6.Perform available tests on the man: A basic semen analysis provides valuable information on male fertility. A post-coital test may be a substitute if resource or cultural barriers to semen analysis exist or where a man is unwilling to provide a sample.
A basic semen analysis is the most important test in the evaluation of the male partner. It should be taken after 3 days of sexual abstinence. Producing a semen sample requires masturbation and ejaculation into a suitable, clean specimen container. Cultural, religious or personal barriers to masturbation may exist, in which instance a spermicide-free condom may be used. As a last resort, a post-coital test can help in assessing the presence of motile sperm, although this test is otherwise no longer recommended in the evaluation of the infertile couple. (ASRM, 2012b, ASRM 2008; NICE, 2012; Griffith and Grimes, 1990; Oei et al, 1998; Hull, 1982; Eimers, 1994; Snick, 1997; Hunault et al, 2005)
A semen analysis provides information on the volume of the ejaculate and sperm count, motility and morphology. According to the World Health Organization (2010) the following values are the lower reference limits for semen parameters from fertile men:
Semen volume (ml): 1.5
Sperm concentration (106/ml): 15
Total number (106/ejaculate): 39
Total motility (%): 40
Progressive motility (%): 32
Normal morphology (% normal forms): 4
Vitality (5): 58
Interpretation of semen analysis results can sometimes be challenging, especially if several parameters have borderline results (Tomlinson, 2013). If the semen analysis is abnormal, it should be repeated in 2-3 months as sperm quality can fluctuate.