Nowadays, infertility is becoming more and more common, and it is said that even mothers-in-law are adapting to the new situation and putting forward new requirements for their future sons-in-law to get married with a “semen test certificate”. As a product of adult male sexual intercourse into the vagina, semen mainly consists of sperm produced by the testicles mixed with secretions from the prostate and seminal vesicle glands, and the most critical indicators are sperm count, motility and morphology. The most critical indicators are the number of sperm, motility and morphology. A certificate of eligibility means that the semen test is normal, but does an adult male really have a “semen test certificate”? The history of semen testing In 1677, the Dutch scientist Ravenhoek first discovered human sperm using a homemade microscope. In 1980, the World Health Organization (WHO) published the first edition of the Laboratory Manual of Human Semen and Semen-Cervical Mucus Interaction, and from 1999 to 2011, semen testing was carried out using the standards of the fourth edition of 1999. The fifth edition was published in 2010 and renamed as the Laboratory Manual for the Examination and Processing of Human Semen, and the Chinese version was published in 2011. This guideline is widely accepted worldwide and has made a great contribution to the relief of millions of patients. 2. Items for semen testing The most critical part of semen testing is to analyze the number, motility and morphology of sperm in semen. The volume of semen usually ranges from 1.5 to 7 ml, and the number of sperm in each ml of semen usually exceeds 15 million. The length of the sperm head is only about 4 microns, which is about one-twentieth of the diameter of a hair. Under a microscope, a normal spermatozoon can be seen swimming continuously like a tadpole. With the help of a microscope, sperm can be analyzed manually, and on this basis, combined with high-definition video and computer analysis software, semen analysis can be performed efficiently and accurately. Semen tests also include sperm chromosome analysis, sperm DNA fragmentation index, sperm acrosome reaction, and glucosidase, which reflects the function of epididymal secretion, as well as other tests for semen inflammation and infection. The Reproductive Center of Jiangsu Provincial People’s Hospital and the National Important Laboratory of Reproductive Medicine of Nanjing Medical University have jointly built a male science laboratory that meets the technical specifications of WHO and the State Ministry of Health. 3. The reference value of semen examination WHO 5th edition stipulates that the lower reference value of sperm concentration is 15 million; the lower reference value of percentage of forward-moving sperm is 32%; and the lower reference value of percentage of normal morphology sperm is 4%. Normal sperm is defined as sperm concentration, percentage of forward-moving sperm and percentage of normal morphology sperm equal to or above the lower limit of the reference value. The corresponding oligospermia refers to a total sperm count of less than 39 million, weak spermia refers to a percentage of forward-moving sperm of less than 32%, teratozoospermia refers to a percentage of normal-form sperm of less than 4%, and azoospermia refers to the absence of sperm in ejaculated semen. 4. Is the quality of male semen declining? The fifth edition of WHO stipulates that the lower limit of the reference value of sperm concentration is 15 million; the lower limit of the reference value of the percentage of forward-moving sperm is 32%; the lower limit of the reference value of the percentage of normal morphology sperm is 4%. The fourth edition has a reference value for sperm concentration of 20 million; a reference value for the percentage of forward-moving sperm of 50% or more than 25% for rapid forward motion, and a lower reference value for the percentage of normal morphology sperm of 15%. According to the new criteria, studies have shown that 15.1% of men are reclassified from “infertile” to “fertile”. It is common to hear people say that the decrease in the reference value is due to a decline in the quality of human semen. This is not the case. First of all, the new reference values were not developed because the quality of human semen is declining, and it is unlikely that it will decline so quickly in 10 years. Some studies have concluded that sperm concentration in men has been declining at an average rate of 6% per year for the past 20 years or so. The Institute of Science and Technology of the Population and Family Planning Commission in China studied the sperm analysis data of 11,726 individuals between 1981 and 1996 and found that the overall quality of male semen in China was declining at a rate of 1% per year. The WHO surveyed nearly 2,000 couples worldwide who were “sexually active and had no contraceptive pregnancy within one year” and then selected the semen parameters of the 5% of the population (from lowest to highest) as the reference value. It can be seen that men with semen parameters below the lower limit of this reference value are not necessarily infertile. A normal semen test only means that the sperm parameters are above the lower limit of the reference value, but it does not guarantee pregnancy, and the so-called “semen test certificate” is not reliable. Routine semen testing can only predict pregnancy outcomes by about 80%, and there is still a large percentage of unexplained infertility in clinical practice. There is still a lack of objective sperm testing methods that can accurately predict pregnancy. 6. Indications for semen testing Semen testing has been included as the first test in the infertility treatment pathway. Infertility is a common condition that refers to couples who have normal cohabiting sex and have been infertile for one year without contraception, about half of which are male factors. Other patients such as cryptorchidism or small testicles, patients with a history of orchitis, and men who are concerned about environmental factors or medications affecting sperm can also opt for semen testing. Tips: Please choose a standard medical institution correctly for the examination, as many unstandardized examinations will not only bring you troubles and troubles, but also bring you unnecessary examinations and treatments. 7. Treatment of abnormal semen test results If your semen test is abnormal, you need to visit a male outpatient clinic, where the physician will examine and treat your condition according to your condition. You need to conduct a self-screening of your lifestyle and work environment to rule out factors such as high temperatures or harmful environmental toxins that may affect you. 8. How to make an appointment for clinic and semen testing If you want to come to the Reproductive Center of Jiangsu Provincial People’s Hospital for semen testing, please visit the male clinic. We promise that no appointment is needed for the test, and the report of the routine semen test is available on the same day, and on all working days (every Friday and Saturday morning). The male specialists and specialist clinics of the Reproductive Center can make appointments through the appointment platform. The appointment methods are as follows: Jiangsu Provincial People’s Hospital unified appointment platform: www.jsph.org.cn 96100 (national calls are charged for local calls only) 18851196100 (SMS appointment) Department direct dial telephone: 025-86862222, 86862233 (medical university); 86204760, 86210612 (women and children) Department code 241 (Medical University), 430 (Women and Children) Specialist codes: Jin Baofang (6015), Wang Zengjun (2424), Song Ninghong (7282) Other appointment methods: on-site appointments, patient service centers, self-help appointments, outpatient physician consultation rooms Address of Medical University: 16 Yongqing Village, Nanjing Address of Women and Children Branch: North Gate Reproductive Center Building, Wutai Mountain Campus, Nanjing Medical University, 368 Jiangdong North Road, Nanjing (Next to Yongqing Lane bus stop) 9. Warm environment for sperm collection The Reproductive Center of Jiangsu Provincial People’s Hospital cares for men’s health and creates a warm environment for sperm collection. We have set up 9 sperm collection rooms with different functions in the Reproductive Center Building of Nanjing Medical University for the convenience of patients. The rooms are warmly and reasonably arranged with good sound insulation, and are equipped with hand-washing sinks and video playback systems. The sperm retrieval rooms are located near the laboratory and can be sent for testing immediately after the semen is removed. Warm tip: You need to abstain from sex for 2 to 7 days before coming to the hospital for examination, and not more than 7 days.