Abnormal Semen Analysis

Abstract

Interpretation of semen analysis (SA) results is an important skill for any clinician who cares for men with subfertility or testicular dysfunction. Confirmed SA abnormalities indicate the presence of male factor infertility, which occurs in 40–60% of subfertile couples, and guides subsequent evaluation and management. Male factor infertility is important to identify because it may be amenable to medical or surgical therapy, and because it may be the presenting symptom of occult health-threatening conditions such as hypogonadism or testicular cancer. Moreover, some causes of severe male factor infertility such as Y chromosome microdeletions and ­chromosomal translocations are ­genetically transmissible and may threaten the health or fertility of the patient’s potential offspring. Semen analysis should be performed according to standard protocol published by the World Health Organization (WHO). Each sample should be collected after an ejaculatory abstinence period of 2–5 days. Samples should be collected in wide-mouthed, sterile containers, maintained as close as possible to body temperature, and analyzed within 1 h. The semen sample is allowed to liquefy and is examined under wet mount light microscopy. The main parameters analyzed are ejaculate volume, pH, sperm concentration (sperm per mL), total sperm number (sperm per total ejaculate), sperm motility (% of sperm with any motility and % of sperm with forward progressive motility), and sperm morphology (% of morphologically normal sperm). Abnormalities of semen parameters are typically described using standard nomenclature (Table 1.1) based upon reference values published by the WHO (Table 1.2).