Semen Parameters in a Fertile Versus Subfertile Population: A Need for Change in the Interpretation of Semen Testing

Ombelet, Willem; Bosmans, Eugène; Janssen, M.; Cox, A.; Blasselaer, J.; Gyselaers, W.; Vandeput, H.; Gielen, J.; Pollet, H.; Maes, M.; Steeno, Omer; Kruger, T. F.

doi:10.1016/s0022-5347(01)63888-6

Cited by 78 publications

(133 citation statements)

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“…The interpretation of these results, regarding the chance of conception for all male lupus patients classified as subfertile in the present study, is hampered by the recent debate concerning the cutoff values for normality in these 2 conventional techniques of semen evaluation. In fact, they do not seem to be the ideal assessment of male fertility potential, and reductions in the cutoff points have been proposed for WHO guidelines and Kruger strict criteria morphology (30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

Gonad evaluation in male systemic lupus erythematosus

Soares¹,

Borba²,

Bonfá³

et al. 2007

Arthritis & Rheumatism

108

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Objective. To assess gonad function in male patients with systemic lupus erythematosus (SLE).Methods. Thirty-five consecutive male patients with SLE according to the criteria of the American College of Rheumatology were prospectively evaluated for demographic and clinical features as well as previous and current treatment. Patients underwent urologic evaluation and testicular Doppler ultrasound. We obtained a hormone profile and performed a semen analysis including morphology and testing for the presence of antisperm antibodies. Patients were compared with 35 age-matched healthy controls.Results. Compared with controls, SLE patients had lower median testicular volumes in both testes, a lower median total sperm count, and a lower median total motile sperm count. The mean sperm volume and percentage of normally formed sperm were lower in SLE patients than in controls. Since all SLE patients had semen alterations, they were further subdivided into 2 groups according to the severity of these abnormalities (group 1, with teratozoospermia [n ‫؍‬ 18], and group 2, with azoospermia or teratozoospermia in combination with oligozoospermia and/or asthenozoospermia [n ‫؍‬ 17]). The frequency of treatment with intravenous cyclophosphamide (IV CYC) after the first ejaculation was higher in group 2 than in group 1. The median testicular volumes measured by ultrasound in both testicles were lower in group 2 than in group 1. Follicle-stimulating hormone levels were higher in group 2 than in group 1. The overall frequency of antisperm antibodies in SLE patients was 40%. The apparent higher frequency of antisperm antibodies in group 1 than in group 2 did not reach significance.Conclusion. SLE patients have a high frequency of sperm abnormalities associated with reduced testicular volume. Postpubertal IV CYC treatment was the major factor in potential permanent damage to the testes.

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Section: Discussionmentioning

confidence: 99%

Gonad evaluation in male systemic lupus erythematosus

Soares¹,

Borba²,

Bonfá³

et al. 2007

Arthritis & Rheumatism

108

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“…Studies by Ombelet et al 16 using receiver-operating characteristics curve obtained a threshold value of sperm morphology of 10% as minimum requirement for fertility in a group of patients in Belgium. More recently, Gunalp et al 17 similarly applied the receiver-operating characteristics curve and positive-and negative-predictive values on semen collected from a population in Turkey and proposed that threshold values of 5% morphology, 14% progressive motility, 30% motility and a concentration sperm count of 9xl0 6 /mL should be considered as the minimum limit for fertility in men.…”

