Semen Analysis Report Research Articles

Metabolomic characterization of semen from asthenozoospermic patients using ultra-high-performance liquid chromatography-tandem quadrupole time-of-flight mass spectrometry.

Asthenozoospermia (AS) is a common factor of male infertility, and its pathogenesis remains unclear. The purpose of this study was to investigate the differential seminal plasma metabolic pattern in asthenozoospermic men and to identify potential biomarkers in relation to spermatogenic dysfunction using sensitive ultra‐high‐performance liquid chromatography–tandem quadruple time‐of‐flight MS (UHPLC–Q‐TOF/MS). The samples of seminal plasma from patients with AS (n = 20) and healthy controls (n = 20) were checked and differentiated by UHPLC–Q‐TOF/MS. Compared with the control group, the AS group showed a total of nine significantly different metabolites, including increases in creatinine, uric acid, N6‐methyladenosine (m6A), uridine, and taurine and decreases in carnitine, nicotinamide, N‐acetylputrescine and l‐palmitoylcarnitine. By analyzing the correlation among these metabolites and clinical computer‐assisted semen analysis reports, we found that m6A is significantly correlated with not only the four decreased metabolites but also with sperm count, motility, and curvilinear velocity. Furthermore, nicotinamide was shown to correlate with other identified metabolites, indicating its important role in the metabolic pathway of AS. Current results implied that sensitive untargeted seminal plasma metabolomics could identify distinct metabolic patterns of AS and would help clinicians by offering novel cues for discovering the pathogenesis of male infertility.

Date Palm Pollen Grains as a Potential Manager for Male Sub-fertility: A Clinical Trial

Medicinal plants are identified and used throughout human history; it has a great economic value especially in drugs discovery. Date palm pollen (DPP) is used traditionally in Sudan for treating sub-fertile male patients. Male infertility is heterogeneous group of disorders, most of them are idiopathic. This study is aimed to investigate the role of pharmaceutical preparation of DPP in amelioration of male sub fertility with detection of any possible adverse effects on the major body system functions, through blood picture, liver enzymes and kidney function. This study is a single group pretest-posttest experimental prospective comparative self-control. Sub-fertile men with Idiopathic oligoasthenozoospermia or azoospermia were received 500 mg capsules of DPP twice daily for three months after conducting their safety profiles to detect any toxic effects on hematological, hepatological and nephrological functions, Blood samples were taken from the patients for serum level of FSH (for azoospermic patients), FSH and Testosterone (for oligoasthenozoospermic patients). Finally, Semen sample have been obtained for computerized assisted semen analysis (CASA) report I and II. DPP administration induced significant increase (p≤0.001) in testosterone level (in oligoasthenozoospermic patients) and FSH level (in azoospermic patients). DPP induced significant changes (p≤0.001) towards improvement in the total and progressive sperm motility percentages measured in oligoasthenozoospermic patients by CASA dynamic analysis report I and II. The toxicological studies for DPP approved their safety use in human.

Reduced sperm concentration in a patient from a suspected post-operative infection: a case study

ABSTRACT A diagnostic semen analysis should be performed as part of a couple’s routine fertility investigations in order to determine sperm quality prior to managing the treatment pathway. The semen analysis report should be considered alongside clinical discussions and a review of both patients’ medical history. However, whilst it is part of the standard patient pathway, a regular up-to-date review at each clinical step of a patients’ journey is not always performed, which may miss potential clinical changes that could impact the most effective management of the couple. This case study reports the impact on the semen quality of a post-operative infection and hospitalisation of a male patient on a fertility management pathway.

Ejaculatory abstinence in semen analysis: does it make any sense?

