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Condition & Treatments 

/ Normal semen, not conceiving

Normal semen test, but still not pregnant? The male side may still matter.

A "normal" semen analysis is reassuring, but it doesn't guarantee fertility. The reference values are based on what most fertile men produce, and a standard test measures only count, movement and shape [1]. It doesn't show sperm DNA damage, hidden infection, antibodies, or problems with sex and ejaculation. A male factor is involved in about half of couples who struggle to conceive [2].

I N   S H O R T

Up to half of fertility problems involve the male partner, even when the semen test looks normal.

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Some of the most common hidden causes, such as sperm DNA damage or infection, need specific tests.

 

Many of them can be treated within around three months.

Talk it through with Prof Raheem

Video £250 · In clinic £400

What a normal test can miss

Sperm DNA damage. Sperm can look normal and still carry broken DNA, which lowers the chance of pregnancy and raises the risk of miscarriage.

Hidden infection or inflammation. Often without symptoms, and missed unless specifically looked for.

Antisperm antibodies. The immune system can coat sperm, stopping them reaching or entering the egg.

Variation between tests. A single normal result may not be typical, and lab quality varies.

Varicocele or hormone imbalance. These can affect sperm function before the numbers change.

Sex and timing. Infrequent sex, timing problems, some lubricants, or difficulty with erection or ejaculation.

Age. Sperm quality declines with age, even when counts look normal.

Tests

Repeat semen analysis, in a specialist Andrology lab.

Sperm DNA fragmentation.

Semen culture and semen microbiome, to look for infection.

Antisperm antibody test.

Hormone profile and scrotal ultrasound.

A detailed sexual and medical history, which often reveals the simplest answers.

What can help

Treating what is found: infection, varicocele, hormone imbalance or DNA damage.

Practical changes: timing, frequency and fertility-friendly lubricants.

Choosing the right treatment, such as IUI or ICSI, with your sperm in the best possible condition.

Testicular sperm for ICSI, for men with high DNA damage, taken fresh on the day of egg collection.

Why this matters to your care

When the semen test is normal, couples are often told the problem is unexplained. Prof Raheem looks beyond the standard test, so a treatable male factor isn't missed.

Our clinic says it's unexplained infertility. Is it worth seeing you?

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Yes. Unexplained often means the male side hasn't been fully assessed.

Do I need all of these tests?

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No. Prof Raheem chooses the tests that fit your history and results.

Could it still be on my partner's side?

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Yes, and often both. Assessing the male side properly helps your partner's team too.

References

1. World Health Organization. WHO laboratory manual for the examination and processing of human semen, 6th edition, 2021. Link

2. Agarwal A, et al. A unique view on male infertility around the globe. Reproductive Biology and Endocrinology, 2015. Link

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