Semen Analysis

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Subject: Semen Analysis

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Definition

  • A complete semen analysis measures both macroscopic and microscopic characteristics of a semen specimen, all of which can provide clues in the workup of male infertility.

  • Reference ranges (WHO):

    • pH: 7.2–7.8

    • Volume: 1.5 mL (95% CI 1.4–1.7)

    • Concentration: ≥15 million/mL (95% CI 12–16)

    • Total sperm number (count): 39 million per ejaculate (95% CI 33–46)

    • Progressive motility: 32% (95% CI 31–34)

    • Total motility (progressive + nonprogressive): 40% (95% CI 38–42)

    • Vitality: 58% live (95% CI 55–63)

    • Morphology: ≥ 30% normal forms (WHO criteria), or

    • ≥ 4% normal forms (“strict” Tygerberg criteria)

Use

  • Primary test for male factor infertility in the workup of infertility in a couple

  • Confirmation of the effectiveness of vasectomy (sperm concentration alone)

Interpretation

Limitations

  • Minimum specimen volume for microscopic analysis is 0.1 mL.

  • Highly viscous specimens may affect accuracy of concentration results.

  • A minimum of two analyses, preferably 1 month apart, are recommended to correct for cyclical variation in sperm concentration.

  • Specimen collection should occur within a window of 48- to 72-hour abstinence to maximize average concentration of live cells.

Suggested Readings

Cooper  TG, Noonan  E, von Eckardstein  S World Health Organization reference values for human semen characteristics. Hum Reprod Update.  2010;16:231–245.
World Health Organization Department of Reproductive Health and Research. World Health Organization Laboratory Manual for the Examination and Processing of Human Semen, 5th ed. Geneva, Switzerland: World Health Organization, 2010.
 
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