How long should I abstain before a semen analysis?

Two to five days. Less reduces the count, more reduces motility, and both distort the result.

Should an abnormal result be repeated?

Yes. Semen parameters vary a lot sample to sample. Repeat after about three months, which is roughly one full production cycle.

Do I need hormone tests as well?

If the semen analysis is abnormal, yes — LH, FSH, testosterone and prolactin are what explain why, and they change what the next step should be.

Does testosterone therapy affect fertility?

Exogenous testosterone suppresses the signals that drive sperm production and can markedly reduce fertility. This is a decision for your own doctor, and a baseline before any such discussion is sensible.

Male fertility testing: what to measure and in what order

Name: Male fertility testing: what to measure and in what order
Creator: Dr. Nikola Topalovic, MD PhD

Medically reviewed by Dr. Nikola Topalovic, MD PhD · Last reviewed 4 September 2026

Male factor contributes to roughly half of couples' fertility difficulty, and it is the cheaper and faster half to investigate. The order of testing matters.

What people notice

Twelve months of trying without conception (six if your partner is over 35)
A previous abnormal semen analysis
History of undescended testis, mumps orchitis, chemotherapy or testicular injury
Reduced libido or erectile difficulty alongside the above
A varicocele, or noticeable change in testicular size

Symptoms overlap between causes. This list is a prompt to measure, not a diagnosis.

Markers worth measuring

Semen analysis: The primary test — concentration, total count, motility, progressive motility and morphology. Everything else is context for it.
Total and free testosterone: Establishes the hormonal baseline; low levels suppress sperm production.
LH and FSH: The critical pair. High FSH with low count suggests primary testicular failure; low LH and FSH point to a pituitary or hypothalamic cause.
Prolactin: Elevated prolactin suppresses the reproductive axis and is a checkable, reversible cause.
Sensitive estradiol: A high estradiol-to-testosterone ratio suppresses gonadotrophins and impairs spermatogenesis.
TSH, free T4, free T3: Thyroid dysfunction in either direction affects sperm parameters.
Ferritin, vitamin D, zinc status: Nutritional contributors that are common, measurable and correctable.

Start with the semen analysis. It is inexpensive, non-invasive and answers the main question directly. Abstain for two to five days beforehand — shorter reduces count, longer reduces motility — and deliver the sample within the laboratory's stated window at body temperature. Parameters vary substantially between samples, so an abnormal result should be repeated after around three months before it is treated as settled.

The three-month rule. Spermatogenesis takes approximately 74 days plus transit time. Anything that affected you three months ago — a fever, a heavy training block, a course of medication, a rough period of sleep — shows up in today's sample. It also means any change you make will not show in a repeat analysis for at least three months.

What the hormones add. The semen analysis says what is happening; LH and FSH say where the problem sits. High FSH with a low count indicates the testis is the limiting factor. Low LH and FSH with low testosterone points upstream to the pituitary, which is investigated differently. Prolactin and thyroid can both suppress the axis and are straightforward to check at the same time.

Scope. FORM measures and explains. Fertility treatment, and any prescribed intervention, is the domain of a fertility specialist or urologist registered where you live. Note that exogenous testosterone suppresses sperm production — a fact worth knowing before any treatment conversation, and one more reason to establish a baseline first.

FAQs

How long should I abstain before a semen analysis?: Two to five days. Less reduces the count, more reduces motility, and both distort the result.
Should an abnormal result be repeated?: Yes. Semen parameters vary a lot sample to sample. Repeat after about three months, which is roughly one full production cycle.
Do I need hormone tests as well?: If the semen analysis is abnormal, yes — LH, FSH, testosterone and prolactin are what explain why, and they change what the next step should be.
Does testosterone therapy affect fertility?: Exogenous testosterone suppresses the signals that drive sperm production and can markedly reduce fertility. This is a decision for your own doctor, and a baseline before any such discussion is sensible.

Measure it properly, in one morning draw.

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Male fertility testing: what to measure and in what order

What people notice

Markers worth measuring

FAQs

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