Background:The precise effect of ejaculatory abstinence on semen parameters is highly debatable, especially among subfertile men. Previous studies on effect of abstinence time on different semen parameters have reported controversial results. The aim of this study was to retrospectively assess the variance of semen parameters with different periods of ejaculatory abstinence among both a population of normozoospermic (n = 1621) and oligozoospermic (n = 416) Tamil men, presenting to a fertility clinic for an infertility evaluation (N = 2037).Materials and Methods:A retrospective analysis of 2037 semen analysis reports involved grouping patients based on their ejaculatory abstinence, that is, <24 h, 1 to 2 days, 3 to 7 days, 8 to 15 days, 16 to 30 days, and >30 days. All semen parameters were assessed as per the World Health Organization (WHO, 2010) recommended guidelines. The unpaired two-tailed t-test and Welch’s analysis of variance (ANOVA) combined with Games–Howell post hoc test were used for statistical analysis. A p value <0.05 was considered to be statistically significant.Result:A retrospective analysis of data (N = 2037) identified no statistically significant differences in semen parameters of sperm concentration, percentage of progressively motile sperm, and normal sperm morphology in both normozoospermic and oligozoospermic individuals across different groups of abstinence. Semen volume was the only parameter that showed a statistically significant difference in both groups (p < 0.0001). In both normozoospermic and oligozoospermic men, the group with <24 h abstinence had the highest mean percentage of progressively motile sperm and normal sperm morphology.Conclusion:The findings of this study suggest that ejaculatory abstinence may be highly arbitrary, and the recommendation of a strict 2- to 7-day abstinence per the WHO may be liberalized. In both normozoospermic and oligozoospermic men, semen parameters associated with an abstinence of <24 h were found to be noninferior as compared to longer ejaculatory abstinence intervals. These findings support in eliminating conservative recommendations as far as abstinence is concerned and suggest that patients may be asked to collect a semen sample on the day they present for an infertility evaluation, regardless of abstinence.

Adherence to WHO 2010 Recommendations in Relation to Semen Analysis Reports in the Laboratories of West Bengal

Background: In 2010, The World Health Organization (WHO) suggested the standards of reporting of semen analysis and the reference values. We tried to determine the adherence to the WHO 2010 standard regarding semen analysis among the laboratories of West Bengal. Methods: An observational study was carried out by collecting the semen analysis reports from different laboratories. Compliance with the WHO 2010 recommendations regarding the reporting of semen analysis and references mentioned was subsequently analyzed. Results: A total of 211 laboratory reports were collected; of which 15 were ART (Assisted Reproductive Technology)-laboratories (7%) and 196 were non-ART-laboratories (93%). More than half of the laboratories did not mention any reference values. Only 7.5% used the phrase “WHO 2010” as the reference. Only 3% of the laboratories reported all the six “important” parameters (volume, pH, sperm concentration, motility, morphology and vitality) and used the WHO 2010 references for all of them. The ART laboratories performed significantly better than their non-ART counterparts in reporting and quoting the WHO 2010 reference values. Conclusion: Even nine years after its introduction, the compliance with the WHO 2010 recommendations on semen analysis was still low among our laboratories. There is need for increased awareness for the laboratory persons in this regard.

Intra-Technician Comparison of Sperm Morphology Evaluation

Objective To identify intra-technician subjective variability in sperm morphology assessment at a single site. Design Intra-technician evaluation of sperm morphology results compared to reported outcome on initial semen analysis using Kruger (Tygerburg) Strict criteria. Materials and Methods This study was a retrospective analysis of 35 semen sample slides stained using a Romanowski stain (Diff-Quick). Slides were randomly selected for semen samples analyzed January 1, 2018 – February 28, 2018 and numbered (1-35). Morphology assessment was performed by 3 andrologists, blinded to initial reported morphology results. The median percentage of normal forms (normal, ≥ 4%) were compared between 3 technicians to the initial reported values. Statistical analysis was performed using One-Way Analysis of Variance (ANOVA) and ANOVA on Ranks using Kruskan-Wallis test, with p < 0.05 considered significant. Results Median percentage of normal forms was 4% for the initial semen analysis report. Whereas, technician 1: 3%, technician 2: 2% and technician 3: 3%. The median values among the technicians were significant (P = 0.021). There were no differences between reported values compared to each technician. However, the median results for technician 3 and technician 2 were different (P < 0.05). Conclusions The findings suggest that there is variability in assessment of sperm morphology between technicians. Inaccurate assessment reporting high percentage of abnormal forms for sperm morphology can result in misrepresented sperm data by clinicians. As a result, since low morphology is an indication for intra-cytoplasmic sperm injection (ICSI) during in-vitro fertilization (IVF) procedures, ICSI can be unnecessarily ordered. The additional financial cost associated with an ICSI procedure may result in financial and emotional burden for the patient. Furthermore, an incorrect abnormal morphology result leads to emotional strain on the male patient leading to the feelings of inadequacy. An increased frequency of quality assurance training of andrology technicians in groups reviewing Kruger (Tygerburg) Strict Criteria is recommended to limit assessment variability. Randomly selected images of sperm morphology from the Kruger Strict Atlas can be used to assess technician sperm morphology evaluations. Disclosures Nothing to disclose. Funding None. To identify intra-technician subjective variability in sperm morphology assessment at a single site. Intra-technician evaluation of sperm morphology results compared to reported outcome on initial semen analysis using Kruger (Tygerburg) Strict criteria. This study was a retrospective analysis of 35 semen sample slides stained using a Romanowski stain (Diff-Quick). Slides were randomly selected for semen samples analyzed January 1, 2018 – February 28, 2018 and numbered (1-35). Morphology assessment was performed by 3 andrologists, blinded to initial reported morphology results. The median percentage of normal forms (normal, ≥ 4%) were compared between 3 technicians to the initial reported values. Statistical analysis was performed using One-Way Analysis of Variance (ANOVA) and ANOVA on Ranks using Kruskan-Wallis test, with p < 0.05 considered significant. Median percentage of normal forms was 4% for the initial semen analysis report. Whereas, technician 1: 3%, technician 2: 2% and technician 3: 3%. The median values among the technicians were significant (P = 0.021). There were no differences between reported values compared to each technician. However, the median results for technician 3 and technician 2 were different (P < 0.05). The findings suggest that there is variability in assessment of sperm morphology between technicians. Inaccurate assessment reporting high percentage of abnormal forms for sperm morphology can result in misrepresented sperm data by clinicians. As a result, since low morphology is an indication for intra-cytoplasmic sperm injection (ICSI) during in-vitro fertilization (IVF) procedures, ICSI can be unnecessarily ordered. The additional financial cost associated with an ICSI procedure may result in financial and emotional burden for the patient. Furthermore, an incorrect abnormal morphology result leads to emotional strain on the male patient leading to the feelings of inadequacy. An increased frequency of quality assurance training of andrology technicians in groups reviewing Kruger (Tygerburg) Strict Criteria is recommended to limit assessment variability. Randomly selected images of sperm morphology from the Kruger Strict Atlas can be used to assess technician sperm morphology evaluations.