Section: Discussionmentioning

confidence: 99%

The Semen of Fertile Black Males: Analysis of 100 Consecutive Cases

et al. 2002

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The fertility potential of any male can be predicted through the evaluation of his semen. Over the years, it seems the figures of sperm density considered compatible with fertility have gradually been reducing. Macleod and Gold 1 and the American Fertility Society 2 recommended that sperm density of 20-40x10 6 /mL should be regarded as the minimum for fertility. These studies were conducted a long time ago and the data were on fertile males from the developed countries.In 1992, the World Health Organization (WHO) 3 proposed that 20xl0 6 /mL should be the universally accepted limit of fertility. This limit has up to recent times been used in assessing the fertility potential of males in both developed and developing countries. However, a wealth of evidence in the reproductive biomedical literature indicates that factors such as nutritional, stress, environmental and demographic status affect the sperm picture of males. 4,5 This implies that there is the need for each country and each region of a country, and even individual laboratories, to establish their own reference parameters. The above studies laid more emphasis on sperm counts. More recent reports specify that other conventional semen parameters, such as morphology, motility and vitality, are equally important in assessing the fertility potentials of males. 6,7 Hence, there is need for the inclusion and increased emphasis on these parameters in all semen analyses and evaluation exercises.A recent study using the Western and WHO's limits of fertility indicates that the male factor to infertility in IleIfe, Nigeria, may be as high as 63.1%. 8 Such a conclusion can only be validated if the normal semen values in fertile males in this environment are known.Chukudebelu 9 and Osegbe et al. 10 have attempted to establish seminal indices in fertile males in Enugu and Lagos, Nigeria, respectively. The results of these studies showed a wide variation in the parameters estimated. It is against this background that we conducted the present study to establish the seminal fluid indices of fertile black males in Ile-Ife, Nigeria, where none exist, and to compare the results with those obtained from other parts of the same country. Subjects and MethodsThis study took place in the antenatal clinics of Obafemi Awolowo University Teaching Hospital Complex, IleIfe, Nigeria. A period of 16 months was fixed for this study. Clearance was sought and obtained from the Research and Ethical Committee of the Obafemi Awolowo University Teaching Hospital Complex for the study.Every consecutive subject who was contacted and agreed to participate in the study was included. They were made up of male partners of pregnant women attending the antenatal clinics of this hospital. Each woman who attended the clinic within the study period was requested to bring the husband to the succeeding clinic. The purpose of the study was explained to husbands who responded and their informed consent obtained. A total of 148 husbands of fertile couples responded, however, only 100 of them agreed to partici...

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“…A spontaneous pregnancy rate of 20.2% (18/89) was observed after 1 year without treatment. An analysis of sperm morphology, as evaluated by [23,29,31] In vivo pregnancies 20 10 3 Kruger et al [32,33] IVF fertilization rates Initial published intervals ≥ 15 14-4 ≤ 3 Intervals as used in practice ≥ 15 14-5 ≤ 4 Eggert-Kruse et al [34] In vivo pregnancies 14 7 4 Ombelet et al [35] Tenth percentile Fertile population 10 ROC curve analysis Fertile vs. subfertile 5 Zinaman et al [36] Healthy couples 8 Günalp et al [38] Fertile vs. [39] Fertile vs. subfertile > 12 9-12 < 9 Haugen et al [40] Tenth [35] compared the semen parameters of 144 males from couples, in whom the wives had achieved a recent pregnancy within 12 months of unprotected intercourse. The subfertile group consisted of 143 consecutive men attending the infertility clinic during the same period, who did not achieve a pregnancy.…”

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confidence: 99%

“…Like Ombelet et al [35], Menkveld et al [37] compared the semen parameters of a fertile and subfertile population. The fertile population comprised a group of 107 healthy males without any history of fertility problems, the partners of whom had a spontaneous pregnancy within 1 year of unprotected intercourse and were pregnant at the time the husband was included into the study.…”

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confidence: 99%

Clinical significance of the low normal sperm morphology value as proposed in the fifth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen

Menkveld¹

2010

Asian J Androl

176

109

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The very low cut-off value for sperm morphology of 4% morphologically normal spermatozoa, as proposed in the new edition of the World Health Organization (WHO) manual on semen analysis, is in agreement with recently published values and reflects the trend of a decline in reported mean values for normal sperm morphology. The reduced value for morphologically normal spermatozoa over the years may be due to several factors. The first is the introduction of strict criteria for the evaluation of sperm morphology. Other reasons may include the introduction of additional criteria for sperm morphology abnormalities and the suggested decrease in semen parameters because of increasing negative environmental influences. Although on its own the newly proposed very low normal value may not provide the strong predictive value for a males' fertility potential, as originally reported for sperm morphology evaluated according to strict criteria, a good predictive value can still be obtained if the holistic, strict approach for sperm morphology evaluation is followed together with additional sperm morphology parameters now available, because certain morphology patterns and sperm abnormalities are now known to be of strong prognostic value. In addition, better international standardization of the technical methodology, consensus on the interpretation of sperm morphology evaluation criteria and standardized international external quality control (EQC) schemes, are of utmost importance to maintain the good predictive value of sperm morphology.

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Semen Parameters in a Fertile Versus Subfertile Population: A Need for Change in the Interpretation of Semen Testing

Cited by 78 publications

References 0 publications

Gonad evaluation in male systemic lupus erythematosus

Gonad evaluation in male systemic lupus erythematosus

The Semen of Fertile Black Males: Analysis of 100 Consecutive Cases

Clinical significance of the low normal sperm morphology value as proposed in the fifth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen

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