Semen analysis is the most important investigation of male subfertility. This is not a test for fertility but a guide for minimal standards of adequacy. What constitutes a ‘normal’ result has been a matter of debate, and recently the WHO normal ranges for semen parameters have changed.
World Health Organization reference limits for semen parameters
| Parameter | Reference limit | 95% confidence interval |
| Semen volume (ml) | 1.5 | 1.4–1.7 |
| Sperm concentration (106/ml) | 15.0 | 12–16 |
| Total number (106/ejaculate) | 39.0 | 33–46 |
| Total motility (PR+NP,%) | 40.0 | 38–42 |
| Progressive motility (PR,%) | 32.0 | 31–34 |
| Normal forms (%) | 4.0 | 3.0–4.0 |
| Vitality (%) | 58.0 | 55–63 |
NP = non-progressive motility; PR = progressive motility
Other consensus threshold values
| pH | ≥ 7.2 |
| Peroxidase-positive leukocytes (106 per mL) | < 1.0 |
| MAR test (motile spermatozoa with bound particles, %) | < 50 |
| Immunobead test (motile spermatozoa with bound beads, %) | < 50 |
| Seminal zinc (μmol/ejaculate) | ≥ 2.4 |
| Seminal fructose (μmol/ejaculate) | ≥ 13 |
| Seminal neutral glucosidase (mU/ejaculate) | ≥ 20 |
References:
- Barratt CLR, Björndahl L, De Jonge CJ, Lamb DJ, Osorio Martini F, McLachlan R, Oates RD, van der Poel S, St John B, Sigman M, Sokol R, Tournaye H. The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidance-challenges and future research opportunities. Hum Reprod Update. 2017 Nov 1;23(6):660-680. [Medline]
- Gatimel N, Moreau J, Parinaud J, Léandri RD. Sperm morphology: assessment, pathophysiology, clinical relevance, and state of the art in 2017. Andrology. 2017 Sep;5(5):845-862. [Medline]
- WHO laboratory manual for the examination and processing of human semen. Fifth edition. 2010 [Full Text]
Created Jan 02, 2019.
