Recommendation to diagnose male factor infertility based on routine semen analysis results

It is apparent that sperm parameters like concentration, motility and morphology are not definitive/adequate fertility measures as sperm is a heterogeneous mixture, and sperm quality is determined by only what is visible in the microscopic field. Objective was to assess the quality variation among different aliquots of an ejaculate and present a concept that may allow interpreting the results in such a way as to determine the clinical usefulness of the semen analysis more accurately.
A laboratory-based cross-sectional study was conducted at Teaching Hospital Jaffna’s Semiology laboratory from July to September 2023 after obtaining Institutional Ethical Review committee approval, analysing 102 semen ejaculates collected through masturbation. The sample was analysed using a Makler counting chamber, and Data was analysed using SPSS version 24, with statistical significance set at P< 0.05.
The three different aliquots obtained from the same ejaculate revealed no significant difference from each other for all three variables like Concentration (P=0.957), Progressive Motility (P=0.810) and Motility (P=0.832). Similarly, the mean and fifth percentile plus 95% confidence level were not significantly different (P= 0.782, P= 0.328, P= 0.370).
When using the Makler counting chamber, the mean value calculated from one aliquot per ejaculate counted on three strips of ten squares should be acceptable, and at least two different ejaculates should be analysed when interpreting the results based on World Health Organization (WHO, 2021) reference limits.