The Effect of the New 2010 World Health Organization Criteria for Semen Analyses on Male Infertility

Capsule:
Fifteen percent of men with previously abnormal semen analysis would be reclassified as normal by the 2010 WHO criteria. This may lead to less male infertility diagnosis or evaluation.

Authors:
Katie S. Murray, D.O., Andrew James, M.D., James B. McGeady, M.D., Michael L. Reed, Ph.D., Wayne W. Kuang, M.D., Ajay K. Nangia, M.B.B.S.

Volume 98, Issue 6, Pages 1428-1431, December 2012

Abstract:

Objectives:
To quantify the effect of the new 2010 World Health Organization (WHO) semen analysis reference values on reclassifying previous semen analysis parameters and definition of patients with male factor infertility.

Design:
A multi-institutional retrospective chart review.

Setting:
University and private male infertility clinics.

Patients:
Men referred for infertility evaluation.

Intervention:
To compare semen analysis values based on 2010 versus 1999 reference criteria.

Main Outcome Measures:
Quantification of the change based on individual sperm parameters and as a whole.

Results:
184 men had at least 2 semen analyses. 13 (7%), 17 (9.2%), 34 (18.4%), and 29 (15.7%) patients changed classification to being at or above the reference value by the 2010 criteria for semen volume, sperm concentration, motility, and morphology respectively. 501 men had one semen analysis on file. 40 (7.9%), 31 (6.2%), 50 (9.9%), and 74 (19.3%) would change classification for volume, concentration, motility, and morphology respectively. Overall, 103 (15.1%) patients who had one or more parameter below the reference value on the original analysis was converted to having all parameters at or above the 2010 reference values.

Conclusions:
The 2010 reference values will result in some infertile men being reclassified as fertile if status is based upon semen analysis alone. This may lead to fewer men referred for proper infertility evaluation or treatment.

  • Jim Hotaling

    To me, the main take home message of this study is how arbitrary our threshold values for semen analyses are. As clinicians, all of us would like a test that can differentiate men with from those without natural or ART reproductive potential. The authors make a point that infertility is defined as the absence of pregnancy after one year of attempts. The reality is that few couples are willing to wait this long; especially at a time when people are having children at more and more advanced ages. Unfortunately, multiple papers have shown that no combination of diagnostic tests can obviate the need for a history and physical. The only semen analysis finding which precludes any chances of successful pregnancy is azoospermia.

  • NicoGarrido

    Dr Murray, congratulations for
    your nice article. It re-opens an eternal debate.

    In an assisted reproduction unit,
    as well as in other fields of medicine, there is a noticeable need for
    diagnostic tools permitting the possibility to predict, in a very accurate
    manner, the success of a certain treatment or intervention.

    From my viewpoint, there is a
    wrong concept when we consider a basic sperm analysis as a diagnostic tool,
    given that it is commonly agreed that its predictive value (as understood by
    its classification power to forecast a pregnancy) is low. Then, this test
    should be (hypothetically) ruled out.

    Moreover, there is no need to
    diagnose fertility: you can only diagnose this when there is a total and maintained
    absence of sperm, and also when motile sperm are found but after one year of
    regular and unprotected sexual intercourses, there is no success.

    To add difficulty, the other half
    of the couple can be a relevant source of bias, and her fertility status will
    influence on the final result.

    That said, basic sperm analysis
    it is still incredibly helpful. It can provide with valuable clues about the
    possibility of having infections, genetic alterations, and also with relevant
    data about the likelihood of the sample to be successfully employed in IUI, or
    IVF.

    All the information is usually
    provided after an easy retrieval and analysis of the sample, with very little
    inconvenience linked.

    I believe the most important
    thing is not linking the results to normality/abnormality or
    fertility/infertility, but as a relevant part of a more complex analysis and
    decision taking process, involving also the partner, oriented mainly to decide
    if additional tests are required, and which kind of ART are more convenient.

  • Mike Hsieh

    There’s a clear under evaluation of the infertile male due to the perception that IVF ICSI is a cure all for male factor infertility. Endocrinopathy or testicular cancer are two diagnosis that cannot be pick up by semen analysis alone. Until OB/Gyn start performing full physical exam and order serum fertility workup on the male partner, bypassing male evaluation can be a fetal error.

  • laurenwroth

    This is an interesting look at the 2010 WHO semen analysis guidelines (compared to the 1999 guidelines). It is a retrospective study looking at how many men would be reclassified as “fertile” based on semen parameters alone. On the one hand, the findings are interesting because many men would be reclassified as “fertile”. On the other hand, the authors make the point several times that 1 year without pregnancy is the definition of infertility (rather than the semen analysis results). The authors make the point that less men may be referred for evaluation with “normal” semen analysis results but I would argue, few men with mildly abnormal SA results have an identifiable underlying problem.

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