The WHO (World Health Organization) manuals provide state-of-the-art guidance on how a semen analysis should be carried out. The much anticipated sixth edition of the WHO semen analysis manual has been released 10 years after its previous version and includes essential updates, such as new reference standards for semen volume and microscopic sperm characteristics of recent fathers. A well-conducted semen analysis remains an essential foundation of the infertility evaluation process and affects patient referral, diagnosis and treatment. However, a male infertility work-up primarily based on routine semen analysis does not provide men with an optimal fertility pathway; the primary reasons for routine semen analysis inadequacy in this context include its low predictive value for natural and assisted conception success, its inability to detect sperm DNA and epigenetic deficiencies that might negatively affect embryo development, implantation and offspring well-being, and the substantial overlap between semen parameters of fertile and subfertile individuals. Ideally, a full andrological assessment should be carried out by reproductive urologists in all men dealing with couple infertility and should include a detailed history analysis, physical examination, semen analysis, endocrine assessment and other tests as needed. Only through a complete male infertility work-up will relevant underlying medical and infertility conditions be revealed and potentially treated or alleviated. The ultimate goals of a comprehensive andrological assessment are to positively influence overall male health, pregnancy prospects and offspring well-being.

WHO（世界卫生组织）手册就如何进行精液分析提供了最先进的指导。备受期待的世卫组织精液分析手册第六版在上一版本发布 10 年后发布，其中包括基本更新，例如新父亲的精液量和微观精子特征的新参考标准。进行良好的精液分析仍然是不孕症评估过程的重要基础，并影响患者的转诊、诊断和治疗。然而，主要基于常规精液分析的男性不育症检查并不能为男性提供最佳的生育途径；在这种情况下，常规精液分析不足的主要原因包括其对自然和辅助受孕成功的预测价值低，它无法检测可能对胚胎发育、植入和后代健康产生负面影响的精子 DNA 和表观遗传缺陷，以及可育和不育个体精液参数之间的大量重叠。理想情况下，生殖泌尿科医生应对所有处理夫妻不育症的男性进行全面的男科评估，并应根据需要包括详细的病史分析、体格检查、精液分析、内分泌评估和其他检查。只有通过完整的男性不育症检查，才能揭示相关的潜在医学和不孕症状况并可能得到治疗或缓解。全面男科评估的最终目标是积极影响整体男性健康、怀孕前景和后代福祉。