Skip to main content Accessibility help
Hostname: page-component-848d4c4894-4rdrl Total loading time: 0 Render date: 2024-06-21T20:39:20.109Z Has data issue: false hasContentIssue false

Chapter 1 - Introduction

Published online by Cambridge University Press:  16 February 2022

David Mortimer
Oozoa Biomedical Inc., Vancouver
Lars Björndahl
Karolinska Institutet, Stockholm
Christopher L. R. Barratt
University of Dundee
José Antonio Castilla
HU Virgen de las Nieves, Granada
Roelof Menkveld
Stellenbosch University, South Africa
Ulrik Kvist
Karolinska Institutet, Stockholm
Juan G. Alvarez
Centro ANDROGEN, La Coruña
Trine B. Haugen
Oslo Metropolitan University
Get access


Gives an overview of the role of semen analysis and spern function testing in the assessment of the reproductive system in adrology and in the aetiology of male factor infertility. Considers the convergence of semen anaysis reference methodology and the vital importance of training in achieving competency and controlling measurement uncertainty. Discusses how the andrology laboratory provides test results that help direct patient management, and the importance of safe and effective sperm preparation as part of assisted conception treatments.

Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Hull, MG, Glazener, CM, Kelly, NJ, et al. Population study of causes, treatment, and outcome of infertility. Br Med J (Clin Res Ed) 1985; 291: 1693–7.Google Scholar
Andersen, AG, Jensen, TK, Carlsen, E, et al. High frequency of sub-optimal semen quality in an unselected population of young men. Hum Reprod 2000; 15: 366–72.CrossRefGoogle Scholar
Sharpe, RM, Irvine, DS. How strong is the evidence of a link between environmental chemicals and adverse effects on human reproductive health? BMJ 2004; 328: 447–51.Google Scholar
Levine, H, Jørgensen, N, Martino-Andrade, A, et al. Temporal trends in sperm count: a systematic review and meta-regression analysis. Hum Reprod Update 2017; 23: 646–9.Google Scholar
Glazer, CH, Bonde, JP, Eisenberg, ML, et al. Male infertility and risk of nonmalignant chronic diseases: a systematic review of the epidemiological evidence. Semin Reprod Med 2017; 35: 282–90.Google ScholarPubMed
Hanson, MB, Eisenberg, ML, Hotaling, JM. Male infertility: a biomarker of individual and familiar cancer risk. Fertil Steril 2018; 109: 619.Google Scholar
Kasman, AM, Del Giudice, F, Eisenberg, ML. New insights to guide patient care: the bidirectional relationship between male infertility and male health. Fertil Steril 2020; 113: 469–77.CrossRefGoogle ScholarPubMed
Lane, M, Robker, RL, Robertson, SA. Parenting from before conception. Science 2014; 345: 756–60.Google Scholar
Siklenka, K, Erkek, S, Godmann, M, et al. Disruption of histone methylation in developing sperm impairs offspring health transgenerationally. Science 2015; 350: aab2006.Google Scholar
Wright, C. Lifestyle factors and sperm quality. In: Aitken, RJ, Mortimer, D, Kovacs, G, eds. Male and Female Factors That Maximize IVF Success. Cambridge: Cambridge University Press, 2020.Google Scholar
Mortimer, D, Barratt, CL, Björndahl, L, et al. What should it take to describe a substance or product as ‘sperm-safe’. Hum Reprod Update 2013; 19 Suppl 1: i1i45.CrossRefGoogle ScholarPubMed
Barratt, CLR, De Jonge, CJ, Sharpe, RM. ‘Man Up’: the importance and strategy for placing male reproductive health centre stage in the political and research agenda. Hum Reprod 2018; 33: 541–5.Google Scholar
Aitken, RJ. Not every sperm is sacred; a perspective on male infertility. Mol Hum Reprod 2018; 24: 287–98.Google Scholar
Cairo Consensus Workshop Group. The current status and future of andrology: a consensus report from the Cairo workshop group. Andrology 2020; 8: 2752.Google Scholar
Björndahl, L, Barratt, CL. Semen analysis: setting standards for the measurement of sperm numbers. J Androl 2005; 26: 11.Google Scholar
Björndahl, L, Barratt, CL, Mortimer, D, Jouannet, P.How to count sperm properly’: checklist for acceptability of studies based on human semen analysis. Hum Reprod 2016; 31: 227–32.Google ScholarPubMed
Riddell, D, Pacey, A, Whittington, K. Lack of compliance by UK andrology laboratories with World Health Organization recommendations for sperm morphology assessment. Hum Reprod 2005; 20: 3441–5.CrossRefGoogle ScholarPubMed
Zuvela, E, Matson, P. Performance of four chambers to measure sperm concentration: results from an external quality assurance programme. Reprod Biomed Online 2020; 41: 671–8.Google Scholar
World Health Organization. WHO Laboratory Manual for the Examination and Processing of Human Semen, 6th edn. Geneva: World Health Organization, 2021.Google Scholar
International Organization for Standardization. ISO 23162:2021 Basic Semen Examination – Specification and Test Methods. Geneva: International Organization for Standardization, 2021.Google Scholar
Keel, BA. Within- and between-subject variation in semen parameters in infertile men and normal semen donors. Fertil Steril 2006; 85: 128–34.CrossRefGoogle ScholarPubMed
Castilla, JA, Alvarez, C, Aguilar, J, et al. Influence of analytical and biological variation on the clinical interpretation of seminal parameters. Hum Reprod 2006; 21: 847–51.Google Scholar
Stokes-Riner, A, Thurston, SW, Brazil, C, et al. One semen sample or 2? Insights from a study of fertile men. J Androl 2007; 28: 638–43.CrossRefGoogle ScholarPubMed
Hirsh, A. Male subfertility. BMJ 2003; 327: 669–72.Google Scholar
Mishail, A, Marshall, S, Schulsinger, D, Sheynkin, Y. Impact of a second semen analysis on a treatment decision making in the infertile man with varicocele. Fertil Steril 2009; 91: 1809–11.Google Scholar
Barratt, CLR, Björndahl, L, De Jonge, CJ, et al. 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; 23: 660–80.Google Scholar
Björndahl, L. What is normal semen quality? On the use and abuse of reference limits for the interpretation of semen analysis results. Hum Fertil 2011; 14: 179–86.Google Scholar
Mortimer, D, Mortimer, ST. The case against intracytoplasmic sperm injection for all. In: Aitken, RJ, Mortimer, D, Kovacs, G, eds. Male and Female Factors That Maximize IVF Success. Cambridge: Cambridge University Press, 2020.Google Scholar
MacLeod, J, Wang, Y. Male fertility potential in terms of semen quality: a review of the past, a study of the present. Fertil Steril 1979; 31: 103–16.Google Scholar
Guzick, DS, Overstreet, JW, Factor-Litvak, P, et al. National Cooperative Reproductive Medicine Network. Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med 2001; 345: 1388–93.CrossRefGoogle ScholarPubMed
Jedrzejczak, P, Taszarek-Hauke, G, Hauke, J, et al. Prediction of spontaneous conception based on semen parameters. Int J Androl 2008; 31: 499507.CrossRefGoogle ScholarPubMed
van Weert, JM, Repping, S, Van Voorhis, BJ, et al. Performance of the postwash total motile sperm count as a predictor of pregnancy at the time of intrauterine insemination: a meta-analysis. Fertil Steril 2004; 82: 612–20.CrossRefGoogle ScholarPubMed
Jequier, AM. The importance of diagnosis in the clinical management of infertility in the male. Reprod Biomed Online 2006; 13: 331–5.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats