Going back even to the Mcleod and Golds breakthrough study in the 1950s which initially set twenty million sperm per ML as the normal threshold for sperm counts, it was known that a large number of men can have normal sperm counts and yet be infertile. This concept of a falsely reassuring semen analysis report is confronted in this article by Boeri et al.
In the study, the authors explore data from the semen analyses from 1358 infertile men. 16% of these men had normal parameters on their first semen analysis. But more than half of those men had abnormal parameters on a second analysis.
The authors then looked at predictors of an abnormal second analysis. They included: lower testicular volume, higher serum FSH and lower total sperm counts.
My conclusions: This article courageously looks at several uncomfortable but known facts about semen analysis. First it acknowledges in its introduction: “…between 20% and 30% of men are infertile despite having semen analysis above limits, normal medical history and normal physical examination…”. Second it acknowledges: “…semen parameters are highly variable biological measures and may vary substantially from ejaculate to ejaculate…” This is known from the results of several publications going back to Guzick et al in the New England Journal of medicine. And finally, it is acknowledged that most guidelines recommend two semen analyses. Therefore, what are the take away points?
First, this may lead to more skepticism of “good” results from over the counter semen test results. . Second the semen analysis is not the be all and end all of male fertility assessment. It’s acknowledged variability of results makes for a lest robust level of certainty associated with its results. Therefore, it encourages a search for more robust testing.
I have been using the Cap-Score semen test assessment of sperm capacitation as standard testing for all my patients without significantly low sperm counts for the past five years. The test offers less variability than standard semen testing and offers a second (in addition to semen analysis) means of assessing the effectiveness of therapy.
