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New who standards for semen analysis - highlights and implications
1. Training Program in Assisted Reproductive Technology 2011 Cleveland Clinic Reproductive Research Center New WHO Standards for Semen Analysis: Highlights and Implications SandroEsteves, MD, PhD Director ANDROFERT Center for Male Reproduction and Infertility Campinas, BRAZIL
4. Cut-off reference values for semen characteristics as published in consecutive WHO manuals *Strict (Tygerberg) criterion
5. New WHO StandardsHow they were obtained 1,953 semen samples of recent fathers Time to pregnancy (TTP) ≤ 12 mo 5 studies in 7 countries on 3 continents Laboratories with QC only Morphology by strict criterion (Kruger) Progressive and non-progressive motility Lower reference limits (5th centile) Esteves, 5
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 Cooper et al: World Health Organization reference values for human semen characteristics. Hum Reprod Update 16: 231-245, 2010 Esteves, 6
7. New WHO StandardsHow they were obtained 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. “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” “The values presented are considered to represent global semen characteristics of fertile men” Esteves, 7
9. New WHO references valuesCritical Appraisal FINLAND (Turku) NORWAY (Oslo) DENMARK (Copenhagen) UK (Edinburgh) USA (Columbia, NYC, Minneapolis, LA) ? FRANCE (Paris) ? ? ? ? ? AUSTRALIA (Melbourne) Esteves, 9
10. Studies used to establish the new standards for human semen characteristics in the 5th ed. WHO Manual Esteves, 10
19. P=0.003 P<0.001 Mori et al. Does varicocele grade determine extent of alteration to spermatogenesis in adolescents? FertilSteril 90: 1769-1773, 2008. Esteves, 19
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21. < 5% strict morphology thresholds currently used