Semen analysis is an important part of the basic workup for infertility. In 30% – 40% of couples diagnosed with infertility there is a male factor. Spermatogenesis and transport takes approximately 70 days. Therefore, any intervention to improve sperm parameters should be given this time before reassessment.
An optimal sample for semen analysis is obtained after 2 – 5 days of abstinence. Reference ranges based on the WHO 5th Edition (2010) were established from a population of fertile men with a time to pregnancy of less than 12 months. The lower 5th centile was used as a threshold for normal semen parameters. The most important results are the concentration (> 15 million/ml), motility (> 40%) and progressive motility (> 32%). Morphology is of lesser importance. In the WHO 1st edition 80.5% normally shaped sperm were required, that was decreased to 50%, 30% and 15% over the next editions. The current 5th edition uses a cutoff of 4% for morphology. Research suggests that even 0% morphology does not preclude a pregnancy.