Initial assessment of a patient should include a blood workup checking for overall health factors that may impact fertility and a hormone profile. For a more comprehensive workup, ultrasounds can be performed for both partners. Another assessment proposed for a male during an initial workup can include a semen analysis. This test assesses semen parameters including motility, concentration and morphology, and occasionally additional parameters such as immune responses (IgA, IgG), vitality, pH and leukocyte presence. While these parameters will give an initial insight into overall issues such as low concentrations (oligozoospermia), poor motility or abnormal morphology, it oftentimes can present itself as normal. A semen analysis would usually be considered ‘normal’ if all parameters were within the reference ranges set by the WHO (2021) and in the absence of seminal plasma anomalies.  
Nevertheless, oftentimes a normal semen analysis can be seen in patients who have had no success conceiving despite trying for extended periods of time (>6 or 12 months of unprotected intercourse), thus instilling a false sense that all is well when in fact it may not be. In these cases, some clinics propose to move to IVF or ICSI to exclude the causality of structural physical abnormalities such as blocked tubesand improve success, despite this having been shown to only be around 31% on average (41% IVF success in patients aged 18-34, decreasing rates with advanced maternal age) (HFEA, 2024).  
Male specialist clinics and laboratories on the other hand may propose to undergo further testing. This is because a normal semen analysis may provide valuable information on standard parameters, however, genetic integrity, infection, or seminal milieu is not assessed. Thus, in-depth, specialised analysis assessing underlying factors beyond standard semen parameters may include DNA fragmentation testing, male microbiome or semen culture testing, or oxidative stress and oxidative-reductive potential testing. It has previously been shown that infection can induce oxidative stress, the accumulation of free radicals with insufficient balancing antioxidants, which in turn can cause DNA Fragmentation. The latter describes breakage, either in one (single-stranded), or both strands (double-stranded) of DNA. This so-called DNA Fragmentation can lead to a halt in development in the embryo, thus causing miscarriages. This means that despite potentially having had a ‘normal’ semen analysis, there may be difficulties conceiving due to the genetic integrity within the sperm.  
Similarly, a semen analysis may reveal that all standard parameters are normal, however pH or MAR binding may be elevated. While this is not an entirely ‘normal’ result, this may be found in specialist, however not in standard analysis as these parameters may not be part of the semen analysis offered. Both those indications suggest that the patient has an infection, potentially increasing oxidative stress/DNA Fragmentation and/or increasing immune responses and thus affecting embryo implantation and development.  
Overall, it may therefore be suggested that a patient with a ‘normal’ semen analysis but no success in conception may want to consider additional, specialist testing to exclude underlying issues. 

If you would like to discuss your semen analysis results or find out more please do get in touch.