Tests & Investigations · 2 min
Your sperm count, what the numbers mean, and when ICSI is genuinely the right call
Top things to know
A semen analysis looks at three main numbers: count, motility, and morphology.
A single low result is not a diagnosis; repeat the test after 8 to 12 weeks.
ICSI is well-evidenced for male-factor problems; routine ICSI without one shows no live-birth advantage.
Heat, smoking, heavy alcohol, and steroids reduce sperm quality; most effects reverse in about 3 months.
What does a semen analysis actually measure?
A looks at three main numbers: count (how many sperm per millilitre), motility (what fraction are moving forward), and morphology (what fraction are normally shaped). The WHO reference ranges have changed over time, partly as the global average has shifted. A single low result is not a diagnosis. Repeat the test after 8 to 12 weeks, because sperm production runs on a 74-day cycle.
The grey zone
When is ICSI the right choice and when is it being oversold?
ICSI was developed for severe male-factor infertility, where conventional IVF would not work. It is appropriate when sperm count, motility, or morphology is severely abnormal, or when previous IVF cycles have shown failed fertilisation.
Where it gets more nuanced
What we honestly do not know
We do not know with high confidence whether the global sperm count decline is reversing, plateauing, or continuing. We do not have great data on whether South Asian populations are following the same trajectory or a different one.
Bottom line
If the clinic is recommending ICSI and there is no male-factor reason in your results, ask them to walk you through why. If there is a male-factor reason, ICSI is well-evidenced. Either way, you are entitled to the answer.
References
- [1] 36377604Levine H et al. Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Hum Reprod Update 2022;29(2):157-176.
- [2] pmid-icsi-vs-ivf-non-male-factor-2021Geng T et al. Routine use of ICSI for non-male factor infertility: a systematic review and meta-analysis. Reprod Biol Endocrinol 2021.
- [3] pmid-varicocele-repair-meta-2024Persad E et al. Surgical or radiological treatment for varicoceles in subfertile men. Cochrane Database Syst Rev 2024.
If you ever decide to raise it
Putting it into words
No words guarantee how an appointment goes. Precise words just make sure what you live with gets described, not rounded down.
Keep it, edit it, or just remember it. Stays on your phone.
2 in 3
ICSI is now used for two-thirds of IVF cycles globally, often without a male-factor justification.
Geng et al, Reprod Biol Endocrinol, 2021
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References
- [1] 36377604Levine H et al. Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Hum Reprod Update 2022;29(2):157-176.
- [2] pmid-icsi-vs-ivf-non-male-factor-2021Geng T et al. Routine use of ICSI for non-male factor infertility: a systematic review and meta-analysis. Reprod Biol Endocrinol 2021.
- [3] pmid-varicocele-repair-meta-2024Persad E et al. Surgical or radiological treatment for varicoceles in subfertile men. Cochrane Database Syst Rev 2024.
Reviewed by clinicians
Authored and reviewed by clinicians from the founding team. Information only, not personalised medical advice.
From the team behind Her Holistic Health, founded by Dr Divpreet Sacha, NHS-trained GP.