The primary test to make the diagnosis of male factor infertility is the semen analysis. The semen analysis a problematic test because so much emphasis is placed on the semen analysis and yet in many circumstances it is not good at predicting if a man will have a child that is genetically his.
The semen is excellent at eliminating male factor as a cause of infertility if it is normal. However, if it is abnormal, it is very poor a predicting male infertility. The normal values are set by the World Health Organization. The shape (morphology) is determined by a set of criteria called “strict criteria” and differ from the WHO morphology criteria.
The American Society for Reproductive Medicine (ASRM) has a set of instructions for how to collect the specimen. Some clinicians prefer the first specimen to be collected without instructions to determine what is occurring naturally. Guidelines suggest obtaining 2 -3 specimens but frequently if the first specimen is normal, further specimens are not required.
The three most important numbers form the semen analysis are the concentration ( > 15 million/ mL), the motility (> 40%) and the total sperm number ( > 39 million/ ejaculate).
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