The Sixth Edition of the WHO Manual for Human Semen Analysis: A Critical Review and SWOT Analysis

Abstract

Semen analysis is the cornerstone of male fertility evaluation with WHO guidelines providing the basis for procedural standardization and reference values worldwide. The first WHO manual was published in 1980, and five editions have been subsequently released over the last four decades. The 6th Edition was published in July 2021. In this review, we identify the key changes of this 6th Edition. Additionally, we evaluate the utility of this 6th Edition in clinical practice using SWOT (strengths, weaknesses, opportunities, and threats) analysis. This new Edition has made the analysis of basic semen parameters more robust, taking into account the criticisms and grey areas of the previous editions. The tests assessing sperm DNA fragmentation and seminal oxidative stress are well-described. The main novelty is that this latest edition abandons the notion of reference thresholds, suggesting instead to replace them with “decision limits”. While this seems attractive, no decision limits are proposed for either basic semen parameters, or for extended or advanced parameters. This critical review of the 6th Edition of the WHO laboratory manual combined with a SWOT analysis summarizes the changes and novelties present in this new Edition and provides an in-depth analysis that could help its global use in the coming years.

Metabolic Syndrome and Male Fertility: Beyond Heart Consequences of a Complex Cardiometabolic Endocrinopathy

“…However, the manual includes only a brief description of the procedures and problems related to luminol and ORP which, as already mentioned, are the most up-to-date techniques. As evidenced by a recent analysis by Boitrelle et al, the new edition of the manual lacks the recent bibliography highlighting the predictive power of seminal OS determined by ORP [ 40 ]. Furthermore, according to the WHO, tests to evaluate OS are considered extremely specialized and used mainly in the research field.…”

SWOT Approach for Audience Online Conversion Rate: An Applied Research on Scenic Spot Projects

“…In the initial stage of SWOT calculation, we should not only pay attention to global search but also carry out collaborative analysis of different indicators. In order to improve the SWOT computation efficiency of the algorithm, this paper needs multistrategy cooperation, so that the strengths, weaknesses, and threats can be repeatedly calculated; finally, accurate results can be obtained Boitrelle F. [ 23 ]. Group behavior pattern, the calculation is as shown in formula ( 5 ).…”

Sperm DNA integrity and male infertility: a narrative review and guide for the reproductive physicians

“…Semen analysis (SA) is the backbone of male infertility assessment, however it does not provide any insight into the functional status of spermatozoa and cannot justify adverse reproductive outcomes or UI when the baseline evaluation of both partners is unremarkable (4). The recently published 6th edition of the WHO laboratory manual for the examination and processing of human semen has acknowledged such limitations, and in an attempt to identify and underline the importance of sperm function testing, it has introduced sperm DNA fragmentation (SDF) as an extended examination and recommends this assessment in certain clinical settings, which has been quoted as a major strength of the new manual (5).…”