Prerequisites Before Semen Analysis
Patients must abstain from sexual activity for 2-3 days before semen collection, and the specimen must be examined within one hour of collection to ensure valid results. 1
Critical Pre-Collection Requirements
Abstinence Period
- Instruct patients to abstain from ejaculation for 2-3 days (48-72 hours) before collection. 1, 2 This is the standard recommendation from the American Academy of Family Physicians and American Urological Association guidelines.
- Inadequate abstinence significantly affects semen volume and sperm concentration, invalidating the entire analysis. 2
- While WHO guidelines traditionally recommend 2-7 days of abstinence, emerging research suggests shorter abstinence periods (even 1 day) may improve sperm quality parameters like motility and DNA integrity, though the 2-3 day standard remains the guideline recommendation. 3, 4, 5
Collection Method
- Collect semen by masturbation or intercourse using specialized semen collection condoms (not regular condoms, which contain spermicides). 1, 2
- If collected at home, keep the specimen at room temperature or body temperature during transport. 1, 2
- The specimen must be examined within one hour of collection, as delayed analysis significantly affects motility assessment and invalidates results. 1, 2
Patient Instructions and History
Information to Provide Before Collection
- Explain the proper collection technique, as improper technique invalidates all results. 2
- Inform patients that two semen analyses performed at least one month apart are required for complete evaluation, as single tests do not account for biological variability. 1, 2
- Advise patients to avoid excessive heat exposure to the scrotum in the days leading up to collection. 1
Essential History to Obtain Before Testing
- Medication history: Document all prescription and non-prescription drugs, particularly anabolic steroids, which significantly reduce fertility. 1, 6, 7
- Gonadal toxin exposure: Ask about occupational exposures to heat, pesticides, and chemicals. 1, 6
- Sexual history: Include frequency and timing of intercourse, sexually transmitted diseases, and duration of infertility. 1
- Medical history: Document systemic illnesses, previous surgeries (especially cryptorchidism), and childhood developmental history. 1
Common Pitfalls to Avoid
- Do not accept specimens collected with inadequate abstinence periods, as this is the most common reason for invalid results. 2
- Do not analyze specimens more than one hour after collection, as motility parameters become unreliable. 1, 2
- Do not rely on a single semen analysis for diagnosis—always obtain at least two samples one month apart. 1, 2
- Ensure the laboratory uses WHO-standardized methods, as many laboratories fail to adhere to proper quality control, leading to unreliable results. 2, 8
Special Circumstances
Post-Vasectomy Semen Analysis
- For vasectomy verification, perform semen analysis 8-16 weeks after the procedure (updated from the older 6-8 week recommendation). 1
- Patients should refrain from ejaculation for approximately 1 week immediately after vasectomy to allow surgical site healing. 1
- Use barrier contraception until azoospermia or rare nonmotile sperm (<100,000 nonmotile sperm/mL) is confirmed. 1