Impact of the New WHO Guidelines on Diagnosis and Practice of Male Infertility
TL;DR: Concerns related to the publication of the new reference values for semen parameters such as the impact on patient referral, diagnosis, treatment of recognized conditions such as varicocele and indications of assisted reproductive modalities are discussed.
Abstract: The World Health Organization (WHO) has established new reference values for semen characteristics in its 5th edition manual which are lower than those previously reported. Several questions arise after a careful examination of the proposed new values, especially regarding the implications of these references for diagnosis and treatment of male infertility. Despite the notable advance of using controlled studies involving couples whose time to pregnancy was less than 12 months to generate the new limits, reference studies are limited with regard to the population analyzed and the methods used for semen evaluation. As such, it seems unreasonable to assume that reference values represent global semen characteristics of fertile men as proposed in the 5 th edition WHO manual. Caution should be exercised to not over- interpret the new reference values as they may fail to accurately discriminate populations of fertile and infertile men. Properly performed semen analyses coupled with an adequate examination of the man can give valuable information related to the organs producing "semen", a highly complex fluid, and thus help in better understanding of the physiology of the reproductive organs and the causes of their dysfunctions. The present commentary discusses concerns related to the publication of the new reference values for semen parameters such as the impact on patient referral, diagnosis, treatment of recognized conditions such as varicocele and indications of assisted reproductive modalities. We conclude that more debate is needed before the adoption of the proposed WHO current reference values by andrology laboratories around the world. For those considering to adopt them, a better approach would be the presentation of reference values by percentiles rather than solely the lower cutoff limits. The time has come for technological developments that bring robust and cost- effective clinically useful sperm function tests to replace, at least partially, the shortcomings of routine semen analysis.
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TL;DR: During the past 20 years, there has been a decline in the concentration and motility of sperm and in the percentage of morphologically normal spermatozoa in fertile men that is independent of the age of the men.
Abstract: Background Several studies have suggested a population-wide decline in the quality of semen over the past 50 years, but clear evidence of decreasing semen quality in recent decades is lacking. Methods From 1973 through 1992 we measured the volume of seminal fluid, the sperm concentration, and the percentages of motile and morphologically normal spermatozoa in 1351 healthy fertile men. The data on the semen samples were collected at one sperm bank in Paris. The data in each calendar year were analyzed as a function of the year of donation, the age of each patient, the year of birth, and the duration of sexual abstinence before semen collection. Results There was no change in semen volume during the study period. The mean concentration of sperm decreased by 2.1 percent per year, from 89 ×106 per milliliter in 1973 to 60×106 per milliliter in 1992 (P<0.001). During the same period the percentages of motile and normal spermatozoa decreased by 0.6 percent and 0.5 percent per year, respectively (both P<0.001). ...
273 citations
TL;DR: The effect of the post thaw interval on the motility of the human spermatozoa and thus widens the insemination window period and safely wait, confirm the parameters like motility and count, and then inseminate the samples instead of blindly insemining them immediately after thawing.
Abstract: Background
Cryopreservation of spermatozoa is a widely used technique to preserve the fertility of males. It can also benefit the armed forces personnel who are to be sent for long recruitments, while leaving their families behind. This study, apart from studying the effects of freezing and thawing, reveals the effect of the post thaw interval on the motility of the human spermatozoa and thus widens the insemination window period.
31 citations
TL;DR: This study aimed to evaluate the role of sperm morphology as an indicator of additional sperm functions among 114 andrology referrals and found it had a negative and significant correlation with the percentage normal spermatozoa.
Abstract: Sperm morphology has been consistently correlated with fertilisation success or failure. The clinical relevance of the percentage normal spermatozoa has been a widely discussed topic amongst infertility specialists and scientists. This study aimed to evaluate the role of sperm morphology as an indicator of additional sperm functions among 114 andrology referrals. The sperm functions that were investigated included chromatin packaging quality (CMA3 test (n = 109), zona-induced acrosome reaction (ZIAR test; n = 36), hemizona assay (HZI; n = 36) and progressive motility (n = 47). Chromatin packaging quality had a negative and significant (P = 0.0001, r = -0.74) correlation with the percentage normal spermatozoa, while progressive motility had a significant and positive correlation (P = 0.0001, 0.59). Accurate sperm morphology scoring as described by the WHO 2010 manual can therefore be used as an indicator of specific sperm functions.