Do pregnancy rates differ with intra-uterine insemination when different combinations of semen analysis parameters are abnormal?

Objective:To evaluate the relationship of one or a combination of semen analysis parameter results on insemination outcomes.Material and Methods:A retrospective analysis was performed to evaluate the effect on pregnancy rates in relation to one or more abnormal semen analysis parameters based on the 2010 World Health Organization semen analysis guidelines.Results:Nine hundred eighty-one couples underwent 2231 intrauterine insemination cycles at the Stanford Fertility and Reproductive Medicine Center. In our study, the pregnancy rates ranged from 11-25% when an individual or combined semen analysis parameters were analyzed. Similar pregnancy rates were found when one, two, and in most cases three parameters were abnormal. When a single parameter was abnormal among volume, concentration, and motility, pregnancy rates were mainly unaffected. There was the exception of total sperm count where pregnancy rates were diminished when counts were below 39 million (p=0.04).Conclusion:Clearly, total sperm in the specimen and not the concentration of sperm per milliliter was the critical factor for predicting pregnancy. Therefore, a reorganization of semen analysis reports should be done emphasizing the total amount of sperm present and de-emphasizing concentration of sperm.

Expert perspectives on semen analysis parameters that are important to patient counseling

The semen analysis is the cornerstone of the male fertility evaluation. Semen parameters of concentration, motility, morphology, and total motile count (TMC) are important for patient counseling and treatment decision-making. Patients frequently have difficulty interpreting semen analysis results and clinic-based test result counseling can be time-consuming. In an effort to develop a patient-centered semen analysis report, we surveyed male fertility experts and obtained consensus on semen parameters that are foundational to clinical decision making.

Validation of artificial neural network models for predicting biochemical markers associated with male infertility

