Semen analysis: looking for an upgrade in class

Objective To review the literature database regarding current methods for diagnosing male subfertility and to critique new testing methods that have the potential to be incorporated as part of routine semen analysis. Design Literature database review. Setting None. Patient(s) None. Intervention(s) None. Main Outcome Measure(s) None. Result(s) Methods for performing high quality semen analysis are standardized and clearly presented in the 2010 World Health Organization (WHO) laboratory manual for the examination and processing of human semen. In spite of the fact that lower reference limits contained therein are now evidence-based, debate persists about their clinical value. One test put forth as being additive to the semen analysis is assessment of DNA integrity. However, due to lack of standardized methods and quality control measures, accessibility to instrumentation, and evidence-based reference values for clinical interpretation this test has not become incorporated into the clinical andrology mainstream. Novel tests that probe molecular function have emerged that also have promise for integration into routine clinical semen analysis. Conclusion(s) Semen analysis, when performed according to WHO guidelines, will yield accurate and precise clinical laboratory data on traditional semen parameters. Due to the biological nature of the specimen in question definitive diagnosis of subfertility and its cause(s) remains enigmatic. Novel tests that may be easily standardized for subsequent multi-center, prospective randomized trials need to be integrated so more meaningful clinical diagnoses can be made.