The usefulness and significance of assessing rapidly progressive spermatozoa

We summarise and comment on the topics discussed by the contributors to this Special Issue. As an introduction, Ann Jequier's [1] generally positive assessment of the new-look manual was tempered with her reservations about reference values, on which other chapters dwelt at length. Aspects of laboratory technique were discussed by Charlene Brazil [2], whose offering gives a rare insight into the actual workings of andrology laboratories and highlights the need for greater involvement of laboratory directors (often clinicians) in assessing the quality of data provided. Experience with the German external quality control programme for semen analysis confirms that some laboratories treat the quality control (QC) samples differently (using a Neubauer chamber, for instance) from routine samples (a Makler chamber) so that the exercise may be undermined and fail to provide proper control of the lab's quality of work. It is one thing to have QC accepted in principle but the essential job of "policing" semen analysis QC falls in no-one's court. Allan Pacey's [3] contribution supports wholeheartedly quality assurance (QA) in andrology but also zeros in on a potential quantitative problem in the precision of normal sperm morphology assessment, when such values are low.Rune Eliasson's [4] characteristically blunt contribution lambasts the whole process of scientific consensus, the mainstay of world health organization (WHO) committees' recommendations. He considers that the perspective of the handbook are too narrow; its recommendations on assessing sperm morphology are inadequate; there to be insufficient emphasis on interpretation of results (cumulative importance of laboratory findings, interpretation of reference limits) or on manipulation of data (e.g. dividing total sperm numbers by days of abstinence and the testicular volume) and finds no mention of how to measure testicular volume. He laces this with invective against the lack of scientific method of those working in ART and reserves particular venom for the morphology method espoused in WHO3 [5] and WHO4 [6] that is given even more prominence in WHO5 [7].Once our hackles are down again, though, his view contain some prickly wisdom. First, if only normal forms are examined, the analysis could provide little indication of testicular dysfunction (other than the reduced output of normal forms) that may be indicated by production of particular abnormal forms. Second, as the normative reference values are so low, it can provide little scope for diagnosis, making it a meaningless end-point.Eliasson's [4] suggestion is that different criteria for categorising spermatozoa as morphologically normal (borderline forms considered normal, as in earlier editions of the WHO manual) should be implemented. These should provide higher percentages of normal forms and thus increase the possibility of distinguishing men with lower perentages of such forms. Thus far more workable and informative reference limits around 40%-60% would be provided by using less restrictive assessment. Howe...

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confidence: 69%

“…Both Eliasson [4] and Lars Björndahl [8] consider that abandoning the distinction between fast-and slow-progressing spermatozoa is a step backwards. Börndahl's [8] contribution refutes WHO5's line of thinking as unnecessarily defeatist, although Pacey [3] confirms the WHO viewpoint that agreement between technicians in velocity assessment is poor.…”

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confidence: 99%

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

Crowther¹,

Handelsman²,

Trevor³

et al. 2010

“…16,17 Abandoning the distinction between fast-and slow-progressing spermatozoa may well be regarded as a backward step. 15,18 However, our experience indicates that the technician's ability to distinguish between fast-(previously grade a) and slow-(previously grade b) moving spermatozoa is poor, making internal and external quality control difficult. The decision to reject categorizing progressive spermatozoa into fast and slow in the WHO 2010 manual was also based on the inability of technicians to gauge velocities accurately and the manual suggests that if velocities need to be known, a computer assisted sperm analyser system should be employed.…”

Section: The Semen Analysis (Who 2010)mentioning

confidence: 98%

Semen analysis and sperm function testing

Franken¹,

Oehninger²

2011

Despite controversy regarding the clinical value of semen analysis, male fertility investigation still relies on a standardized analysis of the semen parameters. This is especially true for infertility clinics in both developing and developed countries. Other optional tests or sophisticated technologies have not been widely applied. The current review addresses important changes in the analysis of semen as described in the new World Health Organization (WHO) manual for semen analysis. The most important change in the manual is the use of evidence-based publications as references to determine cutoff values for normality. Apart from the above mentioned changes, the initial evaluation and handling methods remain, in most instances, the same as in previous editions. Furthermore, the review evaluates the importance of quality control in andrology with emphasis on the evaluation of sperm morphology. WHO sperm morphology training programmes for Sub-Saharan countries were initiated at Tygerberg Hospital in 1995. The external quality control programme has ensured that the majority of participants have maintained their morphological reading skills acquired during initial training. This review reports on current sperm functional tests, such as the induced acrosome reaction, and sperm-zona pellucida binding assays, as well as the impact of sperm quality in terms of DNA integrity, and the relationship of sperm function tests to sperm morphology.

“…disturbed DNA integrity. 4,5 Both with in vivo and in vitro fertilisation, rapidly progressive sperm motility has long been considered to be a useful indicator. Therefore, with the exception of treatment by intracytoplasmic sperm injection, progressive sperm motility is required for success.…”

Section: New Reference Limitsmentioning

confidence: 99%

“…To neglect such information available from the semen sample would impoverish the clinical usefulness of semen analysis. 4 Similar concerns have to be raised regarding evaluation and assessment of sperm morphology. Is it really sufficient to focus on spermatozoa with an 'ideal' morphology?…”

Section: New Reference Limitsmentioning

confidence: 99%

New WHO-reference limits—revolution or storm in a teapot?

Haidl¹

2010

Since release of the latest WHO manual with the new lower reference values of semen parameters, a lot of discussion has been raised about their usefulness and appropriateness for assessment of male fertility. As with the previous reference values the new limits do neither allow an andrological diagnosis based on nosological criteria nor clear-cut differentiation between fertility and sub-/infertility. Therefore, considering the fact that fertility is a continuum, the new lower reference limits should not be overestimated. Most probably, more sperm function tests, such as determination of DNA integrity, and-in the future-assessment of biomarkers, such as sperm proteomics will be included into andrological work-up, thus resulting in a more personalized approach of infertility management. On the other hand, the detailed instructions for standard and advanced semen analysis provided in the new manual are very much appreciated and should be adopted by each seriously working laboratory. Asian Journal of Andrology (2011) INTRODUCTIONRecently the new WHO laboratory manual for the examination and processing of human semen (5th edition) has been published 1 and a Special Issue of the Asian Journal of Andrology to mark that occasion has highlighted in a series of papers the controversies arising from that new edition. This new version of the manual provides substantial changes and improvements compared with the previous versions and contains more detailed information and instruction, thus facilitating the work in the andrological laboratory. Along with a large series of instructive photographs, including those demonstrating normal spermatozoa according to strict criteria and respective pathomorphology, it contains very detailed and clear explanations of all the basic techniques. Moreover, new chapters on sperm preparation for assisted reproduction techniques and cryopreservation have been included. The text also incorporates a series of detailed standardized protocols for more advanced assessments of additional elements of semen analysis, such as the detection of leukocytes, the identification of precursor germ cells and the determination of antisperm antibodies. Most importantly, there is a completely revised chapter on quality control. 2 The most striking changes in this new edition of the WHO manual, however, concern the reference values for semen quality. Whereas the previous reference values were based, more or less, on expert opinion, the new ones were acquired by analysing semen samples from 1800 recent fathers (time to pregnancy of f12 months) living in eight countries on three continents. From these data, one-sided lower reference limits were generated from the fifth percentile of the data distribution. 3 The development of evidence-based reference ranges for semen analysis resolves one of the major concerns of previous editions. These new reference values reveal some drastic differences from the previous ones; for example, progressive motility is considered