How do I interpret semen analysis results, and what are the key parameters to assess?

To interpret semen analysis results, assess the following key parameters against World Health Organization reference values:

• Semen volume: 1.5 ml or more.
• Sperm concentration: 15 million spermatozoa per ml or more.
• Total sperm number: 39 million spermatozoa per ejaculate or more.
• Total motility: 40% or more motile spermatozoa, or 32% or more with progressive motility.
• Vitality: 58% or more live spermatozoa.
• Sperm morphology: 4% or more normal forms.

If the first semen analysis is abnormal, a repeat confirmatory test should be offered ideally 3 months later to allow for a full spermatogenesis cycle, unless there is a gross deficiency such as azoospermia or severe oligozoospermia, in which case repeat testing should be done sooner.

Screening for antisperm antibodies is not recommended as there is no evidence that treatment improves fertility outcomes.