Short answer: a male fertility test is, in the first instance, one test — a semen analysis. It is a laboratory examination of a semen sample that measures volume, how many sperm there are, how well they swim, how many are alive and how many are normally shaped. Everything else in a male fertility work-up follows from what that test shows.
It is worth having, and it is worth having early. The Human Fertilisation and Embryology Authority puts the scale of it plainly: “For around half of couples who are having problems conceiving, the cause of infertility is sperm-related.” Despite that, men are still investigated later than their partners, and often only after months of tests on her.
The sample is examined under a microscope by a trained andrologist, usually within an hour of production. The measurements are:
Results are compared against reference values published by the World Health Organization. The current figures come from the sixth edition of the WHO laboratory manual, published in 2021, and are quoted in full in the current UK guideline, NICE NG257:
Now the part that most explanations leave out, and the part that matters most if you are looking at a result that came back below one of those lines.
These are not pass marks. They are the fifth centile of a distribution of results from around 3,500 men whose partners conceived naturally within twelve months. In other words, they describe where the lowest 5% of recently fertile men sat. They do not draw a boundary between fertile and infertile.
The scientists who wrote the manual say so directly. Writing in Fertility and Sterility in 2022, members of the sixth edition’s editorial board explained: “these distribution data with the fifth centile as the lower reference range do not define limits between fertile and subfertile men. There is a substantial overlap of semen evaluation between fertile and subfertile men, and there are no distinct boundaries between fertile vs. infertile men.”
The sixth edition went further than that. It dropped the old diagnostic labels — oligozoospermia, asthenozoospermia, teratozoospermia and the rest — from the manual entirely, precisely because they encouraged people to read a single number as a diagnosis.
So: a result of 14 million per ml is not a verdict, and 4% normal forms is not a near miss. What matters is the whole picture, repeated, alongside your history and your partner’s results.
Semen quality varies genuinely and substantially from sample to sample in the same man. A recent illness, a fever, a stressful fortnight, a short or long abstinence, a hot bath the day before — all of it moves the numbers. A single low result should almost always be repeated before anyone acts on it, usually after a few weeks.
The reference values are also only valid for the specific laboratory methods the WHO manual sets out. NG257 adds the caveat explicitly: “the reference ranges are only valid for the semen analysis tests outlined by the World Health Organization.” A result from a home postal kit or a smartphone attachment is not the same measurement.
If two or more semen analyses come back abnormal, NG257 recommends a physical examination of the scrotum and testicles, and says to consider blood tests for testosterone and the pituitary hormones FSH and LH. Depending on what that shows, the next steps might include a scrotal ultrasound, genetic testing where the count is very low or absent, or a referral to a urologist.
Where no sperm are found at all — azoospermia — surgical sperm retrieval is often possible, and can be used with ICSI.
This is worth knowing before you are offered them.
Sperm DNA fragmentation testing. NG257 recommendation 1.17.6 says: “Do not carry out testing for sperm DNA integrity (fragmentation).” The HFEA reaches a similar conclusion from a different direction — it has no traffic-light rating for sperm DNA damage testing, and states that “the results of a sperm DNA damage test are unlikely to impact on the management of your treatment.”
FSH as a marker of female ovarian reserve is also now recommended against, for what it is worth, so if you and your partner are being tested together, that one has changed too.
We would rather tell you which tests the current guidance does not support than sell you them. If a test will not change what we do next, it is not worth your money.
NG257 sets out the thresholds:
Things that count as a known cause on the male side include undescended testes as a child, a clinically significant varicocele, previous chemotherapy or pelvic radiotherapy, or previous testicular surgery or injury.
Sometimes, and it is worth trying, because sperm take about three months to develop. What you do now shows up in a sample roughly a quarter later.
The changes with the best evidence behind them are unglamorous: stop smoking, cut alcohol, lose weight if you are carrying a lot of it, stop anabolic steroids and recreational drugs, keep your testicles cool where you reasonably can, and treat any infection. We will be honest with you about which of these is likely to matter in your particular case, and honest when the answer is that lifestyle change is unlikely to close the gap on its own.
A male fertility assessment is £290, and includes the semen analysis and a consultation to go through the result. A couple assessment, covering both of you, is £495. Every result is reviewed by a Fertility Doctor before you are told anything, and you will have it explained by a person rather than emailed a set of numbers.
All of our prices are published in full on our prices page.
Two to seven days is the standard window. Less than two and the volume and count may be artificially low; more than seven and motility tends to fall. We will confirm the exact instructions when you book.
Home kits typically measure sperm concentration only, and sometimes motility. They cannot assess morphology, vitality or the presence of antibodies, and they are not performed by the WHO methods that the reference values depend on. A normal home result is mildly reassuring; an abnormal one needs a proper laboratory test, and a normal one does not rule out a problem.
No. You can book a male fertility assessment with us directly.
No. Men with counts well below the reference values conceive naturally, and where natural conception is unlikely, ICSI — injecting a single sperm directly into an egg — needs only a very small number of viable sperm. A low count changes the route, not usually the destination.
It is a private room and a sample pot. Nobody is watching, nobody comments, and you can produce the sample at home if you can get it to us within the hour and keep it at body temperature. We will tell you plainly how it works when you book, because not knowing is the part that puts people off.
The analysis itself is done the same day. You will have your results at your consultation, after a Fertility Doctor has reviewed them.
If you have been trying for a while and only she has been tested, get tested. Start with a free 15-minute consultation with a Fertility Specialist — no referral needed, and no obligation. Book a free consultation, or read more about our fertility assessments.
