Semen analysis is the first and the main method of male fertility assessment, based on microscopic ejaculate examination, which is carried out under magnification from 200x to 2000x both in a native preparation and on a stained smear in order to identify spermatozoa capable to participate in fertilization. In our practice, we use the latest 6th edition of WHO 2021 recommendations.
If there are no deviations from the references in the spermogram, most likely, infertility is not related to the male factor, but it is worth applying additional tests in order to make sure of this. With normal semen analysis parameters, or in case of minor deviations, it is possible to use the intrauterine insemination (IUI). However, in case of significant deviations in semen parameters, the logical step would be to use in vitro fertilization technologies in the IVF program.
For an embryologist who works with gametes and performs fertilization, it is important to understand which method should be used to achieve the desired result, and that is the information to search in the spermogram. The key parameters in the analysis are macroscopic (volume, viscosity) and microscopic (concentration, motility, morphology of spermatozoa) parameters. Reference spermogram values were calculated on the basis of an extensive WHO population study, in which the probability of natural conception was analyzed in men with various semen parameters. Nevertheless, it is impossible to establish the exact boundaries of norm and pathology for the ejaculate characteristics in relation to ART, since modern fertilization technologies and the long-term experience of our employees make it possible to significantly expand the boundaries of fertility. Presence of at least several viable spermatozoa allows to perform fertilization in the laboratory of embryology, however, for selection of fertilization method (IVF or ICSI), it is important to assess not the specific pathomorphological changes in individual spermatozoa, but the proportion of spermatozoa capable of participating in fertilization. In other words, to help infertile couples, there is no difference in what kind of abnormalities the sperm will carry. Therefore, in the spermogram from our laboratory there are no separate values of proportions of pathologies of the sperm head, neck or tail, there are no indices of teratozoospermia and pathospermia, all these forms are combined into a group of abnormal spermatozoa.