Let’s deep dive into sperm analysis, what it all means and some very important things you need to know to improve your IVF success rates.

For those of you that don’t know me, my name is Michelle Cooke, Period & Hormone Naturopath, Natural Fertility Educator & Naturopathic Emotional Release Practitioner. I’m the Founder and Director of Reproductive Wellness, a clinic located in Melbourne. I see patients online and face-to-face.

Generally, when you go through the IVF process they will do a sperm analysis technically known as a semen analysis. Some of the time, you will get the response from the specialist that “everything is normal”. But is it though? Let’s talk more about this. I don’t intend to take the wind out of your sails, lads. I’m just simply highlighting that your role is such an important one in your collective fertility as a couple. After all it takes an egg and a sperm to make a baby.

Sadly, there has been a huge decline in sperm count and sperm quality issues since 1980 to 2015 a study revealed that there was a 57% decline in sperm count worldwide!

Semen is the fluid surrounding the sperm it provides protection for the sperm for the survival and ability to move (motility), contains high concentrations of sugar fructose which is an energy source for sperm. Furthermore, semen is an alkaline fluid that helps protect the sperm against the acidic environment in the vagina. There are also nutrients in there for the sperm: zinc, protein, calcium, citric acids, magnesium, B12, phosphorus, sodium, potassium etc.

What does a sperm analysis / semen analysis look at?

It is looking at a few different things, let’s look at it in more detail:

  1. Sperm count: this is looking at how much sperm is found in the semen sample

Sperm count is an important factor but if the morphology is poor (lots of abnormal sperm) there is no benefit to have a good count in that instance.

  1. Morphology: this is looking at the size and shape or sperm. It will then show the amount of sperm that is normal when viewed under a microscope.

Different things looked at in morphology: Normal Forms (general over view of what percentage of sperm are normal), Head defects, Neck and midpiece defects, principal piece tail. Not all of these are looked at, depends on the IVF clinic. But it is useful to know as there is specific vitamins and minerals that can help with each part of the sperm which you will learn if you keep reading.

The acceptable range for normal morphology so the amount of normal sperm is 4% according to the new classification by WHO (World Health Organisation). Wait a minute hold up! 4% normal sperm that means 96% of the sperm are abnormal. This means that they have things like two heads, two tails, abnormally shaped head, neck and / or tail and can’t swim. They are not going to working well if this is the case.

Usually if you are doing IVF and your morphology falls below 4% you will need to do ICSI which is like using a little wheelchair for the sperm because they can’t swim properly and injecting it directly into the egg.

Most IVF clinics follow the new acceptable classification by WHO, there are a select few that follow 15% as an ideal.

Things that can happen:


  • Either they are doing break dancing on the spot and not swimming towards the egg



  • They are managing to swim with an abnormally shaped head but then the shape of the head is not appropriate to actually penetrate the egg for fertilisation.

  1. Motility: this is the ability of the sperm to move properly in a forward direction through the female reproductive tract to reach the egg. If sperm don’t swim properly and then fertilisation won’t take place.

Different types of motility: overall, progressive, non-progressive, immotile, total motile count

The aim for motility is that it is 50% or more but that still means that 50% are not motile so not moving. Pretty bad really!

  1. Volume: The amount of semen in the ejaculation

  2. pH: Whether it is alkaline or more acidic. It is meant to be alkaline so generally between 7.2-8

  3. Days abstinence: The number of days that the man has avoided masturbation or sex. The number of days when ejaculation didn’t happen. The ideal is 3 days for a semen analysis. Longer than that means that the sperm are a bit old and the results will look a bit worse.

One that is not always done but should be:

  • Anti-sperm antibodies – looks at immune or genetic issues.

  • Viscosity – this looks at whether the sperm is too thick and clumping and therefore it is difficult to swim through the cervical mucus. A high viscosity will mean sperm is too thick & clumpy.

One that absolutely should be done but is not included:

  • Sperm DNA Fragmentation Index / SCSA – Sperm Chromatin Structure Assay – looks at DNA of the sperm which looks at broken sperm DNA. This is key to look at if you have low morphology, concentration & motility and also if your sperm analysis was classed as ‘normal’ but you are experiencing miscarriages and recurrent miscarriages. This needs to be checked as sperm DNA fragmentation has a HUGE impact on fertility viability and is a major factor for miscarriage and recurrent miscarriage. 

What is the issue with sperm analysis?

When you have a sperm analysis done it is looking at whether it is ‘ok’ for IVF not natural conception. For natural conception we need those ranges to be a lot higher because they are having to do the work themselves. They are not placed in a petri dish in close proximity to the egg so not as cumbersome a swim and in the case of ICSI there is no swimming required they are injected into the egg.

But for IVF it is not ideal to have poor numbers of each of those things I spoke about either because this can impact whether fertilisation takes place, successful implantation and if conception does arise we need to consider the risks to that child. Particularly with sperm DNA fragmentation for instance if there are breaks in the DNA. Remember that chromosomes are made up of DNA strands. To make an embryo half the chromosomes come from mum AND half come from dad.

If you were told that your miscarriage or recurrent miscarriages were due to having chromosomal abnormalities. This will be due to a chromosomal issue with mum, dad or in my experience it is usually BOTH. It means that the embryo has the wrong amount of chromosomes either too many or not enough. Not all embryo’s with the incorrect amount of chromosomes miscarry though this will general result in a baby with a physical or mental disability such as Down syndrome for instance.

Really though at the end of the day, sperm quality issues in general so any poor results found in the semen analysis that I spoke about will contribute to poor fecundity (ability to conceive each month), increased risk of miscarriage and increased risk of potential mental and / or physical disabilities in your baby.

We can do better!

How does poor sperm quality arise?

A big player is environmental aspects: Things like lifestyle factors – smoking cigarettes, vaping, smoking marijuana, illicit drugs, alcohol, heavy metal exposure, pesticides, herbicides, work toxins, being overweight (high oestrogen, low testosterone), sperm temperature (trunks, bike pants, saunas), other endocrine disruptors like BPA found in plastics. It is important to address those issues and provide protection from the environmental toxins there is not any control over (antioxidants).

Can sperm quality issues be treated?

Absolutely! A Naturopath that specialises in Periods & Hormones (ah hem! That is what I do) will be able to improve things like low sperm count, motility, morphology & sperm DNA fragmentation. Treatment involves diet, lifestyle, nutritional medicine & herbal medicine to assist. They will also be able to assist you with interpretation of the semen analysis and what it all means. As an example, if there is poor motility (ability for sperm to move in the right direction towards the egg) I would be looking at giving selenium to help the whip like action of the tail. Selenium is such a common deficiency because of the low levels in our soils in Australia.

If you are about to go through IVF, have done a few cycles which have been unsuccessful, have been experiencing miscarriage or recurrent miscarriage. I would love to help you, go ahead and book a FREE 15 min discovery call to find out more about how we would work together and if we are a good fit.

Thank you so much for watching and / or reading. If you have any questions or comments please pop them down below.