Semen analysis: everything you need to know

A semen analysis is a lab test of a semen sample. It’s used for two things: checking fertility, and checking that a contraceptive method works. For thermal contraception, it’s the check that matters most: your semen analyses are how you know whether the method works for you!

🗓️ When should you get a semen analysis?

It depends on why you’re getting it.

• For a fertility workup: when a couple has been trying for a baby for a while, it’s one of the tests they do.
• After a vasectomy: a few months after the procedure, it checks that there’s no sperm left in the semen. Your surgeon tells you when.
• For thermal contraception, you’ll get one often:
  • before you start, one semen analysis, which should come back normal and shows your starting point⁷;
  • then one a month until month six, then one every two months⁷;
  • until a semen analysis comes back below the threshold, you must use another method of contraception, and the 2012 guide looks for two results below the threshold, three weeks apart⁷;
  • after you stop the thermal method, until you’re back to your starting values: the 2012 guide says 6 to 9 months⁷, and a 1994 study measured 12 to 18 months⁹. Another method takes over from the day you stop.

What counts is the test result, not how long you’ve been at it.

🧭 Where can you get a semen analysis?

A medical testing lab. Not every lab does semen analysis, so call before you go and save yourself the trip.

Our contraception map lists healthcare professionals who know the thermal method, mostly in France, and labs are being added little by little. If you’re in or near Paris, one example is Laboratoire Drouot (in French): you can drop in without an appointment to give a sample, Monday to Friday from 8 am to 2 pm and Saturday from 8 to 10 am³. Check their website before you go!

💶 How much does a semen analysis cost?

The prices and rules in this section are French. Elsewhere, the price, what insurance covers, and whether you need a prescription depend on your country.

In France, the national health insurance (Assurance maladie) rate is €27.50 for a semen analysis with a sperm morphology study (the spermocytogramme, which looks at the shape of the sperm)⁴.

With a prescription, the Assurance maladie reimburses 60%, and your supplemental health insurance (mutuelle) may cover the rest⁵. The prescription comes from a doctor: a GP, gynecologist, urologist, or andrologist. Midwives can prescribe the tests their practice requires⁶, and some do it for the partner of a woman in their care. No text mentions semen analysis specifically, so ask your midwife before counting on it. For a fertility workup, full coverage is sometimes possible: ask the couple’s doctor.

🧪 What happens at the lab?

• Before: 2 to 7 days without ejaculating¹. Above all, keep the same number of days every time, so you can compare your results. For example, always 3 days.
• At the front desk, there’s a form. Most semen analyses are done for people trying to have a baby, so if you’re there for contraception, the form can feel a bit off. Don’t let it throw you: the form changes nothing about the test. Feel free to explain your situation to the lab staff.
• In the room, it’s just you: wipes and somewhere to wash, a small sterile cup, and the instructions on the wall. The sample is collected by masturbation. Some labs let couples in, but it’s fairly rare.
• The part that matters: collect everything! The first drops have the most sperm in them¹. If they miss the cup, the result is off. If that happens, tell the lab.
• At home? Some labs accept a sample collected at home, as long as you bring the cup in quickly and don’t let it cool down. Their instructions come first.
• The results usually come within a few days, by letter, by email, or through your doctor. Ask how you’ll get them, so they reach you in time.

🔬 How do you read a semen analysis?

The report gives a lot of information about the semen (volume, pH, viscosity) and about the sperm. Three numbers matter more than the rest:

• concentration: how many sperm per milliliter of semen;
• motility: how many swim forward;
• morphology: how many have a typical shape (reports in English often say “normal forms”).

A reading tip: concentration is often written “X × 10⁶/mL”, which means X million per mL. For example, 0.2 × 10⁶/mL is 200,000 sperm per mL.

For each of these numbers, and a few others, the WHO gives a lower reference limit¹:

Careful, these aren’t cutoffs for normal! The WHO took them from men whose partner got pregnant within a year: for each value, 5% of those men were below it¹. Being below a reference limit doesn’t mean you’re infertile.

Your report may show other reference values, like the ones from the 2010 edition, with 15 million per mL². To read your result, go by the reference your lab printed, and go over it with your doctor.

The same person’s numbers also vary from one sample to the next¹. An unexpected result is worth redoing before you draw any conclusions.

The words on the report, in plain English²:

• oligozoospermia: fewer sperm than the reference;
• asthenozoospermia: fewer motile sperm than the reference;
• teratozoospermia: fewer typical forms than the reference;
• necrozoospermia: fewer live sperm than the reference;
• cryptozoospermia: no sperm on direct examination, and only a few after the sample is centrifuged;
• azoospermia: no sperm, even after centrifugation.

🌡️ What should you look for with the thermal method?

Here, everything flips: the fewer sperm, the better!

The threshold to reach: under 1 million sperm per mL, on two semen analyses three weeks apart⁷. With the example above, 0.2 × 10⁶/mL, you’re five times below it. This threshold comes from hormonal contraception. It wasn’t set for the thermal method⁸. The 2012 guide counts motile sperm. At Otoko, we recommend looking at the total concentration, motile or not, which is stricter¹¹.

The words on your report change too: cryptozoospermia, or even azoospermia. That’s the result you’re looking for. The word “oligozoospermia” isn’t enough, though: it only means below the 16 million reference, far above the threshold. For contraception, the concentration number is what counts.

What about motility? It drops too, and comes back with the count after you stop⁹. Since we count all sperm, motile or not, motility doesn’t change anything about the threshold.

Below the threshold, the risk goes down, but not to zero. In the WHO’s hormonal contraception trials, men who stayed between 0 and 3 million per mL had a Pearl Index of 8.1: roughly 8 pregnancies for every 100 couples using it for a year. Among men with no sperm left at all, there were none⁸. A second semen analysis checks that the first one wasn’t a one-off, and the follow-up checks that your count stays below the threshold. If your results are already low before you start, you still need another method of contraception¹⁰.

If you need a prescription where you live, ask for a prescription that covers several tests at your first appointment: the follow-up takes several semen analyses a year.

Every step, from your first semen analysis to the day you stop the method, is on our thermal contraception page.

🚪 What’s next?

• Getting a fertility workup? The next step is with the doctor who ordered the test, an andrologist, or a fertility clinic.
• Using the thermal method, or thinking about starting? If you have questions about the method, come talk it through in a session: one hour on a video call with Sam, in English, on your own or as a couple, pay what you can¹¹.

Book an information session

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