Your semen analysis came back abnormal? Here's what it actually means.
- Dr. Sarah Bentolila, DAIM,L.Ac
- Jun 6
- 9 min read
June is Men's Health Month, so we will be talking about our dear dear boys. \
Something that comes up constantly but almost never gets the attention it deserves: the male factor in fertility.
About half of all fertility challenges involve a male component. Most of the clinical energy falls on the female partner. The male partner gets one test, an abnormal number, and a referral.
That is not good enough. And it is not accurate to the biology.
Because sperm, unlike eggs, is produced continuously. The parameters on a semen analysis today are not fixed. They reflect the conditions of the previous 74 days. Which means they are changeable.
Here is what each parameter actually means and what we do about it.
Quick jump to this article's sections
So what does a semen analysis measure?
A standard semen analysis measures four main parameters.
volume (how much fluid)
concentration or count (how many sperm per milliliter)
motility (what percentage are moving and how well)
morphology (what percentage have a normal shape)
some labs add vitality (percentage of live sperm) and pH
most do NO measure DNA fragmentation index (DFI)
Howeer, DFI is arguably the most clinically important parameter and the one most commonly overlooked. More on that below.
What are "normal" numbers?
The WHO reference values, updated in 2021, are:
Volume: 1.4ml or more
Concentration: 16 million per milliliter or more
Total motility: 42% or more moving
Progressive motility: 30% or more moving in a forward direction
Morphology: 4% or more normal forms on strict Kruger criteria
Vitality: 54% or more live sperm.
Below any of these thresholds is considered abnormal. But the thresholds are reference ranges based on fertile men, not diagnostic cutoffs. A man with 14 million sperm per milliliter is below the reference range. A man with 16.5 million is above it. They are not in meaningfully different biological situations. The numbers matter, but so does the full clinical picture.
Low count - oligospermia
The numbers
Count below 16 million per milliliter is oligospermia.
Below 5 million is severe oligospermia.
Zero sperm in the ejaculate is azoospermia, which is a separate conversation entirely and involves either a production failure or a blockage.
Causes of low count
For most men with oligospermia, the causes are correctable or improvable: varicocele (enlarged testicular veins that raise scrotal temperature), hormonal imbalance, heat exposure, oxidative stress, nutritional deficiencies, or lifestyle factors. A urologist will look for structural causes. Chinese medicine addresses the functional ones.
How Acupuncture addresses low count
In Chinese medicine, low count is almost always a kidney jing and yang deficiency pattern. Kidney jing is the deep constitutional essence that governs reproductive capacity. Kidney yang is the warming, activating force that drives spermatogenesis.
When these are depleted either through overwork, chronic stress, poor sleep, constitutional factors, or simply age, the count declines.
Herbal formulas that tonify kidney yang and jing, combined with acupuncture that improves testicular blood flow and normalizes the HPG axis, produce consistent improvements in count over a three-month treatment course.
Science backs acupuncture for low count
A 2024 review in Integrative Medicine in Nephrology and Andrology found that acupuncture produces reductions in elevated FSH and LH alongside improvements in sperm density and viability in men with sperm abnormalities.
A randomized controlled trial using electroacupuncture at BL23, ST36, CV1, and CV4 found significantly greater improvements in total sperm count and motility in the treatment group compared to controls.
The mechanisms include improved Leydig cell function, normalized gonadotropin levels, and enhanced testicular circulation.
Poor motility — asthenospermia
Motility is often more predictive of fertility outcomes than count. A man with 20 million sperm of which 60% are moving forward has a better functional fertility profile than a man with 50 million sperm of which 15% are moving.
The numbers
Total motility below 42%, or progressive motility below 30%, is asthenospermia. It is the most common semen abnormality and the one most directly influenced by oxidative stress.
The mitochondria in the sperm midpiece generate the energy that drives the flagellar movement. When mitochondrial function is compromised — by oxidative stress, heat, nutritional deficiency, or inflammation — the tail stops working properly. You can see this on a semen analysis as reduced progressive motility or a high proportion of sperm that are moving but not going anywhere.
Science backs acupuncture for low motility
A 2025 study published in Frontiers in Endocrinology found that acupuncture improves sperm motility in part through the gut-testis axis — modulating the gut microbiome in ways that reduce testicular oxidative stress and support mitochondrial function in sperm.
