Sperm Morphology, Motility, and Concentration in Fertile and Infertile Men

Guzick, David S.; Overstreet, James W.; Factor-Litvak, Pam; Brazil, Charlene; Nakajima, Steven T.; Coutifaris, Christos; Carson, Sandra Ann; Cisneros, Pauline; Steinkampf, Michael P.; Hill, Joseph A.; Xu, Dong-Ling; Vogel, Donna L.

doi:10.1056/nejmoa003005

Cited by 1,141 publications

(807 citation statements)

References 13 publications

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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

101

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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

101

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“…4 Recent publications comparing sperm morphology cutoff values with in vitro and in vivo pregnancy results in infertile populations or socalled fertile and subfertile populations are in close agreement with the WHO 2010 values. 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.…”

Section: The Semen Analysis (Who 2010)mentioning

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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“…Other authors have recently proposed that even values as high as 50-60 million spermatozoa per ml should be used as lower cutoff level for full reproductive competence. [16][17][18] This concern should not be neglected, because a considerable number of subfertile men may not be referred for andrological work-up by solely taking the new WHO reference values into account.…”

Section: New Reference Limitsmentioning

confidence: 99%

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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Sperm Morphology, Motility, and Concentration in Fertile and Infertile Men

Abstract: Threshold values for sperm concentration, motility, and morphology can be used to classify men as subfertile, of indeterminate fertility, or fertile. None of the measures, however, are diagnostic of infertility.

Cited by 1,141 publications

References 13 publications

Gonad evaluation in male systemic lupus erythematosus

Gonad evaluation in male systemic lupus erythematosus

Semen analysis and sperm function testing

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

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