Is a semen analysis (semen examination) a suitable next step for a healthy male with a history of previous fertility (having one child) who has been trying to conceive for one year without success?

Semen Analysis is Appropriate and Recommended

Yes, order two semen analyses at least one month apart for this man who has been trying to conceive for one year, even though he has proven prior fertility. 1, 2

Why Semen Analysis is Indicated After 12 Months

• The American Academy of Family Physicians recommends beginning male infertility evaluation after 12 months of unprotected intercourse without conception, regardless of prior fertility history. 1, 2
• Prior fertility does not guarantee current fertility—semen parameters can change over time due to aging, illness, medications, lifestyle factors, or new medical conditions that have developed since the previous conception. 3, 4
• The standard 12-month threshold applies to this case since no mention is made of the female partner being over 35 years old or either partner having known risk factors that would warrant earlier evaluation. 1, 2

The Two-Test Requirement is Critical

• Always order two semen analyses separated by at least one month to confirm persistent abnormalities, as semen parameters fluctuate substantially between tests due to biological variability. 1, 2, 5
• A single semen analysis is insufficient for diagnosis because temporary conditions in the three months prior to testing (fever, heat exposure, medications, stress) can negatively affect results. 6
• The substantial biological variation between ejaculates means that one abnormal result cannot definitively diagnose infertility, and one normal result cannot rule it out. 3

Proper Collection Instructions Matter

• Instruct the patient to abstain from sexual activity for 2-3 days before collection, as inadequate abstinence significantly affects volume and concentration, invalidating results. 1, 5
• The sample must be examined within one hour of collection, as delayed analysis affects motility assessment and compromises accuracy. 1, 5
• Collection can be done by masturbation or intercourse using specialized semen collection condoms (not regular condoms, which contain spermicides). 5

Simultaneous Evaluation of Both Partners

• Evaluate both partners simultaneously from the outset—never evaluate only one partner, as male factor contributes to 40-50% of infertility cases. 2, 7
• While ordering semen analysis for the male partner, the female partner should undergo concurrent evaluation including assessment of ovulatory function, ovarian reserve, and structural abnormalities. 2, 7

What Happens After the Semen Analyses

• If both semen analyses show normal parameters (volume ≥1.4 mL, pH >7.2, concentration ≥16 million/mL, progressive motility ≥30%), the evaluation shifts focus to other potential causes including female factors and unexplained infertility. 1
• If sperm concentration is <10 million/mL on either test, order endocrine evaluation including serum testosterone and FSH. 1, 2
• Any abnormal semen parameters require referral to a male reproductive specialist for complete evaluation. 2
• If severe oligospermia (<5 million/mL) or azoospermia is found, order genetic testing including karyotype and Y-chromosome microdeletion testing. 1

Critical Pitfall to Avoid

• Laboratory quality is crucial—many laboratories do not adhere to WHO standardized methods, leading to unreliable results. 1, 5 Ensure the laboratory is accredited and follows WHO protocols.
• Do not assume normal semen analysis equals fertility, as 25% of infertility cases remain unexplained despite normal conventional parameters, and semen analysis alone cannot distinguish fertile from infertile men. 1, 2
• The substantial overlap in semen parameters between fertile men and those in infertile couples means results must be interpreted in clinical context alongside history and physical examination findings. 3, 5