To this day, controversy persists as to what constitutes the “ normal” spermatozoa in semen, as normal and “ pathologic” forms coexist in semen. It must be performed to a consistently high standard in order to evaluate descriptive parameters of the ejaculate. Semen analysis is an imperfect tool but remains the cornerstone of the investigation of male infertility. To accurately use these functional assays, the clinician must understand what the tests measure, what the indications are for the assays, and how to interpret the results to direct further testing or patient management. A variety of tests are available to evaluate different aspects of these functions. Sperm function testing is used to determine if the sperm have the biologic capacity to perform the tasks necessary to reach and fertilize ova and ultimately result in live births.
The methodology used in the assessment of the usual variables in semen analysis is described, as are many of the less common, but very valuable, sperm function tests. A major advance in this new edition of the WHO manual, resolving the most salient critique of previous editions, is the development of the first well-defined reference ranges for semen analysis based on the analysis of over 1900 recent fathers. In as much as the creation of a conventional semen profile will always represent the foundations of male fertility evaluation, the 5th edition of the World Health Organization (WHO) manual is a definitive statement on how such assessments should be carried out and how the quality should be controlled.
Clearly, laboratory seminology is still very much in its infancy. Semen analysis as an integral part of infertility investigations is taken as a surrogate measure for male fecundity in clinical andrology, male fertility, and pregnancy risk assessments.
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