ABSTRACTSeminal fluid is the secretion from many glands comprised of several organic and inorganic compounds including free amino acids, proteins, fructose, glucosidase, zinc, and other scavenging elements like Mg2+, Ca2+, K+, and Na+. Therefore, in the view of development of novel approaches and proper diagnosis to male infertility, overall understanding of the biochemical and molecular composition and its role in regulation of sperm quality is highly desirable. Perhaps this can be achieved through artificial intelligence. This study was aimed to elucidate and predict various biochemical markers present in human seminal plasma with three different neural network models. A total of 177 semen samples were collected for this research (both fertile and infertile samples) and immediately processed to prepare a semen analysis report, based on the protocol of the World Health Organization (WHO [2010]). The semen samples were then categorized into oligoasthenospermia (n=35), asthenospermia (n=35), azoospermia (n=22), normospermia (n=34), oligospermia (n=34), and control (n=17). The major biochemical parameters like total protein content, fructose, glucosidase, and zinc content were elucidated by standard protocols. All the biochemical markers were predicted by using three different artificial neural network (ANN) models with semen parameters as inputs. Of the three models, the back propagation neural network model (BPNN) yielded the best results with mean absolute error 0.025, -0.080, 0.166, and -0.057 for protein, fructose, glucosidase, and zinc, respectively. This suggests that BPNN can be used to predict biochemical parameters for the proper diagnosis of male infertility in assisted reproductive technology (ART) centres.Abbreviations: AAS: absorption spectroscopy; AI: artificial intelligence; ANN: artificial neural networks; ART: assisted reproductive technology; BPNN: back propagation neural network model; DT: decision tress; MLP: multilayer perceptron; PESA: percutaneous epididymal sperm spiration; RBFN: radical basis function network; SRNN: simple recurrent neural network; SVM: support vector machines; TSE: testicular sperm extraction; WHO: World Health Organization

Decreased male fertility potential increase blood pressure reactivity

Background & objectives: Arterial blood pressure is an important physiological parameter in epidemiology of cardiovascular disease. Hypertension has been reported to be generally associated with sympathetic over activity. Several authors have made use of a technique, known as Cold Pressor Test to study blood pressure reactivity to a standard stimulus. Thus this study was undertaken to evaluate the response to the standard stimulus in the normozoospermics and subjects with oligoasthenotetatozoospermia (OAT). Methods: The study was conducted on 60 subjects 30 normozoospermics and 30 oligoasthenotetratozoospermics based on semen analysis report between the age group of 20 years to 25 years. The blood pressure was recorded using the standard auscultatory technique and cold pressor test was done as described by Hines & Brown (1932). Results: The significant increase (p

Microscopic visualization of intravasal spermatozoa is positively associated with patency after bilateral microsurgical vasovasostomy.

We evaluated pre-operative and intraoperative factors associated with successful patency following bilateral microsurgical vasovasostomy (VV). We retrospectively reviewed the charts of 1331 men who underwent bilateral VV by two surgeons between 2006 and 2013. Vasal fluid was examined intraoperatively for gross quality (i.e., clear or opaque and creamy/thick) and for the presence of spermatozoa on microscopy (i.e., whole spermatozoa, sperm fragments, or azoospermia). Post-operative patency was assessed by semen analysis or patient report of conception. Perioperative factors were explored using descriptive statistics and examined in logistic regression models for associations with post-operative patency. The median age at VV was 39 years [interquartile range (IQR): 35-44] and the median obstructive interval (OI) was 7 years (IQR: 4-11). Overall, 1307 patients achieved post-operative patency (98%) while 24 remained obstructed (2%). Among those who became patent, 410 reported conception. After adjustment for potential confounders, only microscopic examination of the intravasal fluid for the presence of spermatozoa (bilateral or unilateral whole spermatozoa vs. sperm parts/azoospermia) at the time of VV was significantly associated with post-operative patency with an odds ratio (OR) of 14.2 (95% CI: 5.8-34.9; p = <1 × 10(-8) ). Identification of bilateral or unilateral sperm fragments vs. azoospermia was also associated with increased odds of post-operative patency with an OR of 3.5 (95% CI: 0.9-13.6; p = 0.08). There was no statistically significant association between age at VV, OI, presence of granuloma, gross fluid quality, or surgeon and post-operative patency after controlling for potential confounders. Identification of whole spermatozoa in the vasal fluid at the time of VV was positively associated with post-operative patency. Our findings stress the need for intraoperative microscopy to aid in post-operative patient counseling.

Prevalence of Male Factor Infertility in Last Ten Years at a Rural Tertiary Care Centre of Central India: A Retrospective Analysis

