Afterword to Semen Analysis in 21st Century Medicine special issue in Asian Journal of Andrology

Abstract

Semen analysis as an integral part of infertility investigations has a surprisingly long history, emerging only slowly, from under a cloud of disrepute and occupying a solitary niche outside conventional pathology tests, until relatively recently. From origins in the 19th century when spermatozoa were only identified as present or absent in cervical mucus samples from postcoital tests, even then a practice deemed “... dabbling.... incompatible with decency and self-respect...” (cited in 1). Only in 1929 was the first paper using quantitative methods, recognisable forerunners of modern semen analysis, reported in a respectable medical journal 2. The clinical perspective on systematic investigation of male infertility with an appropriate focus on semen analysis was first comprehensively outlined in Robert Hotchkiss's 1944 book “Fertility in Men” 1. The systematisation of laboratory semen analysis largely stems from work Dr John MacLeod, a Scot working in New York, who staked out the ground by publishing a series of landmark papers in semen analysis over 4 decades from the early 1940s including, together with a statistician (Ruth Gold), the first large scale normative studies of semen analysis. During the post-WWII decades semen analysis became integrated into routine clinical infertility practice, typically undertaken in specialised laboratories as an adjunct to infertility clinics and performed by a small corps of laboratory scientists who focused exclusively on semen analysis and operating largely outside conventional pathology circles. In the absence of any agency taking responsibility to maintain congruence of laboratory techniques, this inevitably led to unintended divergence of customary practice in methodology and reporting.