Men's Fertility Hub

On the day of your scheduled semen analysis appointment, you will arrive at Illume Fertility and check in with our friendly front desk team. An Illume andrologist will then meet you in the waiting area and guide you to a private collection room. Your partner may accompany you, but no oral sex is allowed (since saliva can affect the integrity of the sample). You will collect the sample by masturbation and hand it directly to staff through our secure pass-through.

Your labeled sample then goes to our on-site andrology lab, where specialists evaluate key factors: count (concentration), motility, morphology, and volume, and calculate total motile sperm (TMS). If results are borderline or abnormal, a repeat analysis may be recommended since values naturally fluctuate over time. 

Prefer not to collect on-site or need a religious accommodation? Ask for a home collection kit and bring your sample to the office within 45 minutes, keeping it as close to body temperature as possible. Your team will give you step-by-step instructions beforehand and answer any questions you may have.

A semen analysis looks at how many sperm are present, how they move, their shape, and the overall volume and quality of the sample. These factors help us understand how well sperm may be able to reach and fertilize an egg. Here's what we measure:

Count (Concentration)

This tells us how many sperm are present in each milliliter of semen. A common reference range for normal concentration is 15 million sperm per mL or higher. Lower numbers do not mean pregnancy is impossible, but they may affect the chances of fertilization.

Motility

This describes how well sperm move. Sperm need to swim forward efficiently to reach the egg. Ideally, at least 40% of sperm are moving, and 32% or more are moving forward in a purposeful way.

Morphology

This refers to sperm shape and structure. We look at how many sperm have a normal head, midpiece, and tail. A commonly used normal reference is 4% or more morphologically normal sperm. This may sound like a low number, but it is typical and not a cause for alarm by itself.

Morphology is evaluated under a high-powered microscope, where andrologists closely examine each part of the sperm:

1. The head carries genetic material and helps attach to the egg.
2. The midpiece provides energy for movement.
3. The tail helps the sperm move forward.

If a higher percentage of sperm have irregular shapes, it may be harder for them to move effectively or bind to the egg. This is called abnormal morphology.

Volume

This is the total amount of semen in the sample. A volume of 1.4 mL or more is considered within a normal range.

Most patients receive the results of their semen analysis within around 1 week, though some tests may take longer. If your semen analysis was ordered by an outside physician (such as a urologist), results are sent to that provider, who will then review them with you.

If you haven’t received your results yet, please contact your referring provider directly for an update.

An abnormal semen analysis result on its own does not equal infertility. Sperm counts can vary from day to day, and results may be affected by lifestyle factors, stress, or recent illness. Your doctor may recommend repeating the test in a few weeks or exploring further evaluation.

Sperm develop in cycles over about 2 to 3 months, and levels can often improve with:

• Lifestyle and nutrition support
• Medication or hormonal treatment
• Varicocele repair, if present
• IUI or IVF with ICSI

Most patients have multiple options, even with results outside of the normal range. Your Illume physician or referring urologist will help you interpret your test results and determine the best next step.

When sperm are not present in the semen (a condition called azoospermia that can be caused by a blockage, prior vasectomy, genetic condition, or low production), there may still be healthy sperm available in the reproductive system. In these cases, sperm can often be retrieved directly and used with IVF and ICSI to fertilize eggs.

The following procedures are performed by a reproductive urologist working closely with your fertility clinic team.

Microsurgical Epididymal Sperm Aspiration (MESA)

MESA is a microsurgical procedure performed with a high-powered operating microscope to carefully retrieve sperm from the epididymis. It is often recommended when a blockage is present or when a larger amount of sperm is needed for multiple IVF attempts or future family-building. This approach allows sperm to be retrieved in a controlled way and can provide enough sperm for freezing and later use.

Testicular Sperm Aspiration/Extraction (TESA or TESE)

TESA/TESE retrieves sperm directly from testicular tissue when sperm count is extremely low or sperm are not present in the semen due to a production issue. In this approach, a small tissue sample is taken from the testicle and examined in the lab to locate usable sperm.  Even if no sperm are seen in the ejaculate, sperm found in the testes can often be used successfully with IVF and ICSI.

Percutaneous Epididymal Sperm Aspiration (PESA)

PESA is a quick outpatient procedure that uses a very thin needle to retrieve sperm from the epididymis, the small tube where sperm are stored before ejaculation. This option is commonly used when sperm are being produced normally but cannot reach the semen because of a blockage or a prior vasectomy. The retrieved sperm are used during IVF with ICSI, where a single sperm is injected directly into each mature egg.