Interpreting Semen Analysis Results

Interpreting Semen Analysis

Results

Sandro C. Esteves, MD, PhD

ANDROFERT, Campinas, Brazil

Reproductive Andrology S urgery Workshop IIReproductive Medicine Unit - J ahra Hospital - Kuwait 2014

Contents

Semen analysis overview

WHO reference values

Implications to clinical management

Proposal of a new report template

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ANDROLOGY AND HUMAN REPRODUCTION C LINIC - REFERRAL C ENTER FOR MALE REPRODUCTIONS ESTEVES, 22014 December

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Semen analysis is the most used biomarker to predict fertility potential



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Routine Semen Analysis

Physical characteristics of ejaculate

Sperm count

Sperm motility

Sperm morphology

Sperm vitality

Leukocyte count

Additional tests (fructose, etc)



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Standardization Pre-analytical

Analytical

Post-analytical

Quality ControlCertification, Validation

Reference valuesWHO Manual

Where to do it?

Esteves, 5

Pre-analytical

Instructions for collection

Rejection criteria

Abstinence period

Analytical

Standard operating procedures

Post-analytical

Report

Is the lab good enough?



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WHO Manual: it is free!

1980 1987 1992 1999

Volume (mL) ND ≥ 2 ≥ 2 ≥ 2

Sperm count (106/mL) 20-200 ≥ 20 ≥ 20 ≥ 20

Total sperm count (106) ND ≥ 40 ≥ 40 ≥ 40

Motility(%) ≥ 60 ≥ 50 ≥ 50 ≥ 50

Progressive motility (%) ≥ 2 ≥ 25% ≥ 25% (a) ≥ 25% (a)

Vitality (%) ND ≥ 50 ≥ 75 ≥ 75

Morphology (%) 80,5 ≥ 50 ≥ 30 (14)*

Leukocytes (106/mL) < 4.7 < 1.0 < 1.0 < 1.0

*Strict criteria (Tygerberg)

WHO Reference Values2010

≥ 1.5

≥ 15

≥ 39

≥ 40

≥ 32% (a+b)

≥ 58

≥ 4*

1.0



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Urology 2012; 79(1):16-22



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How the references were obtained

1953 specimens

Recent fathers (Time-to-Pregnancy ; TTP) ≤ 12 mo.

Data extracted from 5 studies

Laboratories with QC

Morphology by Kruger’s method

Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker H, Behre H, Haugen

T, Kruger T, Wang C, Mibzvo MT, Vogelsong K

World Health Organization reference values for human semen characteristics.

Hum Reprod Update 16: 231-245, 2010.



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Percentile

5% 50%* 95%

Volume (mL) 1.5 3.7 6.8

Count (x106/mL) 15.0 73.0 213.0

Total count (x106) 39.0 255.0 802.0

% Motile 40 61 78

% Progressive motility 32 55 72

% Normal (Kruger) 4 15 44

% Alive 58 79 91

Cooper et al: World Health Organization reference values for human semen characteristics.

Hum Reprod Update 16: 231-245, 2010Esteves, 12

How the references were obtained

Critical Appraisal of the WHO New Reference Values for Human Semen and Impact on

Diagnosis and Treatment of Subfertile Men

Esteves, Zini, Aziz et al, Urology, in press

Columbia

USA

Melbourne

Australia

Turku

Finland

Oslo

Norway

Edimburgh

UK

Paris

France

Copenhagen

Denmark

Esteves, 13

WHO 2010: What changed?

• Percentile “5” to determine lower cutoff limits

• Strict (Kruger) morphology

• Single specimen per individual

Method

• Recent fathers (known TTP)

• Selection bias

Studied population

Esteves et al. Critical Appraisal of the WHO New Reference Values for Human Semen and Impact on

Diagnosis and Treatment of Subfertile Men. Urology 2012; 79(1):16-22.

Esteves, 14

How do the new references impact clinical management?

Referral

Treatment

ART



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Parameters Patient

Volume (mL) 2,3

Count (106/mL) 16,5

Progressive motility (%) 40

Vitality(%) 65

Morphology (%) 9

Referral Deferment

References

1999 2010

≥ 2 ≥ 1.5

≥ 20 ≥ 15

≥ 50 ≥ 32

≥ 75 ≥ 58

(14) ≥ 4



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987 couples with infertility

duration > 12 months

Esteves, Int Braz J Urol 2014

53% reclassification

due to morphology

Semen Analysis Report

Esteves, 17

Abnormal results as per

WHO 1999

38.7%

Redefined as

“Normal” as per

WHO 2010

Cause of infertility in up to 35% men

Guidelines’ recommendation: Palpable (clinical)

Abnormal semen analysis results

Male Infertility Best Practice Policy Committee - AUA, 2004;

European Association of Urology. Guidelines on Male Infertility, 2010.

Varicocele Treatment



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87.8

49.937.4

62.9 56 55.6

8.4 7.3 6.1

No varicocele Grade 2 Varicocele Grade 3 Varicocele

Adolescents with and without Varicocele

Count (million/mL) Progressive motility (% a+b) Morphology (%)

Mori et al. Does varicocele grade determine extent of alteration to

spermatogenesis in adolescents? Fertil Steril 90: 1769-1773, 2008.

P=0.003 P<0.001

Varicocele

Esteves, 19

ICSIIVF & IUI

ART



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Semen analysis alone should not be used to counseling or treatment indication

Semen characteristics that discriminate fertile from infertile men not well defined

Biological variability

Not account for sperm dysfunctions



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History taking, physical examination, endocrine profile and laboratory sperm function testing are minimum standards

Esteves, et al 2011; 2012; 2014

Male infertility evaluation goes far beyond a simple semen analysis



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Reporting: proposal for a new template

Thank You شكرا



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Health & Medicine

Interpreting Semen Analysis Results