Abnormal Semen Analysis

  • John P. Mulhall
  • Peter J. Stahl
  • Doron S. Stember


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).


Clomiphene Citrate Sperm Concentration Semen Quality Viable Sperm Male Factor Infertility 
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Suggested Reading

  1. Male Infertility Best Practice Policy Committee of the American Urological Association, Practice Committee of the American Society for Reproductive Medicine. Report on optimal evaluation of the infertile male. Fertil Steril. 2006;86(5 Suppl 1):S202–9.Google Scholar
  2. Male Infertility Best Practice Policy Committee of the American Urological Association, Practice Committee of the American Society for Reproductive Medicine. Report on varicocele and infertility. Fertil Steril. 2004;82 Suppl 1:S142–5.Google Scholar
  3. Practice Committee of American Society for Reproductive Medicine in collaboration with Society for Male Reproduction and Urology. The management of infertility due to obstructive azoospermia. Fertil Steril. 2008;90(5 Suppl):S121–4.Google Scholar
  4. Showell MG, Brown J, Yazdani A, Stankiewicz MT, Hart RJ. Anti-oxidants for male subfertility. Cochrane Database Syst Rev. 2011;1(1):CD007411.Google Scholar
  5. Sokol RZ. Endocrinology of male infertility: evaluation and treatment. Semin Reprod Med. 2009;27(2):149–58.PubMedCrossRefGoogle Scholar
  6. Stahl PJ, Stember DS, Schlegel PN. Interpretation of the semen analysis and initial male factor management. Clin Obstet Gynecol. 2011;54(4):656–65.PubMedCrossRefGoogle Scholar
  7. World Health Organization. WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organization; 2010.Google Scholar
  8. Zini A, Boman JM. Varicocele: red flag or red herring? Semin Reprod Med. 2009;27(2):171–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • John P. Mulhall
    • 1
  • Peter J. Stahl
    • 2
  • Doron S. Stember
    • 3
  1. 1.Sexual and Reprodictive Medicine Program Department of Surgery Division of Urology, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of UrologyColumbia University College of Physicians & SurgeonsNew YorkUSA
  3. 3.Department of UrologyBeth Israel Medical Center Albert Einstein College of Medicine of Yeshiva UniversityNew YorkUSA

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