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Training Program in Assisted Reproductive Technology 2011 <br />Cleveland Clinic Reproductive Research Center<br />New WHO...
Learning Objectives<br />Esteves, 2<br />
 Semen Analysis<br />Esteves, 3<br />
Cut-off reference values for semen characteristics as published in consecutive WHO manuals<br />*Strict (Tygerberg) criter...
New WHO StandardsHow they were obtained <br />1,953 semen samples of recent fathers<br />Time to pregnancy (TTP) ≤ 12 mo<b...
Percentile distribution of semen characteristics values of recent fathers whose partners had a TTP ≤ 12 months, used to es...
New WHO StandardsHow they were obtained <br />Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker H, Behre H, Haugen T,...
New WHO Standards<br />
New WHO references valuesCritical Appraisal <br />FINLAND<br />(Turku)<br />NORWAY<br />(Oslo)<br />DENMARK (Copenhagen)<b...
Studies used to establish the new standards for human semen characteristics in the 5th ed. WHO Manual<br />Esteves, 10<br />
New WHO StandardsCritical Appraisal  - Summary<br />Esteves, 11<br />
Female Partner Influence on the Potential Fertility of a Man<br />Esteves, 12<br />
Referrals for <br />male partner evaluation<br />New WHO Standards<br /><ul><li>Implications for Clinical Practice</li></u...
Implications for Practice<br /><ul><li>Referrals for male partner evaluation</li></ul>Esteves, 14<br />
Implications for Practice<br /><ul><li>Reclassification of semen analysis reports</li></ul>Couples (N=987) with infertilit...
Male Infertility Evaluation <br />– much more than a simple semen analysis - <br />Esteves, 16<br />
Implications for Practice<br /><ul><li>Varicocele treatment</li></ul>Esteves, 17<br />
Implications for Practice<br /><ul><li>Varicocele treatment</li></ul>Kamal KM, Jarvi K, Zini A: Microsurgical varicocelect...
P=0.003<br />P<0.001<br />Mori et al. Does varicocele grade determine extent of alteration to spermatogenesis in adolescen...
ICSI<br /><ul><li>Severe male factor infertility</li></ul>Semen analysis results fall 	below new reference limits <br />Im...
< 5% strict morphology thresholds currently used
Indications unlike to change due to new WHO reference values</li></ul>Esteves, 20<br />
IUI<br /><ul><li>Mild male factor infertility
Unexplained male infertility</li></ul>Implications for Practice<br /><ul><li>Indications for ART
Impact of new WHO reference values likely to be minimal</li></ul>Esteves, 21<br />
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New who standards for semen analysis - highlights and implications

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New who standards for semen analysis - highlights and implications

