[The significance of the "routine spermiogram". A critical analysis]

A spermiogram includes the determination of the sperm count (normal range 20-250 million/ml), the percentage of motile cells (> 50%) and the percentage of abnormal cells (< 60%). Male infertility is the most important indication for a spermiogram. The values for seminal parameters, however, show only a weak correlation with conception rates, even in the case of in vitro fertilization. This may be due to the wide variability of values in an individual man, but it is also likely that the aetiopathogenesis of infertility is not only determined by parameters that can be assessed microscopically, but in addition by functional parameters that have not yet been identified. The assumption that computer-assisted image analysis of motility and morphology (CASA) would improve the predictive power of seminal parameters has not been verified. However, the spermiogram is useful in therapeutic studies of male infertility. When the extent of relevant alterations is assessed the wide intraindividual variability must be borne in mind. Treatment cannot be assumed to have been successful unless the sperm count increases by more than 50% of the initial value. Side effects of drugs affecting spermatogenesis and recovery after cessation of therapy can be demonstrated by repeated spermiograms. Evidence of the effects of environmental factors can also be seen in the spermiogram, but distinct correlations are difficult to determine. Semen analysis continues to be used in the development of male contraceptives, but is no substitute for the measurement of conception rates.