as a Couple’s Issue for navigating this together.
Why Is a Semen Analysis Important?
Male factor infertility contributes to 40–50% of all cases where couples struggle to conceive. A semen analysis:
- Identifies whether a sperm issue is contributing to difficulty conceiving
- Guides treatment decisions — whether IUI, IVF, or IVF with ICSI is needed
- Establishes a baseline to measure improvement over time
- Rules out male factor when normal, directing attention to female investigations
How to Prepare for a Semen Analysis
Abstinence
- 2–5 days of sexual abstinence is recommended before the test
- Under 24 hours: lower volume and count. Over 7 days: higher numbers but poorer motility
What to avoid
- Alcohol for at least 2–3 days beforehand
- Hot baths, saunas, or jacuzzis in the days before
- Illness with fever in the past month — reschedule if this applies
- Lubricants during collection — only approved non-spermicidal lubricants if needed
Where can I have a semen analysis in South Africa?
All of the following clinics in the Fertility Solutions directory offer semen analysis as part of their fertility investigation services:
- Cape Fertility (Cape Town) | Aevitas Fertility Clinic (Cape Town)
- Neo Fertility (Johannesburg) | Wilgers Infertility Clinic (Pretoria) | Genesis Reproductive Centre (Pretoria)
- Durban Fertility Clinic | C.A.R.E Clinic (Westville) | VitaLab KZN (Umhlanga)
- Fembryo Fertility Clinic (Port Elizabeth)
What Does a Semen Analysis Measure?
Volume — Normal: 1.4 ml or more
Total ejaculate volume. Low volume may indicate obstruction, retrograde ejaculation, or hormonal issues.
Sperm concentration (count) — Normal: 16 million/ml or more
Number of sperm per millilitre. Below this threshold is called oligospermia. No sperm found is called azoospermia.
Total sperm count — Normal: 39 million per ejaculate or more
Volume × concentration. Total sperm available to reach the egg.
Total motility — Normal: 42% or more
Percentage of all sperm showing any movement. Non-motile sperm cannot reach the egg.
Progressive motility — Normal: 30% or more
Percentage moving forward purposefully in a relatively straight line — the most functionally important motility measure.
Morphology — Normal: 4% or more normal forms (Kruger strict criteria)
Percentage of sperm with a normal shape. Abnormal morphology is called teratospermia. In severe teratospermia, ICSI is preferred over conventional IVF.
Vitality — Normal: 54% or more live sperm
Distinguishes live but immotile sperm from dead sperm — important for ICSI treatment planning.
White blood cells — Normal: less than 1 million/ml
Elevated white blood cells suggest infection or inflammation warranting further investigation.
Important: A single semen analysis is not sufficient for a definitive diagnosis. Results vary from sample to sample. If the first test shows abnormal results, a repeat test 2–3 months later is recommended.
Understanding Your Results: Plain-Language Guide
Normozoospermia
All parameters normal. Sperm is unlikely to be the primary cause of difficulty conceiving — investigation of female factors should be prioritised.
Oligospermia (low count)
Mild (5–15 million/ml) may allow for IUI. Severe (below 5 million/ml) typically requires IVF with ICSI.
Asthenospermia (poor motility)
Moderate to severe cases typically require IVF with ICSI. Full guide: Male Infertility: Causes, Tests & Treatments.
Teratospermia (abnormal morphology)
Severe teratospermia is associated with fertilisation failure in conventional IVF — making ICSI the better option.
OAT (oligoasthenoteratospermia — all three parameters low)
Significant male factor infertility. IVF with ICSI is almost always the recommended treatment.
Azoospermia (no sperm)
Requires further investigation to distinguish obstructive from non-obstructive causes. Both can often be treated — surgical retrieval and ICSI make biological parenthood possible for many men with azoospermia. See Male Infertility: Causes, Tests & Treatments for surgical retrieval options.
What Happens After an Abnormal Result?
Your fertility specialist will typically:
- Repeat the analysis in 2–3 months to confirm the result
- Order hormone blood tests (FSH, LH, testosterone, prolactin)
- Arrange a scrotal ultrasound
- Consider genetic testing through Next Biosciences if count is very low
- Discuss treatment options based on the specific parameters and severity
Clinics and Provinces
- Western Cape: Cape Fertility | Aevitas Fertility Clinic
- Gauteng: Neo Fertility | Genesis | Wilgers Infertility Clinic
- KwaZulu-Natal: Durban Fertility Clinic | C.A.R.E Clinic | VitaLab KZN
- Eastern Cape: Fembryo Fertility Clinic
Frequently Asked Questions
How accurate is a semen analysis?
A semen analysis provides useful information but is not a perfect predictor of fertility. Results can vary considerably — always confirm with a repeat test if abnormalities are found.
What is sperm DNA fragmentation?
DNA fragmentation refers to breaks in the genetic material within sperm. High levels are associated with reduced fertilisation rates and increased miscarriage risk. It is not measured in a standard analysis and is considered after repeated IVF failures or recurrent pregnancy loss. Speak to your specialist about this test.
Does a normal result mean we can conceive naturally?
It significantly reduces the chance of male factor being the cause, but does not completely exclude all sperm-related issues (e.g. anti-sperm antibodies). If normal results and a complete female investigation have not identified a cause, your specialist may order additional tests.
External reference: SASREG | WHO on infertility
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before making decisions about fertility treatment.
About the Author
Leigh-Ann Geydien is the founder of Fertility Solutions, South Africa’s only dedicated fertility directory. With a deep commitment to patient advocacy, she built the platform to bridge the gap between those navigating fertility challenges and the clinics and reproductive health specialists best placed to help them.
