World Health Organization reference values for human semen characteristics*‡

Cooper, Trevor G.; Noonan, Elizabeth A.; Eckardstein, Sigrid von; Auger, Jacques; Baker, H. W. G.; Behre, Hermann M.; Haugen, Trine B.; Kruger, Thinus F.; Wang, Christina; Mbizvo, Michael T.; Vogelsong, Kirsten

doi:10.1093/humupd/dmp048

Cited by 2,427 publications

(1,942 citation statements)

References 108 publications

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“…On the other hand, the published data indicate that the average values of basic semen parameters such as sperm concentration and total sperm number among a population of fertile males are much higher. 3 The new WHO manual is a laboratory manual and not an andrological textbook. Thus, it provides invaluable help to perform semen analysis at high quality-controlled standards.…”

Section: Resultsmentioning

confidence: 99%

“…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 as normal when 32% of spermatozoa move forward (instead of 50%), and the lower limit of normally-shaped spermatozoa is 4%.…”

Section: Introductionmentioning

confidence: 99%

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

Haidl¹

2010

Asian J Androl

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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

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Haidl¹

2010

Asian J Androl

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“…Therefore, this is a population of fertile men whose spouses were of high or normal fecundity and who established a pregnancy in f12 months. 14 Nonetheless, there is still scepticism about certain aspects of the new WHO manual. 15 The criticism by Eliasson 15 is mainly aimed at the recommendations for the evaluation of progressive motility and sperm morphology.…”

Section: The Semen Analysis (Who 2010)mentioning

confidence: 99%

“…The following one-sided lower reference limits, the fifth centiles (with 95% confidence intervals), were generated from men whose partners had time to pregnancy ,12 months: semen volume, 1.5 ml (1.4-1.7 ml); total sperm number, 39 million per ejaculate (33-46 million); sperm concentration, 15 million per millilitre (12-16 million); vitality, 58% live (55%-63%); progressive motility, 32% (31%-34%); total (progressive and nonprogressive) motility, 40% (38%-42%); morphologically normal forms, 4.0% (3.0%-4.0%). 14 …”

Section: Reference Limitsmentioning

confidence: 99%

Semen analysis and sperm function testing

Franken¹,

Oehninger²

2011

Asian J Androl

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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.

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“…For example, men below norms may still go on to father pregnancies resulting in a live birth, while men with values within ranges may be unable to do so. The World Health Organization publishes reference values for semen parameters relative to fertility (Cooper et al ., 2010; WHO, 2010). However, the predictive value of these reference values has long been debated for the simple reason that no single or set of semen parameters is highly predictive of male fertility (Wang et al ., 1988; Niederberger, 2011; ASRM, 2013).…”

Section: Introductionmentioning

confidence: 99%

A data‐driven search for semen‐related phenotypes in conception delay

2016

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SummarySperm count, morphology, and motility have been reported to be predictive of pregnancy, although with equivocal basis prompting some authors to question the prognostic value of semen analysis. To assess the utility of including semen quality data in predicting conception delay or requiring >6 cycles to become pregnant (referred to as conception delay), we utilized novel data‐driven analytic techniques in a pre‐conception cohort of couples prospectively followed up for time‐to‐pregnancy. The study cohort comprised 402 (80%) male partners who provided semen samples and had time‐to‐pregnancy information. Female partners used home pregnancy tests and recorded results in daily journals. Odds ratios (OR), false discovery rates, and 95% confidence intervals (CIs) for conception delay (time‐to‐pregnancy > 6 cycles) were estimated for 40 semen quality phenotypes comprising 35 semen quality endpoints and 5 closely related fecundity determinants (body mass index, time of contraception, lipids, cotinine and seminal white blood cells). Both traditional and strict sperm phenotype measures were associated with lower odds of conception delay. Specifically, for an increase in percent morphologically normal spermatozoa using traditional methods, we observed a 40% decrease in conception delay (OR = 0.6, 95% CI = 0.50, 0.81; p = 0.0003). Similarly, for an increase in strict criteria, we observed a 30% decrease in odds for conception delay (OR = 0.7, 95% CI = 0.52, 0.83; p = 0.001). On the other hand, an increase in percent coiled tail spermatozoa was associated with a 40% increase in the odds for conception delay (OR = 1.4, 95% CI = 1.12, 1.75; p = 0.003). However, our findings suggest that semen phenotypes have little predictive value of conception delay (area under the curve of 73%). In a multivariate model containing significant semen factors and traditional risk factors (i.e. age, body mass index, cotinine and ever having fathered a pregnancy), there was a modest improvement in prediction of conception delay (16% increase in area under the curve, p < 0.0002).

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World Health Organization reference values for human semen characteristics*‡

Abstract: The data represent sound reference distributions of semen characteristics of fertile men in a number of countries. They provide an appropriate tool in conjunction with clinical data to evaluate a patient's semen quality and prospects for fertility.

Cited by 2,427 publications

References 108 publications

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

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

Semen analysis and sperm function testing

A data‐driven search for semen‐related phenotypes in conception delay

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