Women’sHealthHospital,Dept. ofObstetricsG accepted 3 November 20131. IntroductionAbout 15% of sexually active, non contracepting couples donot achieve pregnancy within 1 year of marriage and aretherefore described as infertile (1). No cause of infertility canbe found using routine diagnostic work-up in 10–15% of thecouples. A male contribution to infertility is encountered in45–50% of the remaining cases (2). Male and female infertilityfactors often coexist. In 30–45%, the cause of abnormal semenparameters remains enigmatic (idiopathic male infertility)(3,4).Semen analysis is of great value in the initial investigationof the male and its results are often taken as a surrogatemeasure of male fecundity and chances of pregnancy. It alsoprovides information on the functional integrity of thegerminal epithelium, epididymis and accessory sex glands.Additionally, reference ranges for semen parameters from afertile population may provide important data from whichthe diagnosis of infertility or prognosis of fertility can beextrapolated. Routine semen analysis should provide adequateinformation about the physical characteristics of semen(liquefaction, viscosity, pH, color, odor and volume), spermcount, sperm motility and progression, sperm morphology,leukocyte quantification and fructose detection in cases ofazoospermia or oligospermia.From an evidence-based perspective, are the measuredsemen parameters truly and wholly reflective of a man’s repro-ductive capacity? Are those parameters carefully chosen toencompass the multifaceted and complex nature of suchprocess? Are the currently acceptable values for a normalsemen analysis considered accurate ‘pass marks’ for parenthood?Will a normal semen analysis guarantee a successful culminationof a man’s endeavor to father a child? Does an abnormal semenanalysis necessarily designate abnormality?Regrettably, negation is the answer to most, if not all, theaforementioned questions. That said, two fundamental issuesfollow, why and how. Why is the currently applied semenanalysis short of providing an adequate evidence-basedsubstantiation of a man’s fertile capacity? How could we addvalue to such an important and non-invasive investigatory tool?2. Why is the currently adopted semen analysis inadequate?The prognostic value of semen components such as spermcount, motility and morphology, as surrogate markers of malefertility, is confounded by several variables. The fertility poten-tial of a man is influenced by sexual activity, function of acces-sory sex glands and other confounders. Routine semen analysisitself has its own limitations, and does not assess for spermdysfunction such as immature chromatin or fragmentedDNA. Results from at least two, preferably three, properlyspaced separate seminal analyses must be obtained before adefinitive conclusion can be drawn as wide biological variabil-ity exists within the same individual. The numerous character-istics assayed by semen analysis are only few of the many facetsreflecting semen quality. Almost one third of men with anormal semen analysis actually have abnormal sperm function.In contradistinction, men with poor semen analysis results maygo onto father children. Semen analysis should follow theWHO guidelines, laboratory manual for the examination andprocessing of human semen (5). Semen analysis may show adecreased number of sperm (oligozoospermia), decreasedmotility (asthenozoospermia), and many abnormal forms onmorphologic examination (teratozoospermia). These