Key takeaways

• Spermiogram (semen analysis) is the basic test for male fertility assessment and analyzes, in particular, sperm concentration, motility, morphology, volume, and vitality.

• The results of the spermiogram should always be interpreted within the clinical context, as a single test alone does not summarize a man's fertility.

• A normal spermiogram is based on reference thresholds, but these values are not an absolute guarantee of natural conception.

• Alcohol, endocrine disruptors, smoking, excessive heat, metabolic disorders, and certain lifestyle habits can alter sperm quality.

• Modifying lifestyle habits (diet, physical activity, stress, sleep) and using complementary strategies (antioxidants, carnitine, taurine, probiotics, etc.) aims to support male fertility. 

The spermiogram is often one of the first tests prescribed when a baby project is slow to materialize. However, it remains poorly understood and can sometimes be a source of apprehension, even though it is a semen analysis to explore male fertility. This test provides concrete information about sperm quantity, their ability to move, their shape, and the overall quality of the ejaculate. It does not, by itself, provide a definitive diagnosis, but it very usefully guides further fertility assessment.

1. What is a spermiogram?

The spermiogram is an essential medical test for evaluating male fertility. It analyzes several parameters of semen to identify any potential abnormalities.

A. Definition of a spermiogram

The spermiogram is a biological examination that studies several semen parameters after collection in the laboratory. In practice, this semen analysis particularly assesses sperm concentration, motility, morphology, semen volume, and, depending on the case, their vitality. It forms the basis of the male-side exploration in a conception project.

B. Why perform a spermiogram?

A spermiogram is usually requested in cases of difficulty conceiving, but also after certain genital infections, testicular surgery, varicocele, or treatment potentially toxic to the reproductive organs. Its purpose is to objectively assess the quality of the ejaculate beyond subjective impressions.

C. When to perform a spermiogram in a conception project?

In a conception project, a spermiogram is often suggested after 12 months of regular (2 to 3 times a week) and unprotected attempts without pregnancy before age 35, or earlier if known risk factors are present or if the partner is 35 or older. It can also be requested earlier if the man's history suggests a sperm disorder.

2. How is a spermiogram performed?

Before performing a spermiogram, certain conditions must be met to ensure the reliability of the results. These recommendations allow for an accurate analysis of semen quality.

A. Conditions to be observed before the examination

Before a spermiogram, the laboratory usually recommends a period of sexual abstinence of a few days, most often between 2 and 7 days depending on the protocols. This step is important because it directly influences several parameters of the spermiogram results, particularly volume and concentration. It is also advisable to report any recent fever, as it can temporarily alter sperm quality for several weeks.

B. How is sperm collected?

Collection is usually done by masturbation into a sterile container, most often at the laboratory. The goal is to collect the entire ejaculate, as the first fraction is particularly rich in spermatozoa. In other words, the technical quality of the collection is genuinely important for the interpretation of the spermiogram.

C. What happens at the lab after collection?

After collection, the sample is left to liquefy and then analyzed according to a standardized methodology. The laboratory measures macroscopic and microscopic parameters, then establishes the spermiogram results. Depending on the situation, this semen analysis may be supplemented (sperm culture), a test (sperm DNA fragmentation), or other specialized examinations, especially if a spermiogram abnormality is detected.

3. What parameters are analyzed during a spermiogram?

The spermiogram is based on the analysis of several key parameters that assess sperm quality. Each of them provides valuable information about male fertility.

A. Sperm concentration

Sperm concentration refers to the number of spermatozoa per milliliter of semen. This is a key parameter of the spermiogram, but it must be interpreted with the total volume of the ejaculate. A decreased count may suggest oligospermia, a term used when the sperm count is below a concentration of 15 million spermatozoa/mL.

B. Sperm motility

Sperm motility indicates their ability to progress through the female genital tract to the oocyte. Insufficient motility may suggest asthenospermia (progressive motility < 32%).

