Björndahl, L., Esteves, S. C., Ferlin, A., Jørgensen, N., & O'Flaherty, C. (2023). Improving standard practices in studies using results from basic human semen examination. Andrology. https://doi.org/10.1111/andr.13504
Björndahl L, Esteves SC, Ferlin A, Jørgensen N, O'Flaherty C. Improving standard practices in studies using results from basic human semen examination. Andrology. 2023. doi:10.1111/andr.13504
Björndahl, Lars, et al. "Improving standard practices in studies using results from basic human semen examination." Andrology, 2023.
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WHO semen reference limits do not divide fertile from infertile men
WHO semen reference limits cannot serve as a boundary between fertile and infertile men, say five authors in a 2023 short article. The article backs a journal checklist for studies that report semen tests. It also sets out lab methods and wording for those studies.
Key Findings
WHO reference limits mark the lowest 5% of results in a mixed group of men with different fertility. The limits cannot serve as a specific line between infertile and fertile men.
Results below WHO reference values do not automatically place the problem in the male partner, and results above them do not necessarily show that he is fertile.
Counting fewer than 400 sperm raises the random error above 10%. The error is around 14% for 200 cells and around 20% for 100 cells.
Using terms such as oligozoospermia to sort men into groups can be misleading and should be avoided. The authors recommend that papers declare which limits and methods define a group.
The authors report that ejaculates from men in couples who started a pregnancy appear to have much higher results than the WHO reference limits.
Interpretation
The article is a short communication that backs a journal checklist. The advice follows the sixth-edition WHO manual and the ISO 23162 standard. The authors analyzed no datasets. They describe semen quality as a continuum. They call the semen test the first analysis for the male partner of an infertile couple. It guides a later workup that also uses history, a physical exam and other tests. Densely populated regions such as South America remain under-represented in the WHO reference data. Whether regional limits would be more useful needs further study.
RRM Context
The authors describe infertility as a condition of the couple. Restorative reproductive medicine evaluates both partners and seeks the cause before treatment. A semen result read with the full clinical picture fits that approach. The authors also cite growing evidence that a man's testicular function and fertility reflect his general health.
Our editorial summary of this paper, not the article's abstract.
Abstract
The purpose of this article is to provide an explanation of the background behind a checklist that declares the laboratory methods used in a scientific study. It focuses primarily on implementing laboratory procedures to yield reliable results in basic semen examinations. While the World Health Organization (WHO) and international standards provide recommendations for basic semen examination, manuscripts submitted to Andrology frequently lack transparency regarding the specific techniques used. In addition, the terminology used for semen examination results often fails to provide a clear definition of the groups under study. Furthermore, the WHO's reference limits are often misinterpreted as strict boundaries between fertility and infertility. It is important to note that valid clinical andrological diagnoses and treatments cannot rely solely on semen examination results; they require proper laboratory procedures as a foundation for diagnosing and treating male patients. Therefore, scientific journals should promote the adoption of robust laboratory practices and an accurate definition of patient groups. A checklist can facilitate the design of high-quality studies and the creation of informative publications. Further, it can help journals assess submitted manuscripts and improve the overall quality of their publications.
