Relation between semen quality and fertility: a population-based study of 430 first-pregnancy planners
Abstract
Background Semen analysis is part of the routine assessment of infertile couples. WHO defines a sperm concentration above 20x10(6) per mL seminal fluid as normal. We studied the association between semen quality and the probability of conception in a single menstrual cycle in Danish couples with no previous reproductive experience. Methods In 1992-94, we invited 52,255 trades-union members aged 20-35 years, who lived with a partner and had no children to take part in the study; 430 couples agreed. The couples discontinued use of contraception, and were followed up for six menstrual cycles or until a pregnancy was verified within this period. Each man was asked to provide a semen sample at enrolment (which was analysed without freezing). Women kept a daily record of vaginal bleeding and sexual activity. The association between semen quality and likelihood of pregnancy was assessed by logistic regression, adjusted for sexual activity and female factors associated with low fertility. Results There were 256 (59.5%) pregnancies among the 430 couples: 165 (65.0%) among those with a sperm concentration of 40x10(6)/mL or more and 84 (51.2%) among those with lower sperm concentrations. The probability of conception increased with increasing sperm concentration up to 40x10(6)/mL, but any higher sperm density was not associated with additional likelihood of pregnancy. The proportion of sperm with normal morphology was strongly related to likelihood of pregnancy independently of sperm co…
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A study published in The Lancet noted that in men with an increased proportion of sperm with abnormal morphology, the likelihood of pregnancy was decreased.
“These findings were propagated by a study published in The Lancet3 that noted in men with an increased proportion of sperm with abnormal morphology, and the likelihood of pregnancy was decreased.”
From Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction (2017) · cites this paper as [3]
The predictive value of sperm parameters for detecting infertility is low.
“In these studies, although correlations were observed between morphology and natural fertility, the predictive value of sperm parameters for detecting infertility was low.”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [2]
Sperm morphology is correlated with the chances of natural pregnancy in epidemiological studies comparing fertile men whose partners achieved natural pregnancy and infertile men.
“Epidemiological studies comparing fertile men whose partners achieved natural pregnancy and infertile men have demonstrated that sperm morphology was correlated with the chances of natural pregnancy [1, 2, 3].”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [2]
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World Health Organization reference values for human semen characteristics*‡
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“…of America, Americas 487 Swan et al. (2003)21 Yesb France, Finland, Denmark, United Kingdom, Europe 826 Auger et al. (2001)22, Jørgensen et al. (2001)23, Slama et al. (2002)24 Yesb Denmark, Europe 199 Bonde et al. (1998)25, Jensen et al. (2001)26 Yesb aMorphology results not utilised in this study.”
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Trihalomethane Levels in Home Tap Water and Semen Quality
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- Authors
- Bonde, J. P. E., Ernst, E., Jensen, T. K., Hjollund, N. H. I., Kolstad, H., Scheike, T., Giwercman, A., Skakkebæk, N. E., Henriksen, T. B., & Olsen, J.
- Affiliations
- Aarhus University Hospital (DK)
- Aarhus University (DK)
- Copenhagen University Hospital (DK)
- University of Copenhagen (DK)
- Corresponding author
- Bonde, Jens Peter E
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1998-10
- Volume
- 352
- Issue
- 9135
- Pages
- 1172-1177
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2068925756
- Cited by
- 791
- References
- 1
- Citations by year
- 2026: 10 · 2025: 20 · 2024: 21 · 2023: 25 · 2022: 32 · 2021: 24 · 2020: 28 · 2019: 29 · 2018: 36 · 2017: 31 · 2016: 28 · 2015: 36 · 2014: 38 · 2013: 46 · 2012: 40
- FWCI
- 18.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
- Keywords
- semen quality, male fertility, sperm concentration, sperm morphology, conception probability, first pregnancy, subfertility, semen analysis, semen volume, sperm motility, couples without children
- MeSH terms
- Adult, Denmark, Female, Fertility, Humans, Male, Pregnancy, Semen, Sperm Motility, Spermatozoa, World Health Organization, Logistic Models, Odds Ratio
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