Background: Male infertility accounts for 40-50% of infertility, affects 7% of all men. It is commonly due to deficiencies in semen, and semen quality is used as measure of male fecundity. Objective: To retrospectively study profile of male factor infertility, especially abnormal semen parameters in rural area of Central India over a period of 10 years and to find out prevalence of various abnormalities of sperm and sperm counts and also to know yearly variation in prevalence of such abnormalities. Material and Methods: A Retrospective analysis of 10 years was carried out at the Department of Obstetrics and Gynecology and Reproductive Biology Unit of Department of Physiology of a rural tertiary care centre of Central India from January 2005 to December 2014. The case records of total of 3084 male partners of infertile couples consulting the Gynecology Out Patient Department were collected from the Reproductive Biology Unit of Department of Physiology. On the basis of semen analysis report the cases were categorized into four groups; Normozoospermia, Oligozoospermia, Azoospermia and Asthenoteratozoospermia. The results were analyzed using SPSS software. Results: Out of total 3084 semen analysis reports of infertile couples, Normozoospermia was observed in 1104 (35.80%), Oligozoospermia in 1053 (34.14%), Asthenoteratozoospermia in 597 (19.35%) and Azoospermia in 330 (10.70%). Conclusion: Semen analysis is cornerstone for evaluation of infertility in men. It gives an idea about abnormalities of sperm and sperm count. Present study revealed no significant rise in prevalence of male infertility over last 10 years in this region of India. Key words: Fertility; Infertility; Normozoospermia; Semen analysis, Sperm.

A proposed 360° scoring method to replace conventional bidimensional moprhological analysis

In a one-year time span, we noticed that only one-third of our semen analysis reports fit the normal morphology parameters. In this study we sought to investigate the chances of misjudging sperm morphology due to asymmetrical abnormalities or variable head positioning during fixation.

Clinical relevance of routine semen analysis and controversies surrounding the 2010 World Health Organization criteria for semen examination.

Semen analysis is the corner stone of infertility evaluation as it provides information on the functional status of the seminiferous tubules, epididymis and accessory sex glands. The methods on how the human semen should be evaluated are provided by the World Health Organization, which periodically releases manuals that include specific protocols and reference standards. In 2010, the WHO published new criteria for human semen characteristics that were markedly lower than those previously reported. In this review initially it is discussed the limitations of semen analysis as a surrogate measure of a man's ability to father a pregnancy. Secondly, it is analyzed methodology issues that could explain why the newly released reference values were different from those earlier reported. Thirdly, it is speculated on the likely effects of the 2010 WHO criteria in the management of male infertility. Due to the several inherent limitations of semen analysis as a surrogate marker of male infertility, physicians should exercise caution when interpreting results. A template for semen analysis reports that incorporates the distribution of the semen characteristics of recent fathers in centiles rather than solely the minimum thresholds could aid clinicians to better understand how a given patient results compare with the reference population. Importantly, a male infertility evaluation must go far beyond a simple semen analysis, as it has to be complemented with a proper physical examination, a comprehensive history taking, and relevant endocrine, genetic, and other investigations.

Evaluation of semen quality in patients with malignancies referred for sperm banking before cancer treatment

Different cancer treatments such as chemotherapy and radiotherapy can lead to azoospermia and even sterility for an unknown period. Whether the type of cancer could affect semen quality or not is under debate. In this study, we have reviewed semen parameters of men with cancer who deposited their sperm samples at the Avicenna Research Institute tissue bank before undergoing cytotoxic treatment. This descriptive retrospective study examined 73 cases referred to sperm bank, because of malignancy, prior to initiation of cancer treatments including chemotherapy and radiotherapy. The data recorded were age, marital status, reproductive history, semen analysis reports and cancer history of the patients. Semen samples were analysed according to recommendations of the World Health Organization (1999) before freezing. Results of the analysis showed that 71.2% (52) of patients had oligozoospermia, 93.2% (68) teratozoospermia and 86.3% (63) asthenozoospermia. Different groups of cancer patients did not show any differences in oligozoospermia, teratozoospermia and asthenozoospermia. Impaired spermatogenesis even prior to cancer treatment indicates the importance of fertility preservation. As the majority of patients had suitable specimens for freezing and assisted reproduction, sperm banking is recommended to be performed promptly and before any treatment, especially surgery.

National semen analysis reference range reporting: adherence to the 1999 World Health Organization guidelines 10 years later

To determine the adherence by laboratories across the United States to the standard semen analysis guidelines and parameter reference ranges 10 years after being set by the World Health Organization (WHO) in 1999 and to compare compliance between regional laboratories vs. specialty assisted reproductive technology (ART) laboratories. Observational study. Regional clinical and reproductive endocrinology andrology laboratories. Blank or deidentified semen analysis reports were collected from laboratories through direct contact or from reports received as part of clinical care for male infertility. Adherence to semen analysis reference range reporting as recommended by the 1999 WHO guidelines. Semen analyses reports were collected from 111 laboratories from 31 different states. Of 111 laboratories, 26 (23%) reported all reference range parameters in accordance with the guidelines. Of 65 ART laboratories, 21 (32%) complied with all reference range parameters as outlined by the guidelines, vs. 5 of 46 non-ART laboratories (11%). Seventy percent of laboratories that did not report 1999 WHO parameters did so because of differences in reference values for normal morphology. Adherence to WHO 1999 semen analysis reference range guidelines has not been achieved by ART and non-ART laboratories 10 years after being introduced. Non-ART laboratories report reference ranges less accurately than ART laboratories.