C. Sperm morphology

Sperm morphology studies the proportion of forms considered normal according to standardized criteria. A too low proportion may correspond to teratospermia (< 4% normal forms). This parameter is delicate because its evaluation requires good standardization and can vary between laboratories.

D. Semen volume and vitality

Semen volume and vitality complete the analysis. A too low volume may indicate an emission disorder or accessory gland issues, while low vitality indicates. These data enrich the overall interpretation of a normal or pathological spermiogram (see WHO reference values).

4. How to interpret spermiogram results?

The interpretation of a spermiogram relies on comparing the results with established reference values. These benchmarks help assess male fertility and identify any potential abnormalities.

A. WHO reference values

WHO reference values help to contextualize a patient's results compared to a population of men who have successfully conceived within a defined timeframe (< 1 year). They are very useful, but a normal spermiogram is not a guarantee of absolute fertility, nor does a low result mean an inability to conceive. Interpretation must consider the couple's context.

These benchmarks are reference thresholds derived from WHO data and serve as a basis for interpretation, without replacing a complete clinical analysis.

B. What are the possible spermiogram abnormalities?

Common abnormalities include oligospermia for decreased concentration, asthenospermia for decreased motility, teratospermia for morphological alteration, or azoospermia when no spermatozoa are found. A spermiogram abnormality can be isolated or associated with several others. This is why the report should be read holistically.

C. Does an abnormal spermiogram mean infertility?

No. An abnormal spermiogram does not automatically mean male infertility. Firstly, because spermatogenesis spans several weeks, and an infectious episode, significant stress, or heat exposure can transiently alter parameters. Secondly, because fertility also depends on female factors and the timing of intercourse. This is why a second spermiogram is often requested at a later date to confirm the observed profile.

5. Can sperm quality be improved?

It is possible to act on certain factors to improve sperm quality. Environment and lifestyle play a key role in male fertility.

A. Environmental factors that influence male fertility

Sperm quality can be altered by smoking, alcohol, certain pollutants, excessive testicular heat, overweight, and metabolic imbalances. Oxidative stress plays an important role here, as it damages sperm membranes and can affect motility, morphology, and sperm DNA integrity.

B. The role of diet and lifestyle

A high-quality nutritional diet, a more stable weight, regular physical activity, sufficient sleep, and smoking cessation are among the most consistent levers for supporting male fertility. Reducing environmental exposures to oxidative stress and inflammation is a fundamental lever for supporting male fertility (tobacco, alcohol, recreational drugs, endocrine disruptors). A varied and balanced diet, a more stable weight, regular physical activity, sufficient sleep, and stress management help to favorably modulate metabolic disorders (overweight, cholesterol, insulin resistance...).

Inflammation, oxidative stress, and metabolic disorders are self-perpetuating mechanisms that promote spermiogram alterations.

C. Micronutrients involved in male fertility

Clinical data on antioxidants are heterogeneous, but several studies suggest the benefit of certain active ingredient synergies. A meta-analysis reports that carnitine ranks among the most favorable approaches for sperm motility and morphology (Fan et al., 2022), while coenzyme Q10 shows an interesting effect on sperm motility and concentration. Selenium and vitamins C and E are part of the strategy to combat oxidative stress.

In terms of active ingredient synergy, it is logical to consider the following areas:

• motility: carnitine, taurine, coenzyme Q10

• concentration: carnitine, selenium

• morphology: vitamins C and E, zinc, selenium, coenzyme Q10

Food supplements are not a substitute for an adapted lifestyle or a varied and balanced diet. Healthcare professionals (doctors, pharmacists) can guide you for appropriate care.

D. Microbiota involved in male fertility

Intestinal microbiota and seminal microbiota are attracting increasing attention. Recent reviews describe links between intestinal dysbiosis, low-grade inflammation, oxidative stress, and altered sperm parameters. The concept of the gut-testis axis supports the idea that an unfavorable inflammatory or metabolic environment can affect spermatogenesis.

