Semen Analysis: Understanding Your Results and Improving Male Fertility

After a year of trying, the gynaecologist asked for a semen analysis. Your husband put the prescription away in a drawer. "The problem isn't me," he says, or he says nothing. This scene is common, in Morocco as elsewhere. Yet male fertility is involved, at least in part, in up to half of the couples who struggle to conceive, according to the Mayo Clinic.

The WHO stresses this in its first global guidelines on infertility, published in November 2025: the man's work-up is often neglected. And the semen analysis, tahlil al-sa'il al-manawi (تحليل السائل المنوي) in Arabic, is one of the simplest tests of the whole work-up. Here is how it goes, how to read the results, and what can improve them.

Why does the man need tests too?

Because it takes two to make a baby, and causes are shared between both partners. The WHO describes several male causes: blocked ducts after an infection or injury, a hormonal imbalance, testicles that produce poorly (for example after chemotherapy or with a varicocele), or sperm that move poorly or are badly shaped.

In many families, infertility is still seen as "a woman's business". That is wrong, and it is costly: without a semen analysis, a woman can go through months of unnecessary tests and treatments. The July 2026 French guidelines (HAS) also make the semen analysis the first test of the male work-up, and the work-up concerns both partners. The couple's full pathway is described in our article on when to see a doctor about infertility.

How does a semen analysis work?

The test is done on prescription, in a medical laboratory that practises reproductive biology. The steps are always the same:

1. Observe the abstinence period requested by the laboratory, usually a few days (3 days in the British guidelines relayed by GPnotebook).
2. Collect the semen by masturbation into a sterile pot, usually at the laboratory, in a room set aside for this.
3. Have the sample analysed quickly, within two hours at most.

The laboratory often adds a semen culture, which looks for infection. Results arrive within a few days.

How do you read a semen analysis?

Results are compared with the WHO reference values, updated in the 6th edition of its laboratory manual (2021). These are lower limits, matching the 5th percentile: 95% of the men in the WHO reference population have values above them.

A few words come up often on the report:

• oligozoospermia (or oligospermia): too few sperm;
• asthenozoospermia: insufficient motility;
• teratozoospermia: too many atypical forms;
• azoospermia: no sperm at all in the ejaculate.

A result below a limit is not a sentence. These limits are only reliable if the laboratory applies the WHO methods and if the requested abstinence was respected. Sperm quality also varies from one sample to another. If the first analysis is abnormal, it is repeated about three months later, the time of a full sperm-production cycle. In case of azoospermia or a severe abnormality, the recheck is done as soon as possible.

What damages sperm?

Several lifestyle factors play a part, and the good news is that most can be acted on:

• tobacco, including passive smoking, according to the Mayo Clinic;
• alcohol, cannabis and cocaine;
• anabolic steroids, sometimes used in gyms to "build muscle", which the WHO lists among the causes of abnormal sperm;
• excess weight;
• heat: tight underwear, saunas, very hot baths, a laptop on the knees and long hours seated can raise testicular temperature (the Mayo Clinic specifies that the evidence still needs consolidating);
• certain workplace products: pesticides, solvents, heavy metals such as lead.

By analogy with the sauna, long, repeated sessions in a very hot hammam also expose the testicles to heat. Nothing obliges you to give it up, but while trying for a baby, shorter stays in the hot room are a reasonable precaution.

Age matters too. The HAS advises (July 2026) seeing a doctor after 6 months of trying when the man is over 45, and the NHS lists a father aged 45 or more among the risk factors for miscarriage. As for your plate, our article on food and fertility separates what is proven from what is not.

Varicocele, infection, hormones: when to see a urologist?

If the analysis is abnormal, the doctor examines the man: volume and consistency of the testicles, epididymis, vas deferens, looking for a varicocele. They then refer him to a urologist or an andrologist, as recommended by the Strasbourg university hospital (CHRU).

Varicocele is a widening of the veins that drain the testicle, a bit like varicose veins. According to the Mayo Clinic, it is the most common cause of male infertility that can be corrected. Depending on the suspected cause (hormonal imbalance, duct obstruction, chromosomal abnormality), the specialist then prescribes further tests.

Which treatments, and what limits in Morocco?

Solutions depend on the cause. A lifestyle factor can be corrected, an infection or a varicocele treated, or medically assisted reproduction used:

• intrauterine insemination, for a mild to moderate drop in sperm quality, although the NHS considers it of little use in this case (everything about artificial insemination);
• IVF with ICSI, where a sperm is injected directly into each egg, when abnormalities are more marked;
• in azoospermia, sperm can sometimes be surgically retrieved from the testicle.

One limit specific to Morocco: law 47-14 reserves medically assisted reproduction for married couples using their own gametes and prohibits sperm donation. Using a donor, offered in other countries, is therefore not possible. The pathway and legal framework are detailed in our feature on IVF in Morocco.

A diagnosis of male infertility often shakes self-image. Our article on living with infertility as a couple also speaks to men, and to how partners can support each other.