Limitations of semen analysis as a test of male fertility and anticipated needs from newer tests

Capsule:
Semen analysis is the cornerstone for the diagnosis of male factor infertility. Routine semen analysis cannot assess spermatozoal fertilizing potential. New tests should predict the outcome of assisted reproduction and risks to progeny.

Authors:
Christina Wang, M.D., Ronald S. Swerdloff, M.D.

Volume 102, Issue 6, Pages 1502-1507

Abstract:
Semen analysis is the first step to identify male factor infertility. Standardized methods of semen analysis are available allowing accurate assessment of sperm quality and comparison among laboratories. Population-based reference ranges are available for standard semen and sperm parameters. Sperm numbers and morphology are associated with time to natural pregnancy, whereas sperm motility may be less predictive. Routine semen analysis does not measure the fertilizing potential of spermatozoa and the complex changes that occur in the female reproductive tract before fertilization. Whether assisted reproduction technology (ART) is required depends not only on male factors but female fecundity. Newer tests should predict the success of fertilization in vitro and the outcome of the progeny.

  • The article makes a great case for more widespread sperm functional testing. In order for sperm functional testing to gain a higher level of acceptance, it would be useful to have head-to-head trial evidence showing that couples who undergo sperm functional testing as part of their workup get pregnant faster, cheaper and at higher rates than those who don’t. From the article it does not appear that such evidence exists (or does it?) Given the complexities of the issue and the many factors involved, along with the limitations of current testing, would it be feasible to consider such a trial?

  • ranjithrama

    Unfortunately, semen parameters are often interpreted like other laboratory (blood / urine) tests as “normal” and “abnormal”. Often, men are erroneously labeled “fertile” or “infertile” based on a semen analysis. With advances in molecular diagnostics, there is an urgent need as stressed in this article, to identify etiologies of male infertility.

    • Jason Kovac

      It would be great to have a molecular “chip” test that would identify, in NOA men, the exact cause of their infertility. Especially if we had treatments for these specific causes.

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