Semen Analysis and Male Fertility Diagnostics
Summary
Semen analysis remains the cornerstone of male fertility evaluation, providing the primary clinical assessment of reproductive potential. Conventional analysis quantifies key parameters in ejaculate samples: sperm concentration, motility and morphology. Over the past two decades, extended assays for sperm DNA fragmentation, oxidative stress and hyaluronic binding have enriched diagnostic insights into fertilisation potential and underpin selection of assisted reproductive techniques. Standardisation through successive WHO laboratory manuals and complementary ISO guidelines has sought to harmonise protocols and reference frameworks, although inter-laboratory variability and observer dependence continue to pose challenges. Recent technological advances include automated image analysis, smartphone-enabled point-of-care devices and machine-learning algorithms that deliver rapid, objective measurements outside specialised facilities, enabling at-home testing and large-scale epidemiological studies. The shift towards decision limits in place of rigid reference thresholds aims to contextualise semen parameters within individual clinical scenarios, reflecting associations with fertilisation outcomes and broader health indicators. Collectively, these innovations bridge basic science, clinical diagnostics and public health, addressing the global prevalence of male factor infertility and informing patient management across diverse healthcare settings.
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Semen Analysis and Male Fertility Diagnostics publication trend
The graph below shows the total number of articles in semen analysis and male fertility diagnostics across all publications each year (not limited to Nature Index journals).
Technical terms
Semen analysis: A suite of laboratory tests that assess ejaculate for sperm concentration, motility and morphology to evaluate male fertility potential.
Sperm concentration: The number of spermatozoa per millilitre of semen, typically expressed as millions per millilitre.
Sperm motility: The proportion of spermatozoa exhibiting progressive movement, indicating the ability to navigate the female reproductive tract.
Sperm morphology: The assessment of sperm shape and structure, with abnormal forms potentially impairing fertilisation.
Sperm DNA fragmentation: A measure of strand breaks in sperm DNA, reflecting genomic integrity and predictive of fertilisation and pregnancy outcomes.
Oxidative stress: An imbalance between reactive oxygen species and antioxidants in semen, which can damage sperm membranes and DNA.
Decision limits: Clinically derived thresholds that guide diagnostic interpretation by correlating semen parameters with reproductive outcomes, replacing rigid reference ranges.
References
- Introducing a New Smartphone Applied Semen Analyzer, SpermCell™: A Cross-Sectional Validation Study with a Comparative Analysis and a Mini Patient Questionnaire on a Large Sample Cohort. Diagnostics (2024).
- The Sixth Edition of the WHO Manual for Human Semen Analysis: A Critical Review and SWOT Analysis. Life (2021).
- The sixth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen: ensuring quality and standardization in basic examination of human ejaculates. Fertility and Sterility (2022).
- A paradigmatic shift in the care of male factor infertility: how can the recommendations for basic semen examination in the sixth edition of the WHO manual and the ISO 23162:2021 standard help?. Reproductive BioMedicine Online (2022).
- Web- and Artificial Intelligence–Based Image Recognition For Sperm Motility Analysis: Verification Study. JMIR Medical Informatics (2020).
- Interobserver Variability in Semen Analysis: Findings From a Quality Control Initiative. Cureus (2023).
- Implementation of World Health Organization Recommendations for Semen Analysis: A Survey of Laboratories in the United Kingdom. Andrologia (2024).
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