  1. 1. Training Program in Assisted Reproductive Technology 2011 <br />Cleveland Clinic Reproductive Research Center<br />New WHO Standards <br />for Semen Analysis: <br />Highlights and Implications<br />SandroEsteves, MD, PhD<br />Director<br />ANDROFERT<br />Center for Male Reproduction and Infertility<br />Campinas, BRAZIL<br />
  2. 2. Learning Objectives<br />Esteves, 2<br />
  3. 3. Semen Analysis<br />Esteves, 3<br />
  4. 4. Cut-off reference values for semen characteristics as published in consecutive WHO manuals<br />*Strict (Tygerberg) criterion<br />
  5. 5. New WHO StandardsHow they were obtained <br />1,953 semen samples of recent fathers<br />Time to pregnancy (TTP) ≤ 12 mo<br />5 studies in 7 countries on 3 continents<br />Laboratories with QC only<br />Morphology by strict criterion (Kruger)<br />Progressive and non-progressive motility<br />Lower reference limits (5th centile)<br />Esteves, 5<br />
  6. 6. Percentile distribution of semen characteristics values of recent fathers whose partners had a TTP ≤ 12 months, used to establish the reference limits in the 2010 WHO manual<br />Cooper et al: World Health Organization reference values for human semen characteristics. Hum Reprod Update 16: 231-245, 2010<br />Esteves, 6<br />
  7. 7. New WHO StandardsHow they were obtained <br />Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker H, Behre H, Haugen T, Kruger T, Wang C, Mibzvo MT, Vogelsong K<br />World Health Organization reference values for human semen characteristics. <br />Hum Reprod Update 16: 231-245, 2010. <br />“Studies 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, under-represented”<br />“The values presented are considered to represent global semen characteristics of fertile men”<br />Esteves, 7<br />
  8. 8. New WHO Standards<br />
  9. 9. New WHO references valuesCritical Appraisal <br />FINLAND<br />(Turku)<br />NORWAY<br />(Oslo)<br />DENMARK (Copenhagen)<br />UK<br />(Edinburgh)<br />USA<br />(Columbia, NYC, Minneapolis, LA)<br />?<br />FRANCE<br />(Paris)<br />?<br />?<br />?<br />?<br />?<br />AUSTRALIA <br />(Melbourne)<br />Esteves, 9<br />
  10. 10. Studies used to establish the new standards for human semen characteristics in the 5th ed. WHO Manual<br />Esteves, 10<br />
  11. 11. New WHO StandardsCritical Appraisal - Summary<br />Esteves, 11<br />
  12. 12. Female Partner Influence on the Potential Fertility of a Man<br />Esteves, 12<br />
  13. 13. Referrals for <br />male partner evaluation<br />New WHO Standards<br /><ul><li>Implications for Clinical Practice</li></ul>Varicocele treatment<br />Indications for assisted reproductive techniques<br />Esteves, 13<br />
  14. 14. Implications for Practice<br /><ul><li>Referrals for male partner evaluation</li></ul>Esteves, 14<br />
  15. 15. Implications for Practice<br /><ul><li>Reclassification of semen analysis reports</li></ul>Couples (N=987) with infertility duration > 12 months<br />Morphology results <br />accounted for 53% <br />of reclassification<br />Source: ANDROFERT, Brazil<br />Esteves, 15<br />
  16. 16. Male Infertility Evaluation <br />– much more than a simple semen analysis - <br />Esteves, 16<br />
  17. 17. Implications for Practice<br /><ul><li>Varicocele treatment</li></ul>Esteves, 17<br />
  18. 18. Implications for Practice<br /><ul><li>Varicocele treatment</li></ul>Kamal KM, Jarvi K, Zini A: Microsurgical varicocelectomy in the era of assisted reproductive technology: influence of initial semen quality on pregnancy rates. FertilSteril 75: 1013-1016, 2001.<br />Richardson I, Grotas AB, Nagler HM: Outcomes of varicocelectomy treatment: an updated critical analysis. UrolClin North Am 35:191-209, 2008.<br />
  19. 19. P=0.003<br />P<0.001<br />Mori et al. Does varicocele grade determine extent of alteration to spermatogenesis in adolescents? FertilSteril 90: 1769-1773, 2008.<br />Esteves, 19<br />
  20. 20. ICSI<br /><ul><li>Severe male factor infertility</li></ul>Semen analysis results fall below new reference limits <br />Implications for Practice<br /><ul><li>Indications for ART
  21. 21. < 5% strict morphology thresholds currently used
  22. 22. Indications unlike to change due to new WHO reference values</li></ul>Esteves, 20<br />
  23. 23. IUI<br /><ul><li>Mild male factor infertility
  24. 24. Unexplained male infertility</li></ul>Implications for Practice<br /><ul><li>Indications for ART
  25. 25. Impact of new WHO reference values likely to be minimal</li></ul>Esteves, 21<br />
  26. 26. Implications for Practice<br /><ul><li>Indications for ART- Summary</li></ul>Esteves, 22<br />
  27. 27. Expanding the interpretation of the new WHO reference values: focus on the 50th percentile<br />Laboratories seeking to adopt the new standard should determine the strategy that would aid the clear communication of the clinical significance of the results <br />Debate is open <br /><ul><li>Should the new WHO reference values be adopted ? </li></ul>Esteves, 23<br />
  28. 28. Practical Points (1)<br />Esteves, 24<br />
  29. 29. Practical Points (2)<br />Esteves, 25<br />

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