Semen Quality Score Is a Novel Measure of Sperm Quality in Infertile Men

Objectives: We reduced 9 semen characteristics into 2 semen scores. The purpose of this study was to determine if these 2 scores can be used effectively in assessing semen quality in infertile men. Design: A retrospective review of semen analysis reports of 88 infertile men and 19 normal healthy donors. Materials and Methods: Semen samples were obtained from 88 infertile patients with varicocele (77 with varicocele only and 11 with varicocele and infection) and 43 post-vasectomy reversal patients. Specimens were also obtained from 19 normal, healthy donors. Nine semen characteristics (concentration, motility, curvilinear velocity, straight-line velocity, average path velocity, linearity, amplitude of lateral head movement were determined by a computer assisted semen analyzer and 2 evaluated manually (sperm morphology scoring by WHO and Kruger’s strict criteria). Principal component analysis was applied to these parameters after log transformation to reduce the effects of varying scales and distribution. Results: The semen characteristics could be summarized as 2 semen scores which account for 80.3% of all of the variability among original semen characteristics. The first principal component (a weighted sum of all of the semen characteristics accounting for 64.7% of the overall variability) was named “SQ” (semen quality). The second component (a weighted sum of 8 characteristics subtracted from concentration) was considered a measure of relative quantity and was named “RQ.” As a reference standard, the distributions of SQ and RQ among the controls were assigned mean value of 100 ± 10. The semen quality score for varicocele and varicocele with infection group was comparable (78.6 ± 17.4 and 84.8 ± 20.6) but significantly different from the control (100.0 ± 10, p<0.001 and 0.03). Vasectomy reversal patients’ SQ score of 78.2 ± 16.8 was significantly lower from controls (p<0.001). No differences between the patients and controls were seen in the RQ score. Conclusions: The SQ score is a new and effective measure of semen quality in infertile patients with varicocele and in those following vasectomy reversal. High SQ score (>80) indicates good semen quality. The results of semen score can provide simple, meaningful information on the quality of semen specimens for the clinician. This project was supported by a grant from the Cleveland Clinic Foundation.

Determination of laboratory specific percent normal sperm morphology value based on prevasectomy ("fertile") ejaculates.

Semen assessments were performed on ejaculates from 25 men with proven fertility requesting vasectomy. Multiple cytological slides were made simultaneously from each ejaculate and analyzed by a single technician. The morphology data obtained were analyzed for repeatability. The mean +/- SD for normal sperm morphology was 30.6+/-7.3, and the within-subject repeatability was < or =1 SD of the mean for 17 of 25 ejaculates. Technician and laboratory specific criteria for the percent normal sperm morphology component of a semen analysis report (that are clinically meaningful) can be developed using the approach described herein.

Receiver-operating characteristics curves for semen analysis variables: methods for evaluating diagnostic tests of male gamete function.

This study draws on decision analysis to estimate the utility of seminal variables in predicting pregnancy. The infertile couples selected (n = 709) excluded those who had donor insemination or known female factors (history of pelvic infection, ovulatory disorders, endometriosis, and tubal disease). Diagnostic test properties were calculated with respect to pregnancy for two variables derived from the semen analysis report: sperm density, and the total number of motile sperm in the ejaculate (TMS). Receiver-operating characteristic (ROC) curves based on sensitivity and specificity revealed that none of the proposed thresholds for sperm density or TMS is clearly a best choice. The highest positive predictive values for sperm density (75%) and TMS (75%) were associated with cutoff points at five million sperm per milliliter and five million motile sperm per ejaculate, respectively. The false positive rates when these cutoff points were used were 4.3% (sperm density) and 5.6% (TMS). ROC analysis provides visual and numeric evidence of the quality of a diagnostic test and constitutes a set of procedures for incorporating information from new tests of male gamete function into the diagnostic assessment of infertility.