15 citations
Cites result from "Impact of the New WHO Guidelines on..."
...This observation underlines the difference in the reference values between the current and previous WHO manuals, namely including results from laboratories of higher quality control standards especially when assessing sperm morphology (Esteves & Agarwal, 2011)....
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TL;DR: The data provide strong evidence of a statistical threshold for semen samples containing 30% sperm DNA fragmentation resulting in a reduced level of pregnancy success, leading to oxidative stress in the infertile group.
Abstract: Background. Biological mechanisms contribute to the relationship between polycyclic aromatic hydrocarbon (PAH) exposure and infertility in males by altering semen quality. Objectives. The aim of th...
11 citations
01 Jan 2015
TL;DR: The aim of this paper is to perform sperm segmentation using image processing techniques and classification of sperm heads using shape and area of sperm head to accurately segment sperm cells.
Abstract: Infertility is one of the major problems in human being Sperm morphology is one of the evaluation techniques for male infertility The aim of this paper is to perform sperm segmentation using image processing techniques and classification of sperm heads The proposed system works on the digital images of sperm The single Spermatozoa segmented into three parts Sperm Head, Sperm Mid Piece, and Sperm Tail These images are processed and the sperm are segmented The Features are extracted from segmented Images The proposed method accurately segment sperm cells The Fuzzy System used to classify the Sperm Head into normal and abnormal class using shape and area of sperm head
8 citations
References
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TL;DR: There has been a genuine decline in semen quality over the past 50 years, and as male fertility is to some extent correlated with sperm count the results may reflect an overall reduction in male fertility.
Abstract: OBJECTIVE--To investigate whether semen quality has changed during the past 50 years. DESIGN--Review of publications on semen quality in men without a history of infertility selected by means of Cumulated Index Medicus and Current List (1930-1965) and MEDLINE Silver Platter database (1966-August 1991). SUBJECTS--14,947 men included in a total of 61 papers published between 1938 and 1991. MAIN OUTCOME MEASURES--Mean sperm density and mean seminal volume. RESULTS--Linear regression of data weighted by number of men in each study showed a significant decrease in mean sperm count from 113 x 10(6)/ml in 1940 to 66 x 10(6)/ml in 1990 (p < 0.0001) and in seminal volume from 3.40 ml to 2.75 ml (p = 0.027), indicating an even more pronounced decrease in sperm production than expressed by the decline in sperm density. CONCLUSIONS--There has been a genuine decline in semen quality over the past 50 years. As male fertility is to some extent correlated with sperm count the results may reflect an overall reduction in male fertility. The biological significance of these changes is emphasised by a concomitant increase in the incidence of genitourinary abnormalities such as testicular cancer and possibly also cryptorchidism and hypospadias, suggesting a growing impact of factors with serious effects on male gonadal function.
2,481 citations
TL;DR: Semen quality of the reference population was superior to that of the men from the general population and normozoospermic men, and provide an appropriate tool in conjunction with clinical data to evaluate a patient's semen quality and prospects for fertility.
Abstract: BACKGROUND Semen quality is taken as a surrogate measure of male fecundity in clinical andrology, male fertility, reproductive toxicology, epidemiology and pregnancy risk assessments. Reference intervals for values of semen parameters from a fertile population could provide data from which prognosis of fertility or diagnosis of infertility can be extrapolated. METHODS Semen samples from over 4500 men in 14 countries on four continents were obtained from retrospective and prospective analyses on fertile men, men of unknown fertility status and men selected as normozoospermic. Men whose partners had a time-to-pregnancy (TTP) of < or =12 months were chosen as individuals to provide reference distributions for semen parameters. Distributions were also generated for a population assumed to represent the general population. RESULTS The following one-sided lower reference limits, the fifth centiles (with 95th percent confidence intervals), were generated from men whose partners had TTP < or = 12 months: semen volume, 1.5 ml (1.4-1.7); total sperm number, 39 million per ejaculate (33-46); sperm concentration, 15 million per ml (12-16); vitality, 58% live (55-63); progressive motility, 32% (31-34); total (progressive + non-progressive) motility, 40% (38-42); morphologically normal forms, 4.0% (3.0-4.0). Semen quality of the reference population was superior to that of the men from the general population and normozoospermic men. CONCLUSIONS 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.
2,264 citations
"Impact of the New WHO Guidelines on..." refers background in this paper
...It includes new chapters on sperm preparation techniques for assisted conception and cryopreservation....
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...Routine seminal analysis should include: a) physical characteristics of semen, including liquefaction, viscosity, pH, color and odor; b) specimen *Address correspondence to this author at the Av. Dr. Heitor Penteado, 1464, 13075-460, Campinas, São Paulo, Brazil; Tel: +55 19 3295-8877; Fax: +55 19…...
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...Cooper et al. [5] stated in their original report that ‘the studies included in the present analysis were conducted in different regions of the world with some areas over-represented, such as Northern Europe, and others, such as Africa, parts of Europe and Central and South America,…...
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...The mean (±SD) male age was 31 (±5) years (range 18-53) and only 10 men aged more than 45 years....
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...However, several concerns arise from a detailed examination of the studies which generated the current reference values [5, 6-13]....
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TL;DR: By evaluating sperm morphology with the proposed strict criteria, its predictive value in in vitro fertilization is enhanced.
1,095 citations
TL;DR: The volume of seminal fluid, the sperm concentration, and the percentages of motile and morphologically normal spermatozoa in 1351 healthy fertile men from 1973 through 1992 were measured.
Abstract: Background Several studies have suggested a population-wide decline in the quality of semen over the past 50 years, but clear evidence of decreasing semen quality in recent decades is lacking. Methods From 1973 through 1992 we measured the volume of seminal fluid, the sperm concentration, and the percentages of motile and morphologically normal spermatozoa in 1351 healthy fertile men. The data on the semen samples were collected at one sperm bank in Paris. The data in each calendar year were analyzed as a function of the year of donation, the age of each patient, the year of birth, and the duration of sexual abstinence before semen collection. Results There was no change in semen volume during the study period. The mean concentration of sperm decreased by 2.1 percent per year, from 89 ×106 per milliliter in 1973 to 60×106 per milliliter in 1992 (P<0.001). During the same period the percentages of motile and normal spermatozoa decreased by 0.6 percent and 0.5 percent per year, respectively (both P<0.001). ...
1,067 citations
TL;DR: There has been a genuine decline in semen quality over the past 50 years and as male fertility is to some extent correlated with sperm count the results may reflect an overall reduction in male fertility.
Abstract: OBJECTIVE--To investigate whether semen quality has changed during the past 50 years. DESIGN--Review of publications on semen quality in men without a history of infertility selected by means of Cumulated Index Medicus and Current List (1930-1965) and MEDLINE Silver Platter database (1966-August 1991). SUBJECTS--14,947 men included in a total of 61 papers published between 1938 and 1991. MAIN OUTCOME MEASURES--Mean sperm density and mean seminal volume. RESULTS--Linear regression of data weighted by number of men in each study showed a significant decrease in mean sperm count from 113 x 10(6)/ml in 1940 to 66 x 10(6)/ml in 1990 (p < 0.0001) and in seminal volume from 3.40 ml to 2.75 ml (p = 0.027), indicating an even more pronounced decrease in sperm production than expressed by the decline in sperm density. CONCLUSIONS--There has been a genuine decline in semen quality over the past 50 years. As male fertility is to some extent correlated with sperm count the results may reflect an overall reduction in male fertility. The biological significance of these changes is emphasised by a concomitant increase in the incidence of genitourinary abnormalities such as testicular cancer and possibly also cryptorchidism and hypospadias, suggesting a growing impact of factors with serious effects on male gonadal function.
704 citations
"Impact of the New WHO Guidelines on..." refers result in this paper
...At a first superficial analysis, it may be concluded that the reason for such observation is a trend towards male fertility decline, as suggested by Carlsen et al. (1992) [16]....
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