Foreword to Semen Analysis in 21st Century Medicine special issue in Asian Journal of Andrology.

Semen analysis as an integral part of infertility investigations has a surprisingly long history, emerging only slowly, from under a cloud of disrepute and occupying a solitary niche outside conventional pathology tests, until relatively recently. From origins in the 19th century when spermatozoa were only identified as present or absent in cervical mucus samples from postcoital tests, even then a practice deemed “... dabbling.... incompatible with decency and self-respect...” (cited in [1]). Only in 1929 was the first paper using quantitative methods, recognisable forerunners of modern semen analysis, reported in a respectable medical journal [2]. The clinical perspective on systematic investigation of male infertility with an appropriate focus on semen analysis was first comprehensively outlined in Robert Hotchkiss’s 1944 book “Fertility in Men” [1]. The systematisation of laboratory semen analysis largely stems from work Dr John MacLeod, a Scot working in New York, who staked out the ground by publishing a series of landmark papers in semen analysis over 4 decades from the early 1940s including, together with a statistician (Ruth Gold), the first large scale normative studies of semen analysis. During the postWWII decades semen analysis became integrated into routine clinical infertility practice, typically undertaken in specialised laboratories as an adjunct to infertility clinics and performed by a small corps of laboratory scientists who focused exclusively on semen analysis and operating largely outside conventional pathology circles. In the absence of any agency taking responsibility to maintain congruence of laboratory techniques, this inevitably led to unintended divergence of customary practice in methodo logy and reporting. The next development was prompted by the world-changing advent of oral contraception in the 1960s which inspired the rapidly growing World Health Organizazion (WHO) to develop its Human Reproduction Unit (1965) which evolved into its ongoing Human Reproduction Programme (HRP, 1972) with the announcement of eight Task Forces aiming to develop newer forms of contraception [3] but which overlooked male contraception. This oversight was rectified by the inauguration of the Male Task Force (MTF), the history of which was written by the late Dr Geoff Waites in his last paper [4]. Orignally chaired by Dr Alvin Paulsen, whose recent passing is sadly noted, the prime objective of the MTF was to develop practical forms of male contraception. Operating in the milieu of WHO’s various political mandates, this required extending the capabilities to conduct male contraceptive studies to develo ping countries where clinical andrology expertise and semen analysis facilities, if they existed, were ad hoc and bore little resemblance to the methods evolved by Hotchkiss, MacLeod and their successors. In this context, Geoff Waites saw the need, and persuaded HRP to publish the 1st edition of WHO Semen Manual in 1980 which was intended not only to facilitate male contraceptive studies, but also to improve and standardise male infertility investigations, which he understood to be as inseparable as two sides of the same coin – the ability to choose the timing and size of a small healthy family. Under Geoff’s outstanding and resourceful editorship, the WHO Manual went through four editions to become the WHO’s most successful and popular publication as well as setting the well accepted world-wide standard for laboratory semen analysis methods ever since. Despite a hiatus of 2 years (1980–1982), during which the regressive forces that had overlooked male contraception in the first place again prevailed in suspending the MTF, Geoff Waites managed remarkably to maintain the momentum in both the MTF and its WHO Semen Manual and when required to navigate skilfully the inertia and hostility of the WHO bureaucracy.