Abstract
Semen analysis is the corner stone of infertility evaluation as it provides information on the functional status of the seminiferous tubules, epididymis and accessory sex glands. The methods on how the human semen should be evaluated are provided by the World Health Organization, which periodically releases manuals that include specific protocols and reference standards. In 2010, the WHO published new criteria for human semen characteristics that were markedly lower than those previously reported. In this review initially it is discussed the limitations of semen analysis as a surrogate measure of a man's ability to father a pregnancy. Secondly, it is analyzed methodology issues that could explain why the newly released reference values were different from those earlier reported. Thirdly, it is speculated on the likely effects of the 2010 WHO criteria in the management of male infertility. Due to the several inherent limitations of semen analysis as a surrogate marker of male infertility, physicians should exercise caution when interpreting results. A template for semen analysis reports that incorporates the distribution of the semen characteristics of recent fathers in centiles rather than solely the minimum thresholds could aid clinicians to better understand how a given patient results compare with the reference population. Importantly, a male infertility evaluation must go far beyond a simple semen analysis, as it has to be complemented with a proper physical examination, a comprehensive history taking, and relevant endocrine, genetic, and other investigations.
Highlights
The World Health Organization (WHO) periodically releases manuals for the laboratory examination and processing of human semen
Physicians treating infertile couples should exercise circumspection when interpreting the results of routine semen analysis
The male infertility evaluation must go far beyond a simple semen analysis, as it has to be complemented with a proper physical examination, a comprehensive history taking, and relevant endocrine, genetic, and other investigations [10,11]
Summary
The World Health Organization (WHO) periodically releases manuals for the laboratory examination and processing of human semen. The most recent Practice Committee report on varicocele by the American Society for Reproductive Medicine (ASRM) acknowledged the limitations of routine semen analysis and included the presence of an abnormal sperm function test as an indication for treatment [58] Another example is sperm morphology results in which infertility specialists have relied on to recommend treatment modalities owed to their relationship with in vivo and in vitro fertilization [59]. The distribution of semen analysis results of fertile men in centiles, as shown by the new WHO standards, clearly shows that though 5% of the studied men had morphology values below the 4% cutoff point they still could initiate an unassisted pregnancy within twelve months of unprotected intercourse [6,42] These considerations raise the question on how the 2010 WHO references thresholds would affect the current male infertility practice. The male infertility evaluation must go far beyond a simple semen analysis, as it has to be complemented with a proper physical examination, a comprehensive history taking, and relevant endocrine, genetic, and other investigations [10,11]
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