Spermiogram: techniques, interpretation, and prognostic value of results

The ejaculate specimen represents an output derived from the efficiency of three essential biological events: testicular production of sperm, progression and maturation of testicular sperm through epididymides, neurophysiological integrity of the mechanisms leading to the final process of ejaculation. All three events can negatively be affected by temporary conditions in the three months up to seminal analysis (temperature, temporary/seasonal exposure to chemical substances; extended use of medicines), and so it will be negatively influenced by chronic internal conditions (diabetes, chronic liver or kidney diseases, colopathy, etc.) that will be appropriate to call again in the patient's history (anamnesis). In a diagnostic, level-based model of care, a standard semen analysis is a first level procedure (including clinical history, physical general and focused examination, semen analysis) to be performed only when male infertility is suspected, with few or without initial specific clinical indications. Beyond the limits of semen analysis, the test may be useful for the specialist (and also to the patient!) and reliable. The reliability of the semen analysis is linked to whether it is done according to the recommendations and the codified techniques of the World Health Organization (WHO) standard manual (fourth revised edition 1999). A standard semen analysis includes three operative stages: preanalytic phase; analytic phase; postanalytic phase.