The theoretical GELDING model suggests that an increase in the passage of endotoxins of intestinal origin into the general circulation, particularly in obesity, may contribute to a decrease in testicular function. This is a pathophysiological theory to consider in clinical practice, relevant for understanding why metabolic health, inflammation, and fertility are linked.

E. Food supplements: probiotics and sperm quality

A triple-blind, placebo-controlled randomized trial by Abbasi et al. in 2021 in men with unexplained infertility observed, after 80 days of symbiotic (7 probiotic strains + fiber), an improvement in concentration, motility, and morphology, with a decrease in markers of sperm DNA damage (probiotics would thus exert their beneficial effects on sperm parameters via the reduction of oxidative stress). Probiotics offer an interesting avenue for some patients with no clearly identified cause of infertility, but who are affected by an inflammatory and metabolic condition.

6. When to consult after a spermiogram?

A consultation is useful whenever a spermiogram shows an abnormality, or if the baby project is not progressing despite a normal spermiogram. It allows for interpreting the figures, checking medical history, clinical examination, lifestyle, and, if necessary, completing with a hormonal assessment, ultrasound, or specialized examinations. In this logic, the spermiogram is not an end, but a starting point.

Spermiogram FAQ

1. How long does it take to see changes in spermiogram parameters?

Generally, changes are not expected for several weeks. The production of mature sperm takes approximately 2 to 3 months, which explains why hygiene-dietary or nutritional measures are evaluated over this period.

2. Do I need to fast before a spermiogram?

No, a spermiogram does not usually require fasting. However, you must follow the laboratory's instructions regarding abstinence and collection methods.

3. How many days of abstinence are needed before a spermiogram?

Most often, the laboratory recommends between 2 and 7 days of abstinence. This window aims to standardize the semen analysis and make the result more interpretable.

4. How long does it take to get spermiogram results?

The timeframe varies depending on the laboratory. An initial report may be available quickly, but some additional tests (sperm culture, sperm DNA fragmentation test, etc.) require more time.

5. Does an abnormal spermiogram mean a man is infertile?

No. A spermiogram abnormality is not sufficient to conclude definitive male infertility. It must be confirmed, contextualized, and integrated into the couple's history.

6. How much does a spermiogram cost and is it reimbursed?

In France, a spermogram may be covered when prescribed in a medical context. The exact cost depends on the laboratory and associated tests. For reliable individual information, you should check with the laboratory or the Assurance Maladie (French health insurance).

7. How many spermograms are needed to confirm a diagnosis?

Often, two examinations are necessary, spaced apart, especially if the first one shows abnormalities. This helps to limit the effect of natural variations or a transient factor.

8. Can you naturally improve your spermogram?

It is possible to improve certain parameters by addressing environmental exposures (tobacco, alcohol, endocrine disruptors, etc.) and lifestyle (diet, physical activity, sleep, stress). Depending on the profile, a targeted nutritional strategy can also be discussed with a healthcare professional. 

Sources :

 

• WHO. WHO laboratory manual for the examination and processing of human semen, 6th edition, 2021.

• Barratt CLR et al. The sixth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen. Fertility and Sterility, 2021.

• Abbasi B, Abbasi H, Niroumand H. Synbiotic (FamiLact) administration in idiopathic male infertility enhances sperm quality, DNA integrity, and chromatin status: A triple-blinded randomized clinical trial. Int J Reprod Biomed, 2021. PMID: 33842820.

• Fan Y et al. The Effect of Antioxidants on Sperm Quality Parameters and Pregnancy Rates for Idiopathic Male Infertility: A Network Meta-Analysis of Randomized Controlled Trials. Frontiers in Endocrinology, 2022.

• Tremellen K. Gut Endotoxin Leading to a Decline IN Gonadal function (GELDING). Basic and Clinical Andrology, 2016.

• Pietrangelo A et al. Sperm Microbiota and Its Potential Impact on Male Fertility: A Systematic Review, 2026.

• Wang et al. Gut microbiota is involved in male reproductive function: a review. Frontiers in Microbiology, 2024.