A 2024 transcriptome and proteomic study found that acupuncture enhances sperm motility by upregulating proteins involved in energy metabolism and flagellar assembly.
How Chinese medicine views low motility
Herbally, the treatment focuses on blood stagnation ( poor circulation through the testicular vasculature) and kidney yang deficiency.
Herbs that move blood and warm yang, combined with targeted antioxidant support (CoQ10 ubiquinol at 400-600mg daily is the most evidence-supported supplement for motility), produce consistent improvement in progressive motility within the 74-day treatment window.
Abnormal morphology — teratospermia
Morphology is the percentage of sperm with a normally shaped head, midpiece, and tail.
On strict Kruger criteria (the most rigorous assessment method, used by most IVF labs ) anything below 4% is considered abnormal.
This sounds alarming until you realize that a "normal" fertile man has 4-14% normal morphology. The majority of sperm in any ejaculate are abnormally shaped. This is normal.
The question is whether enough of the normal-shaped ones are present and functional.
Morphology is the parameter most sensitive to environmental and oxidative factors, which makes it both the most commonly abnormal and the most responsive to treatment. Heat exposure, alcohol, smoking, and oxidative stress all directly damage sperm morphology during development.
For Chinese medicine
In Chinese medicine, morphology issues map onto both blood stagnation (poor circulation creating a low-oxygen, high-oxidative-stress environment in the testis) and dampness accumulation (inflammatory environment that disrupts normal spermatogenesis). The herbal approach clears the pathological environment while supporting the underlying kidney essence.
For IVF patients specifically
even when ICSI is used and only one sperm needs to reach an egg, morphology still matters. Abnormal sperm morphology is associated with higher DNA fragmentation rates, which affects fertilization, embryo development, and blastocyst conversion. Better morphology means better DNA integrity in the sperm selected for injection.
DNA fragmentation — the parameter most labs don't measure
This is the one I want to spend the most time on because it is the most under recognized parameter in male fertility and the one most responsible for unexplained IVF failures, poor embryo quality, and recurrent pregnancy loss even when standard semen parameters appear normal.
Normal semen analysis test does not mean normal fertility
DNA fragmentation index (DFI) measures the percentage of sperm with damaged or broken DNA strands. A DFI below 15% is considered good. 15-25% is elevated and clinically concerning. Above 25% significantly impairs fertility outcomes. Above 30% is associated with very poor IVF results even with ICSI.
The critical point: a man can have a completely normal semen analysis, normal count, normal motility, normal morphology and still have a DFI of 35%. Which means low fertility.
The standard semen analysis does not detect this. If you have had unexplained IVF failures, poor embryo development, recurrent early pregnancy loss, or a normal semen analysis alongside unexplained infertility, DFI testing is the next step. Ask your RE or urologist specifically for a DNA fragmentation test. The most common are the SCSA, TUNEL assay, and Comet assay.
What causes DFI
High DFI is driven primarily by
oxidative stress in the reproductive tract
testicular heat
varicocele
infection
age
poor lifestyle factors.
It is also the parameter that responds most dramatically to targeted treatment, because the source of DNA damage is the environment in which sperm are maturing, and that environment is changeable.
Chinese medicine and DFI
Acupuncture reduces systemic and local oxidative stress through its documented anti-inflammatory and antioxidant effects.
Chinese herbal medicine addresses the specific pattern driving the oxidative damage.
The supplement protocol for high DFI is:
CoQ10 ubiquinol at 600mg
vitamin C at 1000mg
vitamin E at 400IU
selenium at 200mcg
zinc as zinc glycinate at 30mg
omega-3s at 2-3g daily.
Combined with acupuncture weekly for three months, this protocol consistently produces meaningful DFI reduction within the 74-day sperm cycle.
The 74-day window
The single most important thing to understand from this entire post is the sperm production timeline.
Sperm take 74 days to develop from stem cells in the testis to mature sperm in the ejaculate. This means the sperm in a semen analysis today represent the biological conditions of the previous ten weeks — not today, not last month, but the full preceding production cycle.
This also means that the treatment you start today will show up in a semen analysis in approximately ten to twelve weeks. Not sooner. When patients come in and want to repeat their semen analysis after four weeks of treatment, I have to explain that the sperm being analyzed were already mid-development when we started. The meaningful comparison is pre-treatment versus twelve weeks post-treatment.
For couples planning an IVF retrieval
This timing is the most important planning decision: start treatment for the male partner three months before the planned retrieval. Not one month. Not the week before. Three months. The sperm present at retrieval will be the ones developing in the biological environment you are building right now.
What lifestyle changes actually matter
I cover this at the first appointment in detail, but the big ones that directly impact every semen parameter:
Keep'em cool
Scrotal temperature is the most impactful and most overlooked. The testes are outside the body specifically because spermatogenesis requires a temperature slightly below core body temperature.
Laptops on the lap, prolonged sitting, hot tubs, tight underwear, and extended cycling all raise scrotal temperature and directly damage sperm development.
During treatment, move the laptop to a desk, avoid hot tubs completely, switch to boxer briefs, and limit cycling to under 30 minutes at a time.
Keep it sober
Alcohol at more than three drinks per week has a documented dose-dependent effect on sperm parameters, particularly morphology. The lower the better during treatment.
Smoking and vaping: both drive up DFI and reduce motility. Stop.
Keep calm
Sleep quality affects testosterone production directly. Most testosterone is produced during deep sleep. Poor sleep drives down the hormonal environment supporting spermatogenesis. Seven to nine hours with consistent timing is not optional.
Keep it unplugged
Phone in the pocket — some research suggests RF radiation from phones carried in front pockets may affect sperm. The evidence is not definitive but the precaution costs nothing. Move the phone to a back pocket or bag during the treatment period.
FAQ
Can a varicocele be treated with acupuncture?
A varicocele is a structural issue: enlarged veins in the spermatic cord that raise scrotal temperature and create venous backflow that exposes the testis to adrenal hormones.
Acupuncture does not resolve the structural problem. What it does is improve the testicular environment despite the varicocele: better blood flow, reduced oxidative stress, improved hormonal support for spermatogenesis.
For significant varicocele with major parameter impact, surgical repair or embolization is worth discussing with a urologist. Acupuncture and surgery are not mutually exclusive.
My semen analysis was normal but we still are not getting pregnant. What should I ask for?
Request a DNA fragmentation test. A normal standard semen analysis does not rule out high DFI, and high DFI is one of the leading causes of unexplained infertility and recurrent early pregnancy loss. Also check whether your partner's workup includes uterine cavity assessment and immune factor evaluation, which are frequently overlooked in standard fertility workups.
How long before I can repeat my semen analysis to see if treatment is working?
Twelve weeks minimum from the start of treatment. Before that, you are analyzing sperm that were already in development before treatment began. A repeat analysis at ten to twelve weeks gives a meaningful comparison.
We track BBT-equivalent markers during treatment: energy levels, libido, and any symptomatic changes, but the semen analysis is the objective benchmark and twelve weeks is the correct timing.
Is it worth treating my sperm if we are doing ICSI anyway?
Yes. ICSI selects one sperm to inject, but it cannot select for DNA integrity. High DFI in the sperm pool means the selected sperm is statistically more likely to carry damaged DNA regardless of its appearance under the microscope. Better sperm quality going into an ICSI cycle produces better embryo development and higher blastocyst conversion rates. The investment in sperm quality improvement pays off in embryo quality, which is what actually determines IVF outcomes.
Do I need to see a urologist as well as getting acupuncture?
For most men with mildly to moderately abnormal parameters and no structural cause identified, acupuncture and herbal medicine alongside lifestyle changes is a complete treatment plan. If there is a significant varicocele, hormonal abnormality, or severe oligospermia (below 5 million/ml), I recommend seeing a urologist or reproductive endocrinologist alongside treatment. The two approaches are not competing — a urologist evaluates and treats structural causes, Chinese medicine addresses the functional and environmental ones. Most of my male fertility patients do both.
Looking for Chinese medicine & acupuncture for male fertility ?
It is Men's Health Month. If you or your partner have had an abnormal semen analysis, or if you are preparing for IVF and the male side has been an afterthought, come in.
The 74-day window is open right now.
You can book a new patient appointment here or call us at 626-841-2991.
For the full picture on how we approach male fertility at Taproot, the male fertility page covers the complete treatment protocol.
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