When discussing male fertility, sperm count is often the first, and sometimes only, parameter that people tend to focus on. However, male fertility is far more complex than simply the number of sperm cells present in a semen sample. While sperm count is an important starting point, it does not provide a complete picture of a man’s reproductive potential.
A sperm count refers to the total number of sperm cells in an ejaculate and is calculated by multiplying sperm concentration by semen volume. During a semen analysis, sperm count is one of several parameters routinely measured to assess male fertility. According to World Health Organization (WHO) guidelines, a normal total sperm count is equal to or greater than 39 million sperm cells per ejaculate. Although this threshold helps clinicians identify severe abnormalities, meeting these criteria alone does not guarantee fertility.
One key reason for this is that not all sperm cells within a semen sample have the same functional quality. Sperm motility, or the ability of sperm to move effectively, plays a crucial role in natural conception. Within a sperm count, sperm cells are classified into fast progressive, slow progressive, non-progressive, and immotile categories (Yu et al., 2019). For fertilization to occur, sperm must travel through the female reproductive tract to reach and fertilize the oocyte. When a semen sample demonstrates total sperm motility below 32%, the patient is classified as having asthenozoospermia, a condition that is recognized as a cause of male infertility.
Beyond sperm count and motility, additional semen parameters contribute to male fertility. These include semen volume, pH, appearance, debris, odour, viscosity, liquefaction, vitality, morphology, agglutination, aggregation and the presence of non-sperm cells (Sunder et al.,2022). Abnormalities in any of these factors can indicate underlying issues such as infections, inflammation, or problems with accessory glands, all of which may negatively affect sperm function (Lesley et al., 2024).
Furthermore, it is important to recognize that even when standard semen analysis results fall within normal reference ranges, sperm may still have underlying defects. One well-established factor in male infertility is sperm DNA fragmentation. DNA fragmentation occurs when the genetic material within the sperm is damaged, often due to oxidative stress, infections, environmental exposures, or lifestyle factors. High levels of DNA fragmentation can impair fertilization, embryo development, and implantation, and have been associated with recurrent pregnancy loss and reduced success rates in assisted reproductive treatments (Andrabi et al.,2024).
In recent years, the role of the male reproductive microbiome has also gained attention. Semen microbiome testing of semen samples can identify the presence of bacteria, viruses, and other microorganisms. Certain microbial imbalances or infections may negatively impact sperm quality by increasing inflammation or oxidative stress, even when traditional semen parameters appear normal (Neto et al., 2024). These tests provide valuable additional information that can help identify hidden contributors to male infertility and guide more targeted treatments.
In addition to laboratory testing, a thorough physical examination of the male patient is an essential component of fertility assessment and should always accompany a semen analysis. A physical examination can provide valuable insights into factors that may directly affect sperm production and function. During the examination, clinicians assess testicular size, consistency, and symmetry, as well as the presence of the vas deferens and signs of conditions such as varicocele, which is a common and treatable cause of male infertility. Hormonal abnormalities, previous surgeries, infections, or congenital abnormalities may also be suspected based on physical findings (Fraga et al., 2024). Identifying these issues early can help explain abnormal semen parameters, guide further diagnostic testing, and inform appropriate treatment strategies. Therefore, combining semen analysis with a detailed physical examination allows for a more comprehensive and accurate evaluation of male fertility.
In conclusion, while sperm count is an essential component of male fertility assessment, it represents only one piece of a much larger puzzle. A comprehensive evaluation that includes motility, semen characteristics, DNA integrity, physical examination and microbiome analysis is crucial for accurately understanding male reproductive health and fertility potential.
Yu S, Rubin M, Geevarughese S, Pino JS, Rodriguez HF, Asghar W. Emerging technologies for home-based semen analysis. Andrology. 2018 Jan;6(1):10-19. doi: 10.1111/andr.12441. Epub 2017 Dec 1. PMID: 29194998; PMCID: PMC5745266.
Leslie SW, Soon-Sutton TL, Khan MAB. Male Infertility. [Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562258/
Sunder M, Leslie SW. Semen Analysis. [Updated 2022 Oct 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564369/
Andrabi SW, Ara A, Saharan A, Jaffar M, Gugnani N, Esteves SC. Sperm DNA Fragmentation: causes, evaluation and management in male infertility. JBRA Assist Reprod. 2024 Jun 1;28(2):306-319. doi: 10.5935/1518-0557.20230076. PMID: 38289201; PMCID: PMC11152411.
Neto FTL, Viana MC, Cariati F, Conforti A, Alviggi C, Esteves SC. Effect of environmental factors on seminal microbiome and impact on sperm quality. Front Endocrinol (Lausanne). 2024 Feb 22;15:1348186. doi: 10.3389/fendo.2024.1348186. PMID: 38455659; PMCID: PMC10918436.
Fraga LG, Gismondi JP, Sanvido LV, Lozano AFQ, Teixeira TA, Hallak J. Clinical and Laboratorial Evaluation of Male Infertility. A Detailed Practical Approach. Arch Med Res. 2024 Dec;55(8):103139. doi: 10.1016/j.arcmed.2024.103139. Epub 2024 Dec 5. PMID